Fibromyalgia

The American College of Rheumatology, the US body for arthritis and rheumatology specialists, describes fibromyalgia, also called fibromyalgia syndrome (FMS), as a long-term condition that causes widespread pain. It says it affects 2 to 4% of people, usually women. It is not an inflammatory or autoimmune disease.

NICE's chronic pain guideline, NG193, counts it as chronic primary pain: pain lasting or coming back for more than three months that no other condition explains.

The American College of Rheumatology says the most common symptom is widespread pain in various joints. Severe tiredness and poor sleep are common too, and you may wake unrefreshed after a full night. Then the rest:

• Trouble with memory or clear thinking, known as fibro fog.
• Depression or anxiety.
• Migraines or tension headaches.
• Digestive trouble, such as irritable bowel syndrome or heartburn.
• Bladder trouble from an irritable or overactive bladder, and pelvic pain.

Now read the NHS list of menopause symptoms: hot flushes that make you feel very hot or cold, sleep problems, brain fog, low mood, headaches, muscle aches and joint pains. Many of the same words. No wonder one gets put down to the other.

On menopause, a 2024 review in Climacteric found that fibromyalgia symptoms tend to be worse after menopause, and can get worse after a hysterectomy, with or without the ovaries removed. It says some research suggests a link with the ending of the sex hormones. Suggests, not proves.

A 2026 study in Maturitas, of 169 women in Greece, widens the picture: fibromyalgia came before menopause in 51% of them, alongside it in about 22% and after it in 27%. So fibromyalgia can begin before, around or after menopause.

• The American College of Rheumatology's 2016 criteria, which doctors use to diagnose it, ask for pain in at least four of five regions of the body, generally present for at least three months, alongside a score of other symptoms. The diagnosis stands whatever other diagnoses you have, and it does not rule other illnesses out. So perimenopause and fibromyalgia can both be true at once.
• The American College of Rheumatology says fibromyalgia does not show up on X-rays or blood tests, but those tests can help check for other causes, such as thyroid problems or inflammatory diseases.
• The Pakistan Menopause Society asks doctors at a menopause visit to ask about joint and muscle pains, fatigue and reduced activity (Table 2).

NICE NG193 recommends a supervised group exercise programme, and asks doctors to consider acceptance and commitment therapy (ACT) or CBT. For adults it asks them to consider one of six antidepressants (amitriptyline, citalopram, duloxetine, fluoxetine, paroxetine or sertraline) after a full talk about benefits and harms, explaining that these may help with pain, sleep, distress and quality of life even without depression.

The same guideline lists medicines it says not to start for this kind of pain, citing a lack of evidence, among them gabapentinoids such as pregabalin and gabapentin, opioids, anti-inflammatory painkillers and paracetamol. If you already take one, NICE asks doctors to review it with you and agree a plan together. That is a conversation with your doctor, not something to change alone.

Pain that has gone on for three months or more deserves a proper look, not a shrug. If your mood has been low too, say so.

One British study found that women with long-term pain at 44 had nearly three times the odds of a heavy load of menopause symptoms at 50. Its authors warn that in such women, menopause symptoms may sometimes be treated as pain.

Arrive with notes: where it hurts, how you sleep, how your periods have changed. Symptom tracking shows one way to keep them.

Pain nobody can see is easy for others to doubt. At home it gets called nakhre, or laziness, or just age. Naming it helps everyone take it seriously, you included.

Women with long-term pain ask how to manage salah when getting up and down hurts, and what fasting means with daily medicine. Prayer and fasting questions are for a qualified scholar. When to take a medicine in Ramadan is for whoever prescribed it.