Thomas, Natalie, Gurvich, Caroline, Huang, Katherine et al. · Frontiers in neuroendocrinology · 2022 · DOI
This review examines why ME/CFS affects women much more often than men and how sex hormones may play a role. The authors found that female hormonal changes—such as those during menstrual cycles, pregnancy, and menopause—are linked to ME/CFS onset and symptoms. They suggest that differences in how men's and women's bodies handle stress hormones like cortisol and estrogen may help explain why women develop ME/CFS more frequently and sometimes experience different symptoms.
Understanding sex differences in ME/CFS is crucial because women represent approximately 75% of diagnosed patients, yet sex and hormonal biology remain understudied in ME/CFS research. This review provides a framework for recognizing how hormonal transitions may trigger or worsen ME/CFS, potentially leading to better diagnostic criteria, sex-specific treatment strategies, and improved clinical outcomes for the majority of ME/CFS patients.
This narrative review does not prove causation between hormonal changes and ME/CFS—it identifies associations and suggests biological mechanisms that require experimental validation. The review does not establish which hormonal factors are primary drivers of disease versus secondary consequences of illness, nor does it demonstrate that hormone-targeted treatments will be effective. Individual patient experiences may vary considerably from population-level patterns described.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
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Primary citation
Thomas, Natalie, Gurvich, Caroline, Huang, Katherine, Gooley, Paul R, & Armstrong, Christopher W (2022). The underlying sex differences in neuroendocrine adaptations relevant to Myalgic Encephalomyelitis Chronic Fatigue Syndrome.. Frontiers in neuroendocrinology. https://doi.org/10.1016/j.yfrne.2022.100995
BibTeX
@article{mecfsatlas-thomas-2022-underlying-sex,
author = {Thomas, Natalie and Gurvich, Caroline and Huang, Katherine and Gooley, Paul R and Armstrong, Christopher W},
title = {The underlying sex differences in neuroendocrine adaptations relevant to Myalgic Encephalomyelitis Chronic Fatigue Syndrome.},
journal = {Frontiers in neuroendocrinology},
year = {2022},
doi = {10.1016/j.yfrne.2022.100995},
note = {PubMed: 35421511},
url = {https://www.mecfsatlas.com/evidence/thomas-2022-underlying-sex},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/thomas-2022-underlying-sex
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