Hi, my name is Alyssa and I’m currently a junior nursing student at 
the University of North Dakota.  While browsing through the archives on the 
Listserv, I became interested in the topic of the effect of hormonal alterations 
on fibromyalgia during and following pregnancy.  It seems to me that this topic 
is in need of much more research because most of what I have found is not 
very current.  After reviewing some literature I found the following 
information: 
	In fibromyalgia, there appears to be dysfunction with several 
hormonal systems in the body.  Changes in specific neurotransmitters that 
control the production of hormones may affect their expression.  This then 
affects the functioning of the autonomic nervous system and production of 
hormones.  In four different studies performed by Adler (1999), mean prolactin 
levels of the fibromyalgia subjects increased and were all within the normal 
range.  However, serotonin levels and its metabolism appear to be low.  It is 
still not known as to whether having fibromyalgia causes the variations in 
hormone levels and autonomic nervous system tasks or if the improper 
performance of these systems is a lead-in to fibromyalgia.  Also, in a study 
done by Ostensen, Rugelsjoen, and Wigers (1997), all but one patient in 40 
pregnancies said that the last trimester was the worst as far as fibromyalgia 
symptoms and there was a significant increase in the reports of postpartum 
depression and anxiety.  However, the study showed no hormonal differences 
due to abortion, contraceptives and breastfeeding.  A third article by Schaefer 
(2004) specifically reviewed the topic of fibromyalgia and its effects on 
breastfeeding.  Not much at all is known about the relationship between these 
two phenomena.  The main theme that came from this study was that for 
women with the condition, breastfeeding is often a trying experience.  The 
reasons and implications expressed that led to this conclusion were reports of 
fatigue, muscle and nipple soreness, forced weaning due to a perceived lack 
of milk or discomfort, thoughts of sadness and depression, lack of 
encouragement from family and healthcare providers, and pain requiring 
medications.  For an example, the article discussed an instance where one 
woman perceived she had an insufficient milk supply and even after being 
given oxytocin or trying for long periods to breastfeed, she became frustrated 
and depressed so she stopped.  I don’t feel that the literature reviewed brings 
conclusive answers as far as the effect of different hormones and the effect 
each has on the breastfeeding process.  If anyone has any recent information, 
knowledge or thoughts, it would be much appreciated.

References
Adler, G.  (1999).  Hormonal changes and fibromyalgia.  Current Opinion in 
	Endocrinology & Diabetes, 6(1), 55-66.
Ostensen, M., Rugelsjoen, A., Wigers, SH.  (1997).  The effect of reproductive 
events 
	and alterations of sex hormone levels on the symptoms of 
fibromyalgia.  Scand 
	J Rheumatol, 26(5), 355-60.
Schaefer, K.  (2004).  Breastfeeding in chronic illness: the voices of women 
with 
	fibromyalgia.  MCN, American Journal of Maternal Child Nursing, 29
(4), 
	248-253.

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