Women Gulf War Veterans with chronic conditions Affected Differently than Men

Fibromyalgia Gets Worse During Menstruation; Study Shows Symptoms of Irritable Bowel Syndrome and Interstitial Cystitis Also Worsen

Editor’s note:  Seven percent of veterans of the 1991 Gulf War are women.  This article notes how they are affected differently than their male counterparts, and is an important step in learning more about the chronic multisymptom illness (CMI) that affects – according to the Institute of Medicine of the National Academy of Science -- 250,000 veterans of the 1991 Gulf War. 

Of note, IBS and Fibromyalgia are presumptive conditions for Gulf War veterans, male and female, seeking VA service-connection.

By Charlene Laino, WebMD Health News; Reviewed by Laura J. Martin, MD

(Toronto – WebMD Article) - 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, researchers report.

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 period.

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 period.

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 first period.

Also unknown is why symptoms fluctuate with hormone levels in some women and not others.

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 says.

"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 says.