Fibromyalgia and menopause

Chronic pain at midlife is the theme for World Menopause Month. We went looking at what has been published on it in Maturitas, found four studies worth reading, and asked the authors to write about their own findings.

Musculoskeletal pain, fatigue, brain fog and sleep disturbance belong to both fibromyalgia and menopause, which makes the overlap difficult to see.

Maria G. Grammatikopoulou, Department of Rheumatology and Clinical Immunology, University of Thessaly, and Unit of Reproductive Endocrinology, Aristotle University of Thessaloniki, Greece

Fibromyalgia and menopause can share many symptoms, including musculoskeletal pain, fatigue, brain fog and sleep disturbances, making this an important clinical intersection that deserves greater attention.

Our study explored the relationship between fibromyalgia and menopausal symptoms in 169 peri- and postmenopausal women. We used two validated instruments, the Revised Fibromyalgia Impact Questionnaire and the Greene Climacteric Scale, which to our knowledge had not been brought together before in this population.

What we found

There is a significant association between the severity of fibromyalgia and the intensity of climacteric symptoms. Women with a greater fibromyalgia impact also tended to experience more severe menopausal symptoms. Fibromyalgia score was the strongest independent predictor of climacteric symptom severity, accounting for 27% of the variance.

Higher BMI was associated with both a greater menopausal symptom burden and greater fibromyalgia impact. Osteoporosis was also linked to worse fibromyalgia scores, with affected women scoring around ten points higher.

Interestingly, fibromyalgia preceded menopause in 51% of participants and occurred concurrently with menopause in almost 22%. It developed after menopause in the remaining 27%.

On hormone therapy

Only 6.25% of the peri- and postmenopausal women in our sample were using hormone replacement therapy. Of those, two thirds reported it did not help their fibromyalgia symptoms at all, and the rest were uncertain whether it had.

This is consistent with a randomised controlled trial that found no difference in pain between postmenopausal women with fibromyalgia receiving HRT and those receiving placebo. Current EULAR guidelines do not recommend HRT for managing fibromyalgia pain. HRT remains well established for climacteric arthralgia, which is a different problem.

The practical point is that these two conditions can coexist, and each should be managed according to its own guidelines rather than treated as one.

What it means

These findings emphasize the importance of recognizing the overlap between the two conditions and adopting a holistic approach to women’s health during the menopausal transition.

This was a cross-sectional study, so it cannot establish cause. What it does show is that the two symptom pictures sit on top of each other, and that the burden is heavier where they do.

Read the study

Gkouvi A, Kontouli KM, Pardali EC, et al. Fibromyalgia and menopause: friends with benefits? Maturitas. 2026;208:108899. Open access.