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Menstrual problems in ME/CFS
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'''Menstrual problems''' and '''worsening of existing menstrual/gynaecological problems''' have been reported to occur in some patients with [[myalgic encephalomyelitis]] and [[chronic fatigue syndrome]].<ref name="ICC2011primer" /><ref>{{Cite web | url = https://meassociation.org.uk/2018/09/premenstrual-syndrome-female-hormones-and-me-cfs-by-dr-charles-shepherd-25-september-2018/| title = Premenstrual Syndrome, Female hormones and ME/CFS | last = Shepherd | first = Charles S | authorlink = Charles Shepherd | date = 2018 | website = [[ME Association]]| archive-url = | archive-date = |url-status = | access-date = Nov 12, 2021}}</ref> ==Prevalence== ==Symptom recognition== The [[International Consensus Criteria]] (ICC) for [[myalgic encephalomyelitis]] includes '''Genitourinary dusturbances''' as an optional diagnostic criteria, but does not give examples of these. The ICC primer for clinicians states that females have a higher incidence of peri-menstrual symptoms (symptoms before and during the [[menstrual cycle]]) and these can last two weeks, and ME can involve having more severe peri-menopausal and post-menopausal symptoms.<ref name="ICC2011primer" />{{Rp|19}} The [[Canadian Consensus Criteria]] for ME/CFS recognizes: * [[dysmenorrhea]] * [[premenstrual syndrome]] (PMS) or [[irregular menstrual cycles]]<ref name="canadianconsensus-CCC">{{Citation | last1 = Carruthers | first1 = Bruce M. | authorlink1 = Bruce Carruthers | last2 = Jain | first2 = Anil Kumar | authorlink2 = Anil Kumar Jain | last3 = De Meirleir | first3 = Kenny L. | authorlink3 = Kenny De Meirleir | last4 = Peterson | first4 = Daniel L. | authorlink4 = Daniel Peterson | last5 = Klimas | first5 = Nancy G. | authorlink5 = Nancy Klimas | last6 = Lerner | first6 = A. Martin | authorlink6 = Martin Lerner | last7 = Bested | first7 = Alison C. | authorlink7 = Alison Bested | last8 = Flor-Henry | first8 = Pierre | authorlink8 = Pierre Flor-Henry | last9 = Joshi | first9 = Pradip | authorlink9 = Pradip Joshi | last10 = Powles | first10 = AC Peter | authorlink10 = A C Peter Powles | last11 = Sherkey | first11 = Jeffrey A. | authorlink11 = Jeffrey Sherkey | last12 = van de Sande | first12 = Marjorie I. | authorlink12 = Marjorie van de Sande | title = Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical Working Case Definition, Diagnostic and Treatment Protocols | journal = Journal of Chronic Fatigue Syndrome | volume = 11 | issue = 2 | pages = 7-115 | date = 2003 | pmid = | doi = 10.1300/J092v11n01_02| url = http://www.investinme.org/Documents/PDFdocuments/CanadianDefinitionME-CFS.pdf}}</ref> These are not considered part of the diagnostic criteria, but are listed under possible genitourinary symptoms in the Appendix. Boneva et al. (2011) compared women with [[Chronic fatigue syndrome]] with matched controls, and concluded that: {{quote | text=Amenorrhea, pelvic pain unrelated to menstruation, [[endometriosis]], any gynecological surgery, and specifically [[hysterectomy]] and oophorectomy, were all more common in the CFS than in the control group. These differences between CFS and controls were statistically significant for pelvic pain (pβ=β0.004), endometriosis (pβ=β0.046), and any gynecological surgery (pβ=β0.045) (Table 2). In addition, the CFS group had a significantly greater mean number of pregnancies (2.8 in CFS vs. 2.0 in controls, pβ=β0.05) and greater mean number of gynecological surgeries (1.7 in CFS vs. 1.1 in controls, pβ=β0.05). [[Menopause]] occurred on average 4 years earlier in the CFS group (βΌ42 years vs. 46 years in controls), but this difference was not statistically significant (pβ=β0.11) (Table 2). For the subset of women without a history of surgical menopause, however, the mean age at menopause was similar for the CFS and control groups (approximately 50 years) (table 2).| source=Boneva et al. (2011) <ref name="Boneva2011"/>}} ==Notable studies== *2019, Endometriosis as a comorbid condition in chronic fatigue syndrome (CFS): Secondary analysis of data from a CFS case-control study<ref name="Boneva2019">{{Cite journal | title=Endometriosis as a Comorbid Condition in Chronic Fatigue Syndrome (CFS): Secondary Analysis of Data From a CFS Case-Control Study | date = 2019 | url=https://www.frontiersin.org/article/10.3389/fped.2019.00195|journal=Frontiers in Pediatrics | volume=7|issue = | pages = | last = Boneva | first = Roumiana S. | authorlink = | last2 = Lin | first2 = Jin-Mann S. | authorlink2 = Jin-Mann Sally Lin | last3 = Wieser | first3 = Friedrich | authorlink3 = | last4 = Nater | first4 = Urs M. | authorlink4 = | last5 = Ditzen | first5 = Beate | authorlink5 = | last6 = Taylor | first6 = Robert N. | authorlink6 = | last7 = Unger | first7 = Elizabeth R. | authorlink7=Elizabeth Unger | doi=10.3389/fped.2019.00195/full | pmc = | pmid = | access-date = |issn=2296-2360|quote = | via=}}</ref> - [https://www.frontiersin.org/articles/10.3389/fped.2019.00195/full (Full text)] *2015, Early menopause and other gynecologic risk indicators for chronic fatigue syndrome in women<ref name="Boneva2015">{{Cite journal | title=Early menopause and other gynecologic risk indicators for chronic fatigue syndrome in women | date = Aug 2015 | url = https://journals.lww.com/menopausejournal/Abstract/2015/08000/Early_menopause_and_other_gynecologic_risk.7.aspx|journal=Menopause | volume=22|issue=8 | pages = 826β834 | last = Boneva | first = Roumiana S. | authorlink = | last2 = Lin | first2 = Jin-Mann S. | authorlink2 = Jin-Mann Sally Lin | last3 = Unger | first3 = Elizabeth R. | authorlink3=Elizabeth Unger | language=en-Us | doi=10.1097/GME.0000000000000411 | pmc=PMC5745581 | pmid=25647777| access-date = |issn=1530-0374|quote = | via=}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5745581/ (Full text)] *2013, Perinatal perspectives on chronic fatigue syndrome<ref name="Christley2013">{{Cite journal | title=Perinatal perspectives on chronic fatigue syndrome | date = 2012-06-01 | url=https://www.researchgate.net/publication/235349788_Perinatal_perspectives_on_chronic_fatigue_syndrome | journal=British Journal of Midwifery|volume=20|issue=6 | pages = 389β393 | last = Christley|first = Yvonne | last2 = Martin | first2 = Caroline J Hollins | last3 = Martin | first3 = Colin r | doi=10.12968/bjom.2012.20.6.389|issn=0969-4900}}</ref> - [https://www.researchgate.net/publication/235349788_Perinatal_perspectives_on_chronic_fatigue_syndrome (Full text)] *2011, Gynecologic history in chronic fatigue syndrome (CFS): a population-based case control study<ref name="Boneva2011">{{Cite journal | title=Gynecological History in Chronic Fatigue Syndrome: A Population-Based Case-Control Study | date = 2011-01-01 | url=https://www.liebertpub.com/doi/full/10.1089/jwh.2009.1900|journal=Journal of Women's Health|volume=20|issue=1 | pages=21β28 | last = Boneva | first = Roumiana S. | authorlink = | last2 = Maloney | first2 = Elizabeth M. | authorlink2 = Elizabeth M. Maloney | last3 = Lin | first3 = Jin-Mann | authorlink3=Jin-Mann Sally Lin | last4 = Jones | first4 = James F. | authorlink4 = | last5 = Wieser | first5 = Friedrich | authorlink5 = | last6 = Nater | first6 = Urs M. | authorlink6 = | last7 = Heim | first7 = Christine M. | authorlink7 = | last8 = Reeves | first8 = William C. | authorlink8=William Reeves | doi=10.1089/jwh.2009.1900|pmc=PMC3017420|pmid=21091051 | access-date = |issn=1540-9996|quote = | via=}}</ref> - [https://www.liebertpub.com/doi/abs/10.1089/jwh.2009.1900 (Full text)] *2015, Gynecological Disorders Related to Chronic Fatigue Syndrome<ref name="Coelho2015">{{Cite journal | url=https://jacobspublishers.com/journals/jacobs-journal-of-gynecology-and-obstetrics/fulltext/gynecological-disorders-related-to-chronic-fatigue-syndrome | title=Gynecological Disorders Related to Chronic Fatigue Syndrome | last = Coelho|first = Jk | authorlink = | last2 = Aldrighi | first2 = JM | authorlink2 = | last3 = Oliari | first3 = CB | last4 = Fam | first4 = GYHI | last5 = Rossi | first5 = RM | last6 = Fernandes | first6 = RT | date = 2015 | website = Jacobs Journal of Gynecology and Obstetrics | pages = 014|volume=2|issue=1}}</ref>Β - [https://jacobspublishers.com/uploads/article_pdf/15/scientific_15_917_27052019121107.pdf (Full text)] ==Possible causes== The causes of new or worsening menstrual symptoms in people with [[ME/CFS]] are not fully understood, however other hormonal problems and symptoms resulting from the [[endocrine system]] have been widely reported.<ref name="ICC2011primer">{{citation | last1 = Carruthers | first1 = BM | authorlink1 = Bruce Carruthers | last2 = van de Sande | first2 = MI | authorlink2 = Marjorie van de Sande | last3 = De Meirleir | first3 = KL | authorlink3 = Kenny de Meirleir | last4 = Klimas | first4 = NG | authorlink4 = Nancy Klimas | last5 = Broderick | first5 = G | authorlink5 = Gordon Broderick | last6 = Mitchell | first6 = T | authorlink6 = Terry Mitchell | last7 = Staines | first7 = D | authorlink7 = Donald Staines | last8 = Powles | first8 = ACP | authorlink8 = A C Peter Powles | last9 = Speight | first9 = N | authorlink9 = Nigel Speight | last10 = Vallings | first10 = R | authorlink10 = Rosamund Vallings | last11 = Bateman | first11 = L | authorlink11 = Lucinda Bateman | last12 = Bell | first12 = DS | authorlink12 = David Bell | last13 = Carlo-Stella | first13 = N | authorlink13 = Nicoletta Carlo-Stella | last14 = Chia | first14 = J | authorlink14 = John Chia | last15 = Darragh | first15 = A | authorlink15 = Austin Darragh | last16 = Gerken | first16 = A | authorlink16 = Anne Gerken | last17 = Jo | first17 = D | authorlink17 = Daehyun Jo | last18 = Lewis | first18 = DP | authorlink18 = Donald Lewis | last19 = Light | first19 = AR | authorlink19 = Alan Light | last20 = Light | first20 = KC | authorlink20 = Kathleen Light | last21 = Marshall-Gradisnik | first21 = S | authorlink21 = Sonya Marshall-Gradisnik | last22 = McLaren-Howard | first22 = J | authorlink22 = John McLaren-Howard | last23 = Mena | first23 = I | authorlink23 = Ismael Mena | last24 = Miwa | first24 = K | authorlink24 = Kunihisa Miwa | last25 = Murovska | first25 = M | authorlink25= Modra Murovska | last26 = Stevens | first26 = SR | authorlink26 = Staci Stevens | title = Myalgic encephalomyelitis: Adult & Paediatric: International Consensus Primer for Medical Practitioners | date = 2012| isbn = 978-0-9739335-3-6 | url = http://www.investinme.org/Documents/Guidelines/Myalgic%20Encephalomyelitis%20International%20Consensus%20Primer%20-2012-11-26.pdf}}</ref><ref name="canadianconsensus-CCC">{{Citation | last1 = Carruthers | first1 = Bruce M. | authorlink1 = Bruce Carruthers | last2 = Jain | first2 = Anil Kumar | authorlink2 = Anil Kumar Jain | last3 = De Meirleir | first3 = Kenny L. | authorlink3 = Kenny De Meirleir | last4 = Peterson | first4 = Daniel L. | authorlink4 = Daniel Peterson | last5 = Klimas | first5 = Nancy G. | authorlink5 = Nancy Klimas | last6 = Lerner | first6 = A. Martin | authorlink6 = Martin Lerner | last7 = Bested | first7 = Alison C. | authorlink7 = Alison Bested | last8 =Flor-Henry | first8 = Pierre | authorlink8 = Pierre Flor-Henry | last9 = Joshi | first9 = Pradip | authorlink9 = Pradip Joshi | last10 = Powles | first10 = AC Peter | authorlink10 = A C Peter Powles | last11 = Sherkey | first11 = Jeffrey A. | authorlink11 = Jeffrey Sherkey | last12 = van de Sande | first12 = Marjorie I. | authorlink12 = Marjorie van de Sande | title = Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical Working Case Definition, Diagnostic and Treatment Protocols | journal = Journal of Chronic Fatigue Syndrome | volume = 11 | issue = 2 | pages = 7-115 | date = 2003 | pmid = | doi = 10.1300/J092v11n01_02| url = http://www.investinme.org/Documents/PDFdocuments/CanadianDefinitionME-CFS.pdf}}</ref> Some medications are known to cause side effects that are hormonal.{{citation needed | date = 2020 | reason=Add table of examples}} ==Fibromyalgia == Some people with [[fibromyalgia]] experience new or worsening menstrual or gynaecological symptoms.{{citation needed | date = 2022}} ==Long COVID== Anecdotal reports from people with [[Long COVID]] have reported the sudden onset of significant menstrual problems after developing Long COVID.<ref name="LCNPR2021">{{Cite news | url = https://www.npr.org/2021/03/21/979809515/months-after-contracting-virus-2-women-suffer-crippling-effects-of-long-covid?t=1652828435447| title = Months After Contracting Virus, They Suffer Crippling Effects Of 'Long COVID' | date = March 21, 2021 | website = NPr | access-date = 2022-05-18}}</ref><ref name="Bustle2020">{{Cite news | date = | url = https://www.bustle.com/wellness/covid-19-menstrual-cycles-pandemic | title = Extreme Clotting, Missed Cycles, Seizures: How Periods Have Changed During The Pandemic]. People's periods are even more hellish than usual. | first = Jennifer | last = Gerson|website=Bustle | date = July 16, 2020| access-date = 2022-05-18}}</ref><ref name="Davis2021a">{{Cite journal | last = Davis | first = Hannah E. | authorlink = Hannah Davis | last2 = Assaf | first2 = Gina S. | last3 = McCorkell | first3 = Lisa | last4 = Wei | first4 = Hannah | last5 = Low | first5 = Ryan J. | last6 = Re'em | first6 = Yochai | last7 = Redfield | first7 = Signe | last8 = Austin | first8 = Jared P. | last9 = Akrami | first9 = Athena | date = 2021-07-15| title = Characterizing long COVID in an international cohort: 7 months of symptoms and their impact| url = https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(21)00299-6/abstract|journal=EClinicalMedicine | language=English|volume=38|issue = | pages=101019|doi=10.1016/j.eclinm.2021.101019|pmc=PMC8280690|pmid=34308300|issn=2589-5370}}</ref> Fiona Lowenstein, co-founder of [[Body Politic]] reports: {{Quote | text=I do still have some long-term symptoms. The most notable is that my menstrual periods have changed entirely, and they're very debilitating now. And I have a return of flu-like symptoms as well as fatigue and migraines and sometimes nausea and vomiting. And that's something I never experienced before COVID, but it is something that we see with a lot of long COVID patients and survivors who menstruate.<ref name="LCNPR2021"/>| source=NPR, Mar 21, 2021 | author=[[Fiona Lowenstein]]}} Davis et al. (2021) reported that of the Long COVID patients surveyed who menstruated, over a third experienced relapses of Long COVID symptoms during or during their periods,<ref name="Davis2021a" /> which is the most inflammatory time in the menstrual cycle.<ref name=":0">{{Cite journal | title=The COVID-19 pandemic and the menstrual cycle: research gaps and opportunities | date = 2021-12-02| url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8690231 | journal=International Journal of Epidemiology|volume = | issue = | pages=dyab239 | last = Sharp|first = Gemma C | authorlink = | last2 = Fraser | first2 = Abigail | authorlink2 = | last3 = Sawyer | first3 = Gemma| authorlink3 = | last4 = Kountourides | first4 = Gabriella| authorlink4 = | last5 = Easey | first5 = Kayleigh E | authorlink5 = | last6 = Ford | first6 = Gemma| authorlink6 = | last7 = Olszewska | first7 = Zuzanna | last8 = Howe | first8 = Laura D | last9 = Lawlor | first9 = Deborah A | last10 = Alvergne | first10 = Alexandra | last11 = Maybin | first11 = Jacqueline A|language=en|doi=10.1093/ije/dyab239|pmc=PMC8690231 | pmid=34865021 | access-date = |issn=0300-5771 | quote = | via=}}</ref> Sharp et al. (2021) reports that this is similar to the experience of ME/CFS patients, who have more [[Flare-up|flare-ups]] worsening their systems when they have [[premenstrual syndrome]] and at the start of [[menopause]].<ref name=":0" /> Some [[Long COVID]] symptoms including changes in menstrual cycle overlap with [[menopause]] symptoms, which may result in menopause being misdiagnosed as Long COVID.<ref name="Stewart2021">{{Cite journal | title=Long COVID risk - a signal to address sex hormones and women's health | date = 2021-12-01 | url=https://www.thelancet.com/journals/lanepe/article/PIIS2666-7762(21)00228-3/abstract|journal=The Lancet Regional Health β Europe | volume=11 | last = Stewart | first = Stuart | last2 = Newson | first2 = Louise | last3 = Briggs | first3 = Tracy A. | last4 = Grammatopoulos | first4 = Dimitris | last5 = Young | first5 = Lawrence | last6 = Gill | first6 = Paramjit|language=English|doi=10.1016/j.lanepe.2021.100242|pmid=34746909|issn=2666-7762}}</ref> ==See also== *[[Dysmenorrhea]] *[[Early menopause]] *[[Endometriosis]] *[[Premenstrual syndrome]] *[[Premenstrual dysphoric disorder]] ==Learn more== *[https://medlineplus.gov/periodpain.html Period pain] - MedlinePlus *[https://www.mayoclinic.org/diseases-conditions/perimenopause/symptoms-causes/syc-20354666 Perimenopause] *[https://meassociation.org.uk/2018/09/premenstrual-syndrome-female-hormones-and-me-cfs-by-dr-charles-shepherd-25-september-2018/ Premenstrual Syndrome, Female hormones and ME/CFS] - ME Association ==References== {{reflist}} [[Category:Signs and symptoms]] [[Category:Endocrine signs and symptoms]] β [[Category:Genitourinary signs and symptoms]] β [[Category:Genitourinary diseases and disorders]] β [[Category:Pain signs and symptoms]] β
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