Fibromyalgia Screening in Patients With Unexplained Chronic Fatigue

Christopher A. Aakre, MD, MSc


Menopause. 2021;28(1):93-95. 

In This Article

Abstract and Introduction


Women often complain of symptoms of fatigue and generalized aches and pains around menopause. Even though fibromyalgia is more prevalent in midlife women, not all women presenting with aches and pain and disrupted sleep meet diagnostic criteria for fibromyalgia. This Practice Pearl addresses the distinction between chronic fatigue syndrome and fibromyalgia and the management of fibromyalgia in perimenopausal and postmenopausal women.


Fatigue is a symptom frequently reported by menopausal women. Chronic fatigue is diagnosed after the fatigue has been present for at least 6 months, and it has a very wide differential diagnosis. A focused history and physical examination are an important part of the evaluation of chronic fatigue. Initial laboratory work-up typically includes a complete blood count, electrolytes, creatinine, transaminases, HIV testing, and thyroid-stimulating hormone level. Select patients may need focused additional testing as dictated by their histories and examinations. Unfortunately, comprehensive testing may identify the cause of the fatigue only in about 1 in 20 cases.[1] The presence of chronic undifferentiated fatigue is not synonymous with chronic fatigue syndrome, which is a distinct clinical diagnosis.