Sex Hormones and Pain in Regularly Menstruating Women With Fibromyalgia Syndrome

Pain Research Center, Department of Anesthesiology, University of Utah, Salt Lake City, Utah, USA.
Journal of Pain (Impact Factor: 4.01). 12/2006; 7(11):851-9. DOI: 10.1016/j.jpain.2006.04.005
Source: PubMed


Fibromyalgia syndrome (FMS) is more prevalent in women than in men. The skewed sex distribution in the prevalence has prompted questions of if and how sex hormones may be involved in the pathophysiology of FMS. In this study, we evaluated the levels of sex hormones and pain sensitivity at different phases of a menstrual cycle in regularly menstruating women with FMS relative to age-matched healthy women. Participants (n = 74 in each group) underwent a 9-day urine test to identify the date of ovulation. Three laboratory visits were scheduled to ascertain the varying levels of estrogen (E) and progesterone (P): Late-follicular phase (high E, low P); mid-luteal phase (high E, high P); and perimenstrual phase (low E, low P). At each visit, blood was drawn and ischemic pain testing was performed. The groups did not differ in the fluctuation of luteal hormone, follicular-stimulating hormone, E, and testosterone across a menstrual cycle. FMS patients showed slightly elevated P levels during the mid-luteal phase relative to healthy women but levels were within the normal range. Women with FMS showed consistently lower pain thresholds and tolerance relative to healthy women throughout the menstrual cycle. Pain threshold at the late follicular phase was modestly related to the P level. The results suggest that the disproportionate prevalence of females with FMS is not likely to be attributable to hormonal factors. Furthermore, the role of sex hormones in pain sensitivity for both FMS and healthy women seems to be limited. PERSPECTIVE: Normally menstruating women with FMS and healthy women do not seem to show fluctuating threshold and tolerance to the ischemic pain test. The role of sex hormones in the hyperalgesia of FMS appears limited.

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    • "Research thus far has demonstrated mixed findings on how the stage of menstrual cycle (and accompanying changes in steroids such as estradiol and progesterone) covaries with experimental pain sensitivity (e.g., [6] [7] [8]). Several studies have shown regular, isochronal fluctuations in pain sensitivity [9] [10] [11] [12] [13], while others have not found this effect [14] [15] [16]. Clearly, methodological factors (e.g., characteristics of samples, menstrual phase nomenclature, and nature of noxious stimuli) have contributed to these discrepancies [7] [17]. "
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    ABSTRACT: Background. Separate lines of research have shown that menstrual cycling and contextual factors such as the gender of research personnel influence experimental pain reporting. Objectives. This study examines how brief, procedural interactions with female and male experimenters can affect experimentally reported pain (cold pressor task, CPT) across the menstrual cycle. Methods. Based on the menstrual calendars 94 naturally cycling women and 38 women using hormonal contraceptives ( ) were assigned to low and high fertility groups. This assignment was based on estimates of their probability of conception given their current cycle day. Experimenters (12 males, 7 females) engaged in minimal procedural interactions with participants before the CPT was performed in solitude. Results. Naturally cycling women in the high fertility group showed significantly higher pain tolerance (81 sec, ) following interactions with a male but not a female experimenter. Differences were not found for women in the low fertility or contraceptive groups. Discussion. The findings illustrate that menstrual functioning moderates the effect that experimenter gender has on pain reporting in women. Conclusion. These findings have implications for standardizing pain measurement protocols and understanding how basic biopsychosocial mechanisms (e.g., person-perception systems) can modulate pain experiences.
    Full-text · Article · Apr 2015 · International Journal of Endocrinology
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    • "However, research examining the associations between hormonal fluctuations across the menstrual cycle and experimental (i.e., exogenous) pain sensitivity has produced mixed findings. Some studies show that women report variability in external pain sensitivity across different phases of the menstrual cycle [26], [48], [50], [58], whereas other studies have not found these effects, leading the researchers to conclude that they do not exist [4], [42], . These discrepancies have mostly been attributed to empirical, methodological factors, such as variability in noxious stimuli induction and how menstrual phases are defined [59]. "
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    ABSTRACT: We explored the social-signaling hypothesis that variability in exogenous pain sensitivities across the menstrual cycle is moderated by women's current romantic relationship status and hence the availability of a solicitous social partner for expressing pain behaviors in regular, isochronal ways. In two studies, we used the menstrual calendars of healthy women to provide a detailed approximation of the women's probability of conception based on their current cycle-day, along with relationship status, and cold pressor pain and ischemic pain sensitivities, respectively. In the first study (n = 135; 18-46 yrs., Mage = 23 yrs., 50% natural cycling), we found that naturally-cycling, pair-bonded women showed a positive correlation between the probability of conception and ischemic pain intensity (r = .45), associations not found for single women or hormonal contraceptive-users. A second study (n = 107; 19-29 yrs., Mage = 20 yrs., 56% natural cycling) showed a similar association between greater conception risk and higher cold-pressor pain intensity in naturally-cycling, pair-bonded women only (r = .63). The findings show that variability in exogenous pain sensitivities across different fertility phases of the menstrual cycle is contingent on basic elements of women's social environment and inversely correspond to variability in naturally occurring, perimenstrual symptoms. These findings have wide-ranging implications for: a) standardizing pain measurement protocols; b) understanding basic biopsychosocial pain-related processes; c) addressing clinical pain experiences in women; and d) understanding how pain influences, and is influenced by, social relationships.
    Full-text · Article · Mar 2014 · PLoS ONE
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    • "Hysterectomy was chosen because it is one of the most common surgeries in women in the United States,2 second only to cesarean section. Moreover, previous studies suggest interactions between the hormonal milieu and pain,3–6 observations that further suggest a role for exploring the effects of hysterectomy on pain and other fibromyalgia-related symptomatology. Thus, the current study examined a large group of women with fibromyalgia with the goal of exploring whether such symptomatology is worse among those who had undergone a hysterectomy with or without an oophorectomy at some point in the past. "
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    ABSTRACT: Fibromyalgia is a troubling disease characterized by chronic pain. This study explored whether pain and other fibromyalgia symptoms are worse among women who had undergone a hysterectomy with or without an oophorectomy versus those who had not. Consecutive women who were seen at the Fibromyalgia Treatment Program at a tertiary medical center between 2001 and 2004 and who completed the Fibromyalgia Impact Questionnaire (FIQ) and Short Form-36 Health Survey (SF-36) at initial evaluation were included in this study. A total of 813 women were included; 328 had had a hysterectomy. Total FIQ scores from women who had had a hysterectomy were higher (worse symptoms) than those who had not (58.1 vs 56.4, P = 0.002). FIQ subscale scores of pain (P = 0.003), fatigue (P = 0.030), stiffness (P = 0.035), and depression (P = 0.008) were also worse in women who had had a hysterectomy. Similar to the FIQ, SF-36 physical component scores were worse in women who had had a hysterectomy (P = 0.045). Pain and other fibromyalgia symptom severity was worse in women who had had a hysterectomy with or without an oophorectomy.
    Full-text · Article · Oct 2011 · Journal of Pain Research
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