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Early menopause and other gynecologic risk indicators for chronic fatigue syndrome in women

Boneva, Roumiana S. MD, PhD; Lin, Jin-Mann S. PhD; Unger, Elizabeth R. PhD, MD

doi: 10.1097/GME.0000000000000411
Original Articles

Objective This study aims to examine whether gynecologic conditions are associated with chronic fatigue syndrome (CFS).

Methods This study includes a subset of 157 women from a population-based case-control study in Georgia, United States, conducted in 2004-2009. Gynecologic history was collected using a self-administered questionnaire. Crude odds ratios (ORs) with 95% CIs and ORs adjusted for body mass index and other covariates, where relevant, were estimated for gynecologic conditions between 84 CFS cases and 73 healthy controls.

Results Cases and controls were of similar age. Women with CFS reported significantly more gynecologic conditions and surgical operations than controls: menopause status (61.9% vs 37.0%; OR, 2.37; 95% CI, 1.21-4.66), earlier mean age at menopause onset (37.6 vs 48.6 y; adjusted OR, 1.22; 95% CI, 1.09-1.36), excessive menstrual bleeding (73.8% vs 42.5%; adjusted OR, 3.33; 95% CI, 1.66-6.70), bleeding between periods (48.8% vs 23.3%; adjusted OR, 3.31; 95% CI, 1.60-6.86), endometriosis (29.8% vs 12.3%; adjusted OR, 3.67; 95% CI, 1.53-8.84), use of noncontraceptive hormonal preparations (57.1% vs 26.0%; adjusted OR, 2.95; 95% CI, 1.36-6.38), nonmenstrual pelvic pain (26.2% vs 2.7%; adjusted OR, 11.98; 95% CI, 2.57-55.81), and gynecologic surgical operation (65.5% vs 31.5%; adjusted OR, 3.33; 95% CI, 1.66-6.67), especially hysterectomy (54.8% vs 19.2%; adjusted OR, 3.23; 95% CI, 1.46-7.17). Hysterectomy and oophorectomy occurred at a significantly younger mean age in the CFS group than in controls and occurred before CFS onset in 71% of women with records of date of surgical operation and date of CFS onset.

Conclusions Menstrual abnormalities, endometriosis, pelvic pain, hysterectomy, and early/surgical menopause are all associated with CFS. Clinicians should be aware of the association between common gynecologic problems and CFS in women. Further work is warranted to determine whether these conditions contribute to the development and/or perpetuation of CFS in some women.

From the Centers for Disease Control and Prevention, Atlanta, GA.

Received August 21, 2014; revised and accepted November 5, 2014.

The findings and conclusions expressed in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

This work was presented, in part, as a poster at the International Association for Chronic Fatigue Syndrome/Myalgic Encephalomyelitis Conference, Ottawa, Canada, September 2011, and at the Women’s Health Conference, Washington, DC, March 21 to 24, 2013.

Funding/support: This study was supported by the US Government.

Financial disclosure/conflicts of interest: None reported.

Address correspondence to: Roumiana S. Boneva, MD, PhD, Centers for Disease Control and Prevention, Mailstop A-30, 1600 Clifton Rd, Atlanta, GA 30333. E-mail:

© 2015 by The North American Menopause Society.