WebMD Medical News
Laura J. Martin, MD
April 16, 2010 (Toronto) -- Symptoms of irritable bowel syndrome (IBS),
fibromyalgia, and a painful bladder condition called interstitial cystitis (IC)
seem to get worse in some women right before and during menstruation,
All three are disorders of the autonomic nervous system. That's the part of
the brain, spinal cord, and nerves that controls functions such as blood
pressure and bladder control; these functions are largely involuntary and below
our level of consciousness.
"Since other autonomic disorders like migraine and fainting seem to have
menstrual variations, we theorized that these conditions would have these
variations as well," says Thomas Chelimsky, MD, professor of neurology at Case
Western Reserve University in Cleveland.
IBS is characterized by abdominal pain, constipation, bloating, and
diarrhea, while fibromyalgia is characterized by pain throughout the body,
along with tender points. IC patients have pain in the bladder. All three
conditions affect women more than men. Stress and anxiety can exacerbate
symptoms of all three, Chelimsky tells WebMD.
For the study, 79 women with IBS, 77 women with fibromyalgia, and 129 women
with IC filled out a questionnaire asking about the severity of their symptoms
throughout the month.
A total of 25% of the IBS patients, 18% of the fibromyalgia patients, and 9%
of the IC patients reported worsening of symptoms during or before their
While not addressed by the study, Chelimsky believes fluctuations in hormone
levels may explain the findings.
"Estrogen is a pain preventative," Chelimsky says. Levels are at their
lowest right before menstruation and are still low while a woman has her
Additionally, 15% of women in the study reported worse pain at menopause,
another time estrogen levels drop. In a surprising finding that the researchers
could not explain, 37% of women said symptoms got worse at the time of their
Also unknown is why symptoms fluctuate with hormone levels in some women and
The findings of the poster presentation were reported here at the annual
meeting of the American Academy of Neurology.
Asked to comment on the findings, Nathan Wei, MD, clinical director of the
Arthritis and Osteoporosis Center of Maryland, says, "This study confirms the
clinical impression made by practitioners for many years -- that hormonal
shifts play a major role in symptom exacerbation."
Chelimsky says that other research shows that women with IBS, fibromyalgia,
and IC who are on estrogen-containing birth control pills seem to have fewer
symptoms than other women with the conditions.
"I wouldn't recommend patients go on the pill [for this reason]," Chelimsky
"But if they have bad periods, they may want to get on an exercise program.
Studies have shown that's the best thing you can do to improve symptoms," he
SOURCES:American Academy of Neurology 62nd Annual Meeting, Toronto, April 10-17,
2010.Thomas Chelimsky, MD, professor of neurology, Case Western Reserve
University, Cleveland.Nathan Wei, MD, clinical director, Arthritis and Osteoporosis Center of
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