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Menstrual problems in ME/CFS
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==Symptom recognition== The [[International Consensus Criteria]] (ICC) for [[myalgic encephalomyelitis]] includes '''Genitourinary dusturbances''' as an optional diagnostic criteria, but does not give examples of these. The ICC primer for clinicians states that females have a higher incidence of peri-menstrual symptoms (symptoms before and during the [[menstrual cycle]]) and these can last two weeks, and ME can involve having more severe peri-menopausal and post-menopausal symptoms.<ref name="ICC2011primer" />{{Rp|19}} The [[Canadian Consensus Criteria]] for ME/CFS recognizes: * [[dysmenorrhea]] * [[premenstrual syndrome]] (PMS) or [[irregular menstrual cycles]]<ref name="canadianconsensus-CCC">{{Citation | last1 = Carruthers | first1 = Bruce M. | authorlink1 = Bruce Carruthers | last2 = Jain | first2 = Anil Kumar | authorlink2 = Anil Kumar Jain | last3 = De Meirleir | first3 = Kenny L. | authorlink3 = Kenny De Meirleir | last4 = Peterson | first4 = Daniel L. | authorlink4 = Daniel Peterson | last5 = Klimas | first5 = Nancy G. | authorlink5 = Nancy Klimas | last6 = Lerner | first6 = A. Martin | authorlink6 = Martin Lerner | last7 = Bested | first7 = Alison C. | authorlink7 = Alison Bested | last8 = Flor-Henry | first8 = Pierre | authorlink8 = Pierre Flor-Henry | last9 = Joshi | first9 = Pradip | authorlink9 = Pradip Joshi | last10 = Powles | first10 = AC Peter | authorlink10 = A C Peter Powles | last11 = Sherkey | first11 = Jeffrey A. | authorlink11 = Jeffrey Sherkey | last12 = van de Sande | first12 = Marjorie I. | authorlink12 = Marjorie van de Sande | title = Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical Working Case Definition, Diagnostic and Treatment Protocols | journal = Journal of Chronic Fatigue Syndrome | volume = 11 | issue = 2 | pages = 7-115 | date = 2003 | pmid = | doi = 10.1300/J092v11n01_02| url = http://www.investinme.org/Documents/PDFdocuments/CanadianDefinitionME-CFS.pdf}}</ref> These are not considered part of the diagnostic criteria, but are listed under possible genitourinary symptoms in the Appendix. Boneva et al. (2011) compared women with [[Chronic fatigue syndrome]] with matched controls, and concluded that: {{quote | text=Amenorrhea, pelvic pain unrelated to menstruation, [[endometriosis]], any gynecological surgery, and specifically [[hysterectomy]] and oophorectomy, were all more common in the CFS than in the control group. These differences between CFS and controls were statistically significant for pelvic pain (pβ=β0.004), endometriosis (pβ=β0.046), and any gynecological surgery (pβ=β0.045) (Table 2). In addition, the CFS group had a significantly greater mean number of pregnancies (2.8 in CFS vs. 2.0 in controls, pβ=β0.05) and greater mean number of gynecological surgeries (1.7 in CFS vs. 1.1 in controls, pβ=β0.05). [[Menopause]] occurred on average 4 years earlier in the CFS group (βΌ42 years vs. 46 years in controls), but this difference was not statistically significant (pβ=β0.11) (Table 2). For the subset of women without a history of surgical menopause, however, the mean age at menopause was similar for the CFS and control groups (approximately 50 years) (table 2).| source=Boneva et al. (2011) <ref name="Boneva2011"/>}}
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