Why Does Fibromyalgia Affect More Women?

What is fibromyalgia?

Fibromyalgia is a chronic disorder, which involves widespread pain in the muscles and bones along with chronic fatigue and cognitive difficulties. This medical condition is often misdiagnosed because its symptoms are subjective without a clear known cause. 

A few of the classic symptoms of fibromyalgia are fatigue and joint pain. Currently, there is no cure for fibromyalgia, but there are some medications, exercises, and therapies that can help ease the symptoms. Effectively managing stress and lifestyle changes may also help.

The exact cause of the disorder is still not completely understood. However, researchers believe that fibromyalgia affects how the brain processes pain signals, which amplifies painful sensations. The disorder also involves a combination of factors working together such as genetics, infections, and physical or emotional trauma. 

A person with fibromyalgia experiences a range of symptoms with varying intensities. Over time, the intensity of the symptoms can either increase or decrease and often resemble other types of conditions. For many years, fibromyalgia was often misdiagnosed. Doctors have to heavily rely on the patient’s medical history, symptoms, and result of the physical examination along with an accurate manual tender point examination.

Fibromyalgia Affects More Women than Men

Fibromyalgia is predominantly diagnosed in women. According to US government statistics, 90% of fibromyalgia cases are seen in women. Men can get it, but they would experience it differently than women. Men usually have fewer and milder symptoms compared to women. They tend to have shorter periods of discomfort as well. The reason could be the number of tender points men have. Men may only have six tender points in the body while women have 18. 

Although the exact reasons regarding gender differences in fibromyalgia are still not completely understood, several theories have explanations why women suffer more than men. 

The Estrogen Connection

Since fibromyalgia peaks in women during reproductive years, it is believed that female hormones play a significant role to the higher incidence and severity of the disorder. Most women who suffer from fibromyalgia complained that pain tends to worsen just before and during their monthly period. This could be due to hormonal fluctuations women experience. Estrogen is said to plunge right before the start of menstruation and starts to rise again after monthly periods.

Estrogen is a hormone that helps protect against the pain. During pregnancy, the level of estrogen is very high to protect and prepare women from the pain of childbirth. However, in the case of menstruating women, the level of estrogen is said to fluctuate every month, which leads to the worsening of fibromyalgia symptoms. It is also believed that men effectively release endorphins, which is are natural substances that activate pain-killing receptors present in the brain. Studies have suggested that in general, women have lower pain thresholds when compared to men, which explains the hormonal and endorphin difference.

Role Played by Testosterone

Men also have small amounts of estrogen. However, estrogen levels in men do not fluctuate throughout the month, which happens to menstruating women. The higher sensitivity towards pain is said to be triggered by the changes in the amount of estrogen. Also, the male hormone called testosterone may be protective against any kind of pain.

According to studies, men who have the highest levels of testosterone are said to be at the lowest risk of developing fibromyalgia. Women also have the hormone testosterone but only in small amounts. Some researchers suggest a theory that testosterone can protect men from experiencing the discomfort that comes along with fibromyalgia including a lesser occurrence of migraines and other pain conditions, which seem to be quite common in women.

Do men suffer from fibromyalgia?

Although the symptoms of fibromyalgia are much lesser in men as compared to women, men can still suffer from the disorder. Some experts believe that the number of incidences in men would be higher than the actual numbers would indicate. Since fibromyalgia is often considered as a woman’s syndrome, fibromyalgia in men is often overlooked. There is also a concept among physicians that the disorder is something more of a female problem and least in men. Moreover, when it comes to generalized pain complaints, men tend to see doctors less often than women since most men would believe that reaching out to a doctor for some vague unknown pain may appear less manly.

Fortunately, there has been an increase in the awareness of fibromyalgia in the general public as well as medical circles. Hence, fibromyalgia symptoms in men are becoming increasingly common for doctors to identify. If a proper and timely diagnosis is carried out, then male patients would at least find some relief from it. Currently, there are several approved medications for the treatment of fibromyalgia in both men and women.

Study of the Genes 

The study of genes, especially gene expression, is a vital aspect when it comes to gender questions about fibromyalgia. However, we are more than just genes. Our body’s hormones have the power to tell our genes when and how to act. Some of these genes in our body are static, while some would turn on and off, which is known as gene expression. This gene expression is said to provide a lot of hope for our healthy future. Below are the three main reasons why females are more prone to developing fibromyalgia and other autoimmune problems than the male population.

1. Stress Reactions

It can be simple as well as complicated to identify the differences on how men would react to stress as opposed to women. It would be simple to observe how men, in general, would seem to disengage from others during a stressful situation. On the other hand, women are more likely to engage and would actually try to seek out any kind of social connections when experiencing stress.

A new study has looked into the differences in the functioning of the body in relation to this particular tendency. The study demonstrated the functioning of the brain and mainly focused on the amygdala, which is responsible for responses involving fear and fear conditioning. The study measured and documented the engagement and disengagement reaction to stress, and the results were surprising.

The subjects of the study were monitored when they were under intentional stress and their hormone level responses were also measured. Next, they were given a facial recognition test. It was seen that the ability of men to recognize friendly or threatening faces diminished while the women’s ability was heightened. 

The study did not go into detail on how long these stress-related responses continued to differently affect both genders. However, it was clearly observed that the women's stress response was longer than men. This hypothesis seems true since more women actually suffer from chronic stress than men. 

2. Immune-Related Factors

Stress hormones tend to affect the immune system by depressing or delaying responses. Most individuals who deal with chronic health challenges are often said to report an impaired immune system along with an increase in the occurrence of flu, colds, and other health problems. However, it is different to an overactive immune response, which ultimately leads to autoimmunity. Still, they are both parts of the same equation. Thus, the immune system and the increased risk of having autoimmune diseases are definitely influenced by gender-related hormones.

A report from the National Institute of Health mentioned that gender plays an important role in the increased incidence of autoimmune diseases such as arthritis and lupus, which tend to occur more in females than males. This is also related to a higher number of antibodies circulating along with other factors.

3. Hormonal Levels

Studies have already demonstrated that women have more hormonal activities during stress when compared to men. It has been often said that fibromyalgia mostly occurs in women than men due to hormonal factors. Hormones tend to have a direct effect on our gene expression. The duration of exposure to the different types of hormones can turn on or off various genes, which are related to disease and systemic function. The difference in the gene expression of men and women may cause women to differently react to stress.

In studies conducted on mice, frequent grooming was an indicator of higher stress levels. When stress factors were introduced to both male and female subjects, the behaviors that demonstrated stress increased. One of the significant difference was that for the female subjects, the grooming behavior was becoming more compulsive and obsessive,  which was in direct proportion to the estrogen levels in the body. The higher amount of estrogen, the more intense the subject would tend to become.

The dominance of estrogen has always been a topic of discussion in relation to chronic illnesses as well as autoimmune conditions. The following are symptoms of high estrogen levels:

• Thyroid issues
• Loss of hair
• Insomnia
• Weight gain
• PMS
• Fatigue
• Cognitive impairment 
• Cold feet and hands

These symptoms are quite familiar, so it is no wonder that estrogen dominance is often linked to systemic dysfunction, which would include autoimmune conditions, rapid signs of aging, and heightened allergic responses.