Sex Hormones and Pain in Regularly Menstruating Women With Fibromyalgia Syndrome

Article · December 2006with16 Reads
DOI: 10.1016/j.jpain.2006.04.005 · Source: PubMed
Abstract
Unlabelled: 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.
    • Both FM and EDSH are more prevalent in women than in men [4,33,34]. The FM pathogenesis remains unclear, but the role of sex hormones seems to be limited [35,36]. EDSH is considered to be linked to autosomal dominant inheritance, but the role of sex hormones on the musculoskeletal system possily explains the predominance of EDSH in women.
    [Show abstract] [Hide abstract] ABSTRACT: Fibromyalgia (FM) and hypermobility type Ehlers-Danlos syndrome (EDSH) share a series of common clinical signs. A clinical distinction between both diseases is occasionally difficult to be established. The physical changes observed in the mechanical properties of skin and joints do not distinctly distinguish these disorders. In addition, similar ultrastructural dermal changes are observed in both EDSH and some FM cases. The molecular alterations remain largely undisclosed in both diseases. As a result, EDSH remains undiagnosed in some FM patients. This condition deteriorates quality of life and possibly leads to prominent health problems.
    Full-text · Article · Dec 2015 · Clinical Rheumatology
    • 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.,678). Several studies have shown regular, isochronal fluctuations in pain sensitivity910111213, while others have not found this effect141516. Clearly, methodological factors (e.g., characteristics of samples, menstrual phase nomenclature, and nature of noxious stimuli) have contributed to these discrepancies [7, 17].
    [Show abstract] [Hide abstract] 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
    • All studies used the menstrual cycle as a proxy for the ovarian hormone levels, therefore, all used self-reports to identify the different phases of the menstrual cycle, assuming that each phase reflected the actual hormonal levels or changes in hormone levels. Only 4 studies confirmed hormone levels or stage of menstrual cycle by direct measures using blood [42,75], daily urine samples [68], or ovulation kits [62] . It is well established that there are individual differences in hormone levels across cycles as well as in cycle length, both within and between women [68].
    [Show abstract] [Hide abstract] ABSTRACT: Most chronic non-cancer pain (CNCP) conditions are more common in women and have been reported to worsen particularly during the peak reproductive years. This phenomenon suggests that ovarian hormones might play a role in modulating CNCP pain. To this end, we reviewed human literature aiming to assess the potential role of ovarian hormones in modulating the following CNCP conditions: musculoskeletal pain, migraine headache, temporal mandibular disorder, and pelvic pain. We found 50 relevant clinical studies, the majority of which demonstrated a correlation between hormone changes or treatments and pain intensity, threshold, or symptoms. Taken together, the findings suggest that changes in hormonal levels may well play a role in modulating the severity of CNCP conditions. However, the lack of consistency in study design, methodology, and interpretation of menstrual cycle phases impedes comparison between the studies. Thus, while the literature is highly suggestive of the role of ovarian hormones in modulating CNCP conditions, serious confounds impede a definitive understanding for most conditions except Menstrual Migraine and endometriosis. It may be that these inconsistencies and the resulting lack of clarity have contributed to the failure of hormonal effects being translated into medical practice for treatment of CNCP conditions.
    Full-text · Article · Aug 2014
    • 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].
    [Show abstract] [Hide abstract] 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
    • The modulation of fibromyalgia pain by gonadal hormones is less certain. Several studies report FM pain did not fluctuate during the menstrual cycle (Alonso et al., 2004;Okifuji and Turk, 2006;Samborski et al., 2005), although another study reported menstrual cycle effects in about 50% of patients (Pamuk and Cakir, 2005). In post-menopausal women with fibromyalgia, hormone replacement did not affect pain ratings (Stening et al., 2011).
    [Show abstract] [Hide abstract] ABSTRACT: Women disproportionately suffer from many deep tissue pain conditions. Experimental studies show that women have lower pain thresholds, higher pain ratings and less tolerance to a range of painful stimuli. Most clinical and epidemiological reports suggest female gonadal hormones modulate pain for some, but not all, conditions. Similarly, animal studies support greater nociceptive sensitivity in females in many deep tissue pain models. Gonadal hormones modulate responses in primary afferents, dorsal horn neurons and supraspinal sites, but the direction of modulation is variable. This review will examine sex differences in deep tissue pain in humans and animals focusing on the role of gonadal hormones (mainly estradiol) as an underlying component of the modulation of pain sensitivity.
    Full-text · Article · Jul 2013
    • P. Montoya (*) Research Institute on Health Sciences (IUNICS), University of the Balearic Islands, Cra. de Valldemossa km 7.5, 07122 Palma de Mallorca, Spain e-mail: pedro.montoya@uib.es FM patients as compared with healthy controls, other studies have found no significant group differences in sex hormones levels [8], or just a modest relationship between progesterone levels and pain sensitivity during the late follicular phase [11]. Accordingly, it has been suggested that pain hypersensitivity observed in these chronic pain patients could be related to menopausal transition rather than to fluctuating ovarian hormones during the menstrual cycle [12].
    [Show abstract] [Hide abstract] ABSTRACT: Fibromyalgia (FM) is a chronic pain condition characterized by high prevalence in women. In particular, estrogen deficit has been considered as a potentially promoting factor of FM symptoms. This study was aimed to examine the relationship between age-of-onset of menopause and pain sensitivity in FM. For this purpose, pain sensitivity was assessed in 74 FM and 32 pain-free control women. All participants were postmenopausal and underwent a detailed semi-structured clinical interview, including data about menopause transition, previous history of hysterectomy or ovariectomy, and menses time. Participants were divided into two groups depending on age-of-onset of menopause: early menopause [≤49 years] vs. late menopause [>49 years]. Pain and non-pain thresholds were assessed by using cold, heat, mechanical, and electrical stimulation. FM women showed higher overall pain sensitivity as compared with healthy subjects. FM women with early age-of-onset of menopause displayed greater pain and non-pain sensitivity than FM women with late age-of-onset of menopause, whereas no differences were observed in healthy women due to age-of-onset of menopause. These results suggest that an early transition to menopause (shortening the time of exposure to estrogens) may influence pain hypersensitivity and could be related to aggravation of FM symptoms.
    Full-text · Article · Feb 2013
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