It’s a fact. Fibromyalgia and chronic fatigue syndrome, as well as many autoimmune conditions such as arthritis, lupus, and multiple sclerosis, affect millions of women. In a disproportionate ratio, they affect women more than men.
“Of the estimated 50 million Americans living and coping with autoimmune disease, more than 75% of them are women.” (1)
Does this make you say, “Tell me something I didn’t already know?”
Over the years, I’ve read lots of articles on the subject and the most common answer as to why this is true is that it’s related to hormones. So let’s dig in a bit and see if we can shed more light on the matter.
Is fibromyalgia an autoimmune disease?
To be honest, I’m so tired of this question I’d rather skip it. But, I know there’s always someone who’s unaware of the debate and it’s helpful to provide clarification. No, fibromyalgia isn’t – at this time – considered an autoimmune disease. It’s designated as a syndrome rather than a disease because it lacks a specific, definable etiology, meaning its origin can’t be pinpointed at this time.
The causes of syndromes are unknown. You may be interested to know that along with fibromyalgia, restless leg, myofascial pain, irritable bowel, and some migraine conditions are considered syndromes as well.
Some conditions shift from one category to the other as research continues and more is learned about their causes.
Because fibromyalgia is known to frequently co-exist with various autoimmune conditions, it’s observed to behave like autoimmune conditions. It has flares and is reactive to the same factors that affect autoimmune conditions including gut health, insulin levels, stress, and more.
There’s a large contingent of experts who believe that it’s a matter of time before fibromyalgia will be reclassified as an autoimmune condition. One Pubmed abstract refers to the classification this way, “FM is postulated to be an autoimmune disorder.” (2)
In the past 15 years, I’ve seen it classified as a rheumatological condition and then re-classified as a neurological or central-nervous system disorder. My take on the topic is probably not popular, but it’s mine, nonetheless.
I don’t really care.
At least, I don’t care as it relates to my specific work with individual clients. I understand that classification matters for further study, etc., but as far as my day-in day-out work with people, the classification is irrelevant.
What I care about most is what causes fibromyalgia and what makes it better or worse. Here’s how I share my view on classification. We often hear the old phrase, “If it walks like a duck and quacks like a duck, then it’s likely a duck.” To me, when it comes to fibromyalgia, I don’t focus on whether or not it’s a duck. I focus on how it walks and how it quacks!
Fibromyalgia walks and quacks like autoimmune conditions. For that reason, I study them both, find treatments and protocols that work for both, and will continue to look for solutions that positively impact both challenges.
The vital difference between genetics and gene expression
Have you been told that your health challenges are all in your genes? Have any of your family members been diagnosed with fibromyalgia and/or other co-existing autoimmune conditions?
The study of genes – and more importantly, gene expression – is a vital component in the gender question regarding fibromyalgia.
We are more than just our genes.
Our body’s signals (hormones) have the ability to literally tell our genes when and how to act. Some genes are static while others turn on and off like switches. (3) It’s this switching process (gene expression) which provides the most hope for a healthy future.
The study of epigenetics floods a beacon of hope on an otherwise misleading portrait of a bleak future. Epigenetics studies the outside factors that affect gene expression. Factors such as nutrition, relationships, and beliefs have a profound and lasting impact on our risks of developing disease and our ability to heal from chronic health challenges. Be sure to check out the resources at the end of this article for more details on this topic.
For now, here are three main factors to review that reflect reasons why females are more likely to suffer from fibromyalgia and autoimmune challenges than males.
1) Reactions to stress
Identifying the differences in how men react to stress as opposed to women is both simple and complicated. It’s simple to observe how men – in general – seem to disengage from others when under stress, while women are more likely to engage and actually seek out social connections.
New studies take a pointed look at the differences in body function relating to this tendency. These studies mainly focus on the brain.
One study in particular, demonstrated the brain function focusing on the amygdala (4) (the part of the brain responsible for the fight, flight, or freeze response). As expected, the engagement and disengagement to stress were measured and documented. However, the results of the stress response were surprising.
The study subjects were monitored while under intentional stress and their hormone level responses were measured. They were then given a cognitive test regarding facial recognition. The men’s ability to recognize faces (and discern whether they were friendly or threatening) diminished while women’s ability to discern faces was heightened.
While the study didn’t go into details about how long these stress hormones continued to affect the genders differently, I’d surmise that the stress response in women continued longer than for men.
This hypothesis seems to be true considering that women suffer from chronic stress more often than men. In fact, the rates of women experiencing long term stress disorders such as generalized anxiety, PTSD, depression, and irritable bowel syndrome are all nearly double that of men. Furthermore, Debra Bangasser from Temple University states, ”Some differences may contribute to disease and some may not. Problems occur when the system is responding when it shouldn’t be or when it’s responding for a really long time in a way that becomes disruptive.” (5)
2) Hormone levels
Studies already demonstrate that women have increased hormonal activity under stress in contrast to men. It’s often postulated that fibromyalgia occurs more often in women than men because of “hormones.” But what does that really mean?
Hormones have a direct effect on gene expression; therefore, the types of hormones and the duration of exposure to these hormones can turn on or off various genes related to disease and systemic function. The gene expression difference in men and women may cause women to react to stress differently.
In studies using rats, the tendency to groom frequently is an indicator of high stress. When stress factors are introduced to both male and female study subjects, the behaviors that demonstrate stress increase. The significant difference, however, is that for female subjects, the grooming behavior becomes compulsive and obsessive in direct proportion to the levels of estrogen in the body. The more estrogen, the more frenetic the subject becomes. (6)
Estrogen dominance has long been discussed in relationship to chronic illness and autoimmune conditions. Do you experience any of these symptoms of estrogen dominance?
- Weight gain
- Hair loss
- Cold hands/feet
- Thyroid dysfunction
- Fibrocystic and/or tender breasts
- Impaired metabolism
- Cognitive impairment
Considering these familiar symptoms, it’s no wonder that estrogen dominance is linked to systemic dysfunction including autoimmune conditions, heightened allergic responses, and rapid aging. (7)
There are other hormonal factors to consider regarding the “over reactive” stress response in women. This stress response triggers the gene expression responsible for disrupting the endocrine system. That’s where significant problems begin.
The heightened stress response in women is generally considered to be a survival instinct. Women – as the reproductive gender – may need a higher rate of stress hormones to assure procreation.
However, that heightened ability (at chronic levels) tips the scales into disruption, dysfunction, and the tendency toward disease. The resulting endocrine disruption increases the risk factors for thyroid dysfunction, glycemic dysregulation, diabetes, and more. (8)
3) Immunity factors
Now we get to the topic of the immune system and autoimmunity. Stress hormones affect the immune system by depressing or delaying response. Many people who deal with chronic health challenges report an impaired immune system and increased frequency of colds, flu, etc.
This is different from the over active immune response that leads to autoimmunity. Yet, they’re both part of the same equation. The immune system – and the risk for autoimmune predisposition – are definitely impacted by gender-related hormones.
According to this National Institute of Health report, “It is well established that gender plays a profound role in the incidence of autoimmunity with diseases such as lupus occurring much more frequently in females than in males. This is related to higher numbers of circulating antibodies as well as other factors.” (9)