clinical observations suggest that women with fibromyalgia and a previous hysterectomy with or without an oophorectomy suffer from more pain and other disease - related symptomatology . 1 to date , however , this association has not been thoroughly explored . this study further examined this association in a large group of women , some of whom had undergone hysterectomy with or without an oophorectomy and some of whom had not . hysterectomy was chosen because it is one of the most common surgeries in women in the united states,2 second only to cesarean section . moreover , previous studies suggest interactions between the hormonal milieu and pain,36 observations that further suggest a role for exploring the effects of hysterectomy on pain and other fibromyalgia - related symptomatology . thus , the current study examined a large group of women with fibromyalgia with the goal of exploring whether such symptomatology is worse among those who had undergone a hysterectomy with or without an oophorectomy at some point in the past . this study was approved by the mayo clinic institutional review board in rochester , mn . thereafter , we assessed consecutive women who were seen at the fibromyalgia treatment program at the mayo clinic between 2001 and 2004 . all these women had consented to be part of a larger study , as previously described.79 all had had the diagnosis of fibromyalgia confirmed using the american college of rheumatology 1990 criteria.10 at the time of their clinic visit , all patients completed two previously validated questionnaires , the fibromyalgia impact questionnaire ( fiq)11 and the short form-36 health survey ( sf-36).12 information on age , race , duration of fibromyalgia symptoms , and hysterectomy and oophorectomy status at the time of completion of the self - report questionnaires was subsequently abstracted from the medical record . descriptive statistics were used to characterize the sample based on age , race , duration of fibromyalgia symptoms , and hysterectomy and/or oophorectomy status . univariate comparisons between groups were performed using one - way analysis of variance or  tests , where appropriate . multiple regression models were used to analyze the relationship between hysterectomy / oophorectomy status and fibromyalgia symptoms ( fiq and sf-36 ) while adjusting for potential confounding variables or statistically significant baseline differences between groups ( eg , age ) . analyses were performed using jmp software ( version 8 , sas institute inc , cary , nc ) . this study was approved by the mayo clinic institutional review board in rochester , mn . thereafter , we assessed consecutive women who were seen at the fibromyalgia treatment program at the mayo clinic between 2001 and 2004 . all these women had consented to be part of a larger study , as previously described.79 all had had the diagnosis of fibromyalgia confirmed using the american college of rheumatology 1990 criteria.10 at the time of their clinic visit , all patients completed two previously validated questionnaires , the fibromyalgia impact questionnaire ( fiq)11 and the short form-36 health survey ( sf-36).12 information on age , race , duration of fibromyalgia symptoms , and hysterectomy and oophorectomy status at the time of completion of the self - report questionnaires was subsequently abstracted from the medical record . descriptive statistics were used to characterize the sample based on age , race , duration of fibromyalgia symptoms , and hysterectomy and/or oophorectomy status . univariate comparisons between groups were performed using one - way analysis of variance or  tests , where appropriate . multiple regression models were used to analyze the relationship between hysterectomy / oophorectomy status and fibromyalgia symptoms ( fiq and sf-36 ) while adjusting for potential confounding variables or statistically significant baseline differences between groups ( eg , age ) . analyses were performed using jmp software ( version 8 , sas institute inc , cary , nc ) . 328 had had a hysterectomy ( hysterectomy alone : 60 , hysterectomy plus unilateral oophorectomy : 24 , hysterectomy with bilateral oophorectomy : 244 ) . the median interval from hysterectomy to completion of the questionnaires was 12 years ( range < 142 years ) . of the 214 women who reported experiencing symptoms only after surgery , the median reported that duration of ongoing symptoms at the time of questionnaire completion was 5 years ( range < 147 years ) . of incidental note , comparisons of fiq and sf-36 summed total scores or subscale scores between the three hysterectomy groups described previously did not reveal any statistically significant differences ( table 1 ) . however , as measured by the fiq , pain ( p = 0.024 ) was worse among patients who had undergone surgery in univariate analyses . similarly , as measured by the sf-36 , physical function ( p = 0.008 ) and pain ( p = 0.045 ) were also worse among women who had undergone surgery ( table 2 ) . in multiple linear regression analyses , total fiq scores from women who had undergone surgery were significantly higher ( more severe symptoms ) than from women who had not ( p = 0.002 ) ( table 3 ) . similarly , fiq subscale scores of ability to do work ( p = 0.027 ) , pain ( p = 0.003 ) , fatigue ( p = 0.030 ) , stiffness ( p = 0.035 ) , and depression ( p = 0.008 ) were also higher among women who had had surgery . higher scores for physical impairment ( p = 0.095 ) , and anxiety ( p = 0.072 ) were also observed in this group , although these differences in scores did not reach statistical significance ( table 3 ) . the sf-36 physical component score ( p = 0.045 ) and pain subscale ( p = 0.013 ) were also worse for women who had had surgery compared with women who had not . trends toward poorer scores among women who had undergone surgery were also observed in the physical functioning ( p = 0.069 ) and general health ( p = 0.097 ) subscales . 328 had had a hysterectomy ( hysterectomy alone : 60 , hysterectomy plus unilateral oophorectomy : 24 , hysterectomy with bilateral oophorectomy : 244 ) . the median interval from hysterectomy to completion of the questionnaires was 12 years ( range < 142 years ) . of the 214 women who reported experiencing symptoms only after surgery , the median reported that duration of ongoing symptoms at the time of questionnaire completion was 5 years ( range < 147 years ) . of incidental note , comparisons of fiq and sf-36 summed total scores or subscale scores between the three hysterectomy groups described previously did not reveal any statistically significant differences ( table 1 ) . however , as measured by the fiq , pain ( p = 0.024 ) was worse among patients who had undergone surgery in univariate analyses . similarly , as measured by the sf-36 , physical function ( p = 0.008 ) and pain ( p = 0.045 ) were also worse among women who had undergone surgery ( table 2 ) . in multiple linear regression analyses , total fiq scores from women who had undergone surgery were significantly higher ( more severe symptoms ) than from women who had not ( p = 0.002 ) ( table 3 ) . similarly , fiq subscale scores of ability to do work ( p = 0.027 ) , pain ( p = 0.003 ) , fatigue ( p = 0.030 ) , stiffness ( p = 0.035 ) , and depression ( p = 0.008 ) were also higher among women who had had surgery . higher scores for physical impairment ( p = 0.095 ) , and anxiety ( p = 0.072 ) were also observed in this group , although these differences in scores did not reach statistical significance ( table 3 ) . the sf-36 physical component score ( p = 0.045 ) and pain subscale ( p = 0.013 ) were also worse for women who had had surgery compared with women who had not . trends toward poorer scores among women who had undergone surgery were also observed in the physical functioning ( p = 0.069 ) and general health ( p = 0.097 ) subscales . our results indicate that a history of having had this procedure is associated with worse symptomatology . to our knowledge , the current study is the largest us study to describe such findings and underscores the importance of probing further into how this association might be explained . our study raises a major concern that patients with chronic pain ( such as those with fibromyalgia ) may be undergoing surgery , such as a hysterectomy , in the hope of mitigating pain when , in fact , the cause of some of this discomfort may be an underlying chronic pain disorder , such as fibromyalgia . indeed , wolfe et al10 reported that women with fibromyalgia are likely to have more lifetime surgical procedures compared with women with other rheumatologic disorders . similarly , langenberg et al13 reported that prior chronic pelvic pain is an independent risk factor for pelvic surgeries in patients with interstitial cystitis and painful bladder syndrome . the studies from wolfe et al and langenberg et al , coupled with the findings reported here , suggest that hysterectomy should be preceded by a thoughtful assessment of pain and some consideration of the possibility that the fibromyalgia itself might at times be the cause of chronic pelvic pain . certainly , many patients with fibromyalgia need to undergo hysterectomies , but the fact that some of these patients continue to manifest troubling symptoms even after such a procedure underscores the point that a thoughtful preoperative evaluation is indicated . thus , surgeons should consider an underlying diagnosis of fibromyalgia prior to undertaking a hysterectomy in patients with chronic pain . it also remains possible , however , that this type of surgery may alter pain sensitivity . pain modulation related to estrogen has also been partially demonstrated in other disorders such as migraines and temporomandibular disorder.4,14 more germane to our findings , previous reports suggest that various other surgical procedures and/or trauma might predispose to the development of fibromyalgia.1,15,16 our study has both limitations and strengths . for example , the medical indications for hysterectomy and oophorectomy were unavailable , as were details on the exact surgical procedure undertaken and use and duration of hormone therapy . despite such limitations , our large sample size , high questionnaire completion rate , and consecutive recruitment approach allow us to report on findings that are truly provocative . in conclusion , this study represents a systematic assessment and comparison of symptoms on the basis of prior hysterectomy with or without a unilateral / bilateral oophorectomy in a large group of women with fibromyalgia . these results suggest a need for further investigation of the underlying mechanisms in women with fibromyalgia , particularly in respect of hysterectomy .
objectivefibromyalgia is a troubling disease characterized by chronic pain . 
 this study explored whether pain and other fibromyalgia symptoms are worse among women who had undergone a hysterectomy with or without an oophorectomy versus those who had not.methodsconsecutive women who were seen at the fibromyalgia treatment program at a tertiary medical center between 2001 and 2004 and who completed the fibromyalgia impact questionnaire ( fiq ) and short form-36 health survey ( sf-36 ) at initial evaluation were included in this study.resultsa total of 813 women were included ; 328 had had a hysterectomy . 
 total fiq scores from women who had had a hysterectomy were higher ( worse symptoms ) than those who had not ( 58.1 vs 56.4 , p = 0.002 ) . 
 fiq subscale scores of pain ( p = 0.003 ) , fatigue ( p = 0.030 ) , stiffness ( p = 0.035 ) , and depression ( p = 0.008 ) were also worse in women who had had a hysterectomy . 
 similar to the fiq , sf-36 physical component scores were worse in women who had had a hysterectomy ( p = 0.045).conclusionpain and other fibromyalgia symptom severity was worse in women who had had a hysterectomy with or without an oophorectomy .