Fibromyalgia and pregnancy – management for patients

Information for patients

Fibromyalgia is a common chronic pain condition characterised by widespread pain; as well as other symptoms, such as fatigue, sleep disruption and cognitive disturbance.

Some of the symptoms of fibromyalgia are also common in pregnancy in general – such as back pain, fatigue, changes in mood, and difficulties with memory and concentration. This can make it difficult to differentiate between the symptoms of pregnancy and fibromyalgia pain when it occurs.

Body changes, such as fluctuations in hormone levels and weight gain, may have an impact on your movement, activity levels and sleep. These changes may in turn have an impact on how you cope with your fibromyalgia symptoms.

You will come across many healthcare professionals during your pregnancy, some will know a lot about fibromyalgia, while others may know less. Remember YOU are the expert on your body and how your fibromyalgia affects you.

General management skills

Fibromyalgia is often described, by people living with it, as an ‘invisible disease’. Communication is therefore key. Know your ‘own normal’, so that you can clearly communicate how things are new or different, if you develop any difficulties.

Plan for your appointments - write down any questions you have to discuss with the professional you are seeing. If you struggle with memory and concentration, take someone with you to keep notes and to remind you of any important questions you wanted to ask.

Before pregnancy

• If you are currently taking medication, you will need to review this with your GP.
• Optimise your pain management plan; review pain management strategies such as planning, pacing, relaxation and flare-up management (see resources).
• Optimise your health, weight and physical conditioning to prepare for the physical changes brought on by pregnancy, and the physical demands of looking after your baby. Get some support from a physiotherapist, if you need advice or support with finding the right level of exercise for you.
• Optimise your mental health. If you are struggling with anxiety or low mood, speak to your GP and ask about referral to your local psychological well-being service. Being pregnant can often cause an increase in worries and stress, and having some support and tools to manage your psychological well-being, could help you during your pregnancy (see information on how to self-refer and some self-management videos under the resources below).

During pregnancy

• You may have to evaluate the level of activity you feel comfortable maintaining day-to-day. People report that their fatigue levels worsen and they feel more tired, particularly during the first and third trimester. You may need to plan more time for rest and recovery. A few lucky individuals find that their energy levels actually improve.
• Discuss your birth plan with your midwife/birthing team. Discuss and plan how to manage pain and fatigue, if you are struggling.
• Ask for help you would like during appointments. This can include referral to physiotherapy or mental health services.
• 1 in 5 women experience pelvic girdle pain during pregnancy. Although this is common, this is not a ‘normal part’ of pregnancy and you should seek help. You can self-refer to your local physiotherapy department for support (see the referral information under resources below).

After pregnancy and birth

• Have a plan in place for support with housework and looking after your baby.
• Recovery from pregnancy may take longer compared to those without fibromyalgia – give yourself time, ask for support from loved ones and speak to your healthcare visitor or GP if you have any concerns.
• Following pregnancy, 1 in 9 women will have ongoing pelvic girdle pain symptoms; muscle and joint related pains like wrist pain or new back pain (from lifting your baby or the car seat) is also common due to the demands on your body from lifting and feeding postures. Again, if these problems persist, you can self-refer to your local Physiotherapy Department, or check if your GP surgery has a “First Contact Practitioner”, for some basic advice and exercises.
• Most people living with fibromyalgia find that they return to their pre-pregnancy levels of activity and symptoms, although it may take a long time.

Further support/ information available

• How to refer to the pelvic health physiotherapy team for pelvic girdle pain during pregnancy: https://www.cuh.nhs.uk/clinics/pelvic-health/
• How to refer to musculo-skeletal physiotherapy team for joint or muscle pain following pregnancy: https://www.cuh.nhs.uk/our-services/outpatient-physiotherapy/
• Fibromyalgia UK - www.fmauk.org (opens in a new tab)
• Live Well With Pain - https://livewellwithpain.co.uk/ (opens in a new tab)
• Pain Concern – www.painconcern.org.uk (opens in a new tab)
• Information on self-referral to the Psychological Well-being service, and some self-management videos, can be found here: https://www.cpft.nhs.uk/talkingtherapies/ (opens in a new tab)