Fibromyalgia is a complex chronic pain condition characterised by widespread body pain that can move around the body and change in location and intensity from day to day. However, fibromyalgia is about much more than pain. People living with fibromyalgia may also experience fatigue, brain fog, sleep disturbance, headaches and migraines, digestive symptoms, temperature intolerance and a range of other neurological and whole-body symptoms.
Fibromyalgia can affect both men and women, but it is much more common in women. For many women, there also appears to be a connection between hormonal changes and the way their pain and other fibromyalgia symptoms are experienced.
This is particularly relevant during perimenopause, the transitional stage leading up to menopause, which can last for up to ten years before the final menstrual period. Many women notice changes in their symptoms throughout their menstrual cycle, but for some, perimenopause can be a particularly difficult time, with existing symptoms becoming more pronounced. It is also not uncommon for women to develop new, widespread aches and pains which may result in a diagnosis of fibromyalgia during this stage of life.
Can perimenopause cause widespread pain?
Research demonstrates that a significant number of women who have never experienced chronic pain or fibromyalgia start noticing more aches, stiffness and joint or muscle pain as they approach menopause.
For women already living with fibromyalgia, the hormonal shifts of perimenopause may coincide with an increase in pain. This can make an already complex condition feel even more difficult to manage.
And it isn’t only pain that can overlap.
Perimenopause can bring changes in sleep, mood, cognition, temperature regulation and migraine patterns, all of which are often features of fibromyalgia. When several of these symptoms occur at the same time, it can become difficult to work out what is related to fibromyalgia, what may be related to perimenopause and what may have another underlying cause.
How do hormones affect pain?
The relationship between hormones, perimenopause and pain is complex and still being investigated, but there is growing evidence that changing sex hormones may influence pain perception and sensitivity.
As oestrogen and progesterone fluctuate and eventually decline during the menopausal transition, this can affect several mechanisms involved in pain regulation. Oestrogen, for example, has effects on inflammatory pathways, the nervous system and pain processing, while changes in oestrogen and progesterone may influence pain sensitivity and the way the body responds to pain.
This is particularly interesting when we consider fibromyalgia and central sensitisation.
Fibromyalgia is thought to involve changes in the way the nervous system processes and amplifies pain signals. In someone with an already sensitised nervous system, additional factors such as hormonal fluctuations may contribute to an increase in symptoms.
Sleep is another important piece of the puzzle. Sleep disturbance is common during perimenopause and menopause, whether due to night sweats, insomnia, anxiety, changing sleep patterns or other menopausal symptoms. Unfortunately, poor sleep can also increase pain sensitivity and make fatigue, brain fog and fibromyalgia symptoms more difficult to manage.
So, for some women, perimenopause can become a bit of a perfect storm: changing hormones, disrupted sleep, increased stress, fatigue and a more sensitive pain system can act as a catalyst for the onset of fibromyalgia.
For women who already have fibromyalgia, hormonal changes may be one of several factors contributing to a flare or change in symptom severity.
This is why I don’t believe in looking at pain in isolation.
Instead, it can be helpful to step back and consider the whole picture: hormonal changes, menstrual cycle patterns, sleep, stress, nutrition, gut health, physical activity, medications, nutritional deficiencies and the way the nervous system is responding to pain.
What can help with fibromyalgia and perimenopause pain?
If you’re a woman between 36 and 60 and you’re experiencing new or worsening aches and pains, it can be easy to feel like your body is suddenly working against you. If you already live with fibromyalgia or another chronic pain condition, an increase in symptoms during perimenopause can be particularly frustrating.
But there are things you can do to support your body through this transition.
Whether you’re experiencing fibromyalgia pain, perimenopause-related aches and pains, or a combination of the two, nutrition, lifestyle and appropriately prescribed herbal and nutritional medicines may form part of a broader symptom-management strategy.
In my practice, I see this overlap regularly. As a naturopath and clinical nutritionist working with women in perimenopause, menopause and fibromyalgia, I’m interested in understanding the whole picture rather than treating pain as an isolated symptom.
One of the questions I’m asking is: how much might the hormonal transition be contributing to your symptoms, and how might this be interacting with an already sensitised pain system?
Depending on the individual, a naturopathic approach to fibromyalgia and perimenopause may include:
- Nutrition for fibromyalgia and menopause: establishing an anti-inflammatory, nutrient-dense eating pattern that supports energy, blood sugar regulation, hormonal health and overall nutritional status without unnecessary restriction.
- Herbal medicine for perimenopause: considering evidence-informed herbal medicines and phytoestrogens where appropriate to support specific menopausal symptoms.
- Nutritional support for pain: assessing and correcting nutritional deficiencies or insufficiencies, such as vitamin D, magnesium, iron, B vitamins or omega-3 fatty acids, where relevant. These nutrients have important roles in nervous system function, inflammation and pain physiology.
- Stress and nervous system regulation: recognising the impact of ongoing stress on pain sensitivity and supporting practical strategies that help regulate the nervous system without adding another overwhelming list of things to do.
- Sleep support: improving sleep habits and addressing factors contributing to poor sleep, with nutritional or herbal support considered where appropriate.
- Gut health: supporting digestion and the gut microbiome, particularly where digestive symptoms such as IBS, bloating or altered bowel habits occur alongside fibromyalgia or menopause symptoms. This is a huge topic in its own right and one I explored in another blog on fibromyalgia and gut health!
- Lifestyle and pacing: finding safe and realistic ways to incorporate movement, rest, recovery and other lifestyle strategies according to your individual capacity, rather than taking an all-or-nothing approach.
The goal isn’t to promise a quick fix or suggest that fibromyalgia can be cured by addressing hormones and perimenopause. Instead, it’s about identifying the factors that may be contributing to your symptoms and finding practical ways to support your body and improve your quality of life.
You don’t have to put it all down to “just hormones”
If you’re experiencing new, persistent or worsening pain, it’s important not to automatically assume that it’s perimenopause or fibromyalgia. New symptoms should always be discussed with your doctor or healthcare team so that other potential causes aren’t overlooked.
But if you’ve noticed that your fibromyalgia symptoms, chronic pain, aches, sleep or other symptoms seem to be changing as you move through perimenopause or menopause, it may be worth looking at the connection.
Hormonal changes may be one piece of the puzzle and understanding that connection can help you take a more informed and individualised approach to managing your symptoms.
As an Adelaide naturopath and clinical nutritionist, I work with women experiencing fibromyalgia, chronic pain, perimenopause and menopause symptoms, both in person in South Australia and online across Australia and New Zealand.
If you’re wondering whether your changing hormones could be contributing to your pain, or you’re looking for a more holistic approach to managing fibromyalgia and perimenopause symptoms, I’d be happy to chat with you about how naturopathic, nutritional and herbal support may fit alongside your existing healthcare.
Want to understand my approach to ME/CFS, fibromyalgia and long COVID – including the dietary patterns and supplements I commonly recommend? Watch my free masterclass, Navigating Invisible Illness, to learn more.
