Abstract
A case-control study was conducted to determine whether menstrual and gynecologic
abnormalities precede the onset of chronic fatigue syndrome (CFS) in women with this
disorder to a greater extent than that observed among healthy controls. We identified
150 women who met the 1988 Centers for Disease Control criteria for CFS from the Brigham
and Women’s Hospital Cooperative CFS Research Center. A comparison group of 149 women
being seen for nongynecologic conditions were selected from the waiting area of the
Brigham and Women’s Hospital Internal Medicine outpatient department. Women with and
without CFS completed self-administered questionnaires on menstrual, reproductive,
and medical history. Women with CFS reported increased gynecologic complications and
a lower incidence of premenstrual symptomatology. After adjustment for age, a somewhat
greater number of cases compared with controls self-reported irregular cycles, periods
of amenorrhea, and sporadic bleeding between menstrual periods. Factors suggestive
of abnormal ovarian function—such as a history of polycystic ovarian syndrome, hirsutism,
and ovarian cysts—were reported more often in CFS cases compared with controls. Frequent
anovulatory cycles due to ovarian hyperandrogenism (PCOS) or hyperprolactinemia may
increase risk for CFS through loss of the potential immunomodulatory effects of progesterone
in the presence of continued estrogen production. We hypothesize that frequent anovulatory
cycles due to PCOS and/or hyperprolactinemia may explain the increased reporting of
gynecologic complications and the lower reported premenstrual symptomatology observed
in women with CFS.
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References
- The chronic fatigue syndrome.Ann Intern Med. 1994; 121: 953-959
- The chronic fatigue syndrome.Am J Med. 1991; 90: 730-739
- Chronic fatigue syndrome.Clin Infect Dis. 1992; 15: 812-823
- Chronic fatigue and the chronic fatigue syndrome.Ann Intern Med. 1995; 123: 81-88
- Prevalence of fatigue and chronic fatigue syndrome in a primary care practice.Arch Intern Med. 1993; 153: 2759-2765
- Chronic fatigue syndrome.Ann Intern Med. 1988; 108: 387-389
- Somatization disorder in patients with chronic fatigue.Psychosomatics. 1989; 30: 388-395
- Clinical Gynecologic Endocrinology and Infertility.Williams and Wilkins. 1989; : 213-231
- The “chronic active Epstein-Barr virus infection” syndrome and primary fibromyalgia.Arthritis Rheum. 1987; 30: 1132-1136
- High frequency of fibromyalgia in patients with chronic fatigue seen in a primary care practice.Arthritis Rheum. 1990; 33: 381-387
- Fibromyalgia and sex hormones.J Rheumatol. 1992; 19 (Letter): 831
- High androgen levels in chronic fatigue patients.J Clin Endocrinol Metab. 1995; 80: 3390-3391
- Possible upregulation of hypothalamic 5-hydroxytryptamine receptors in patients with postviral fatigue syndrome.BMJ. 1992; 304: 1010-1012
- Neuroendocrine responses to d-fenfluramine and insulin-induced hypglycemia in chronic fatigue syndrome.Biol Psychiatry. 1995; 37: 245-252
- Chronic fatigue syndrome.Lancet. 1991; 338: 707-712
- Immunologic abnormalities associated with chronic fatigue syndrome.Clin Infect Dis. 1994; 18: S136-S141
- Immunologic abnormalities in chronic fatigue syndrome.J Clin Microbiol. 1990; 28: 1403-1410
- Immunological abnormalities in the chronic fatigue syndrome.Med J Aust. 1989; 151: 122-124
- Prolactin receptor on human lymphocytes and their modulation by cyclosporin.Biochem Biophys Res Commun. 1984; 121: 899-906
- Changes in thymic estrogen receptor expression following orchidectomy.Cell Immunol. 1979; 42: 194-196
- Corticotropin-releasing factor (CRF) and interleukin-1 (IL-1) receptors in the brain-pituitary-immune axis.Psychopharmacol Bull. 1989; 25: 299-305
- Type 1 interleukin-1 receptors in the mouse brain-endocrine-immune axis labelled with [125I] recombinant human interleukin-1 receptor antagonist.J Neuroimmunol. 1992; 41: 51-60
- Estradiol-induced alteration of the immune system.Immunopharmacology. 1986; 11: 47-55
- Immune-neuro-endocrine interactions.Endocr Rev. 1996; 17: 65-102
- Oral dehydroepiandrosterone in physiologic doses modulates immune function in postmenapausal women.Am J Obstet Gynecol. 1993; 169: 1536-1539
- Effectiveness of dehydroepiandrosterone in reduction of cryptosporidal activity in immunosuppressed rats.Antimicrob Agents Chemother. 1992; 36: 220-222
- Immune-neuro-endocrine interactions.Endocr Rev. 1996; 17: 65-102
- Persisting illness and fatigue in adults with evidence of Epstein-Barr virus infection.Ann Intern Med. 1985; 102: 7-16
- Endometriosis and mullerian anomalies.Obstet Gynecol. 1987; 69: 412-415
- The relation of endometriosis to menstrual characteristics, smoking, and exercise.JAMA. 1986; 255: 1904-1908
Article Info
Publication History
Published online: August 16, 2004
Footnotes
☆This research was supported by grant No. U01-AI-32246 from the National Institute of Allergy and Infectious Diseases, NIH, and by a gift from the SS DeYoung Foundation
Identification
Copyright
© 1998 Excerpta Medica Inc. Published by Elsevier Inc. All rights reserved.

