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A Multimodal Approach to Symptomatic Endometriosis: A Proposed Algorithm for Clinical Management.
Reprod Sci
January 2025
Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Recent research has proven that peripheral (PS) and central sensitization (CS), mental health, and myofascial dysfunction all play a role, alongside nociception, in the genesis and in the perpetuation of endometriosis' symptoms. However, such components of pain are still largely ignored in clinical practice, although not considering such contributors may entail serious consequences on women's health, including the choice of unnecessary surgery and leaving the real causes of pain untreated. At the present time, we are facing a paradox by which 25-40% of women who undergo laparoscopic surgery for pelvic pain do not have an obvious diagnosis, while the percentage of women with endometriosis who have signs of CS, of depressive or anxiety disorders, or who have an increased pelvic muscle tone ammounts to 41-55%, 15-88% and 28-73%, respectively.
View Article and Find Full Text PDFNociplastic Pain in Endometriosis: A Scoping Review.
J Clin Med
December 2024
Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC V6H 3N1, Canada.
Endometriosis is an inflammatory chronic condition associated with nociceptive, neuropathic, and nociplastic pain. Central sensitization (CS) is the primary nociplastic pain mechanism. However, there are currently no standardized methods for detecting CS or nociplastic pain.
View Article and Find Full Text PDFStudy Question: Do recent changes in European Society of Human Reproduction and Embryology (ESHRE) clinical guidelines result in more comprehensive diagnosis of women with endometriosis?
Summary Answer: The latest shift in clinical guidelines results in diagnosis of more women with endometriosis but current ESHRE diagnostic criteria do not capture a sizable percentage of women with the disease.
What Is Known Already: Historically, laparoscopy was the gold standard for diagnosing endometriosis, a complex gynecological condition marked by a heterogeneous set of symptoms that vary widely among women. More recently, changes in clinical guidelines have shifted to incorporate imaging-based approaches such as transvaginal sonography and magnetic resonance imaging.
Recent Trends in Medical Management of Endometriosis.
J Obstet Gynaecol India
December 2024
Nowrosjee Wadia Maternity Hospital, Mumbai, India.
Endometriosis affects about 10 percent women in the reproductive age group globally and approximately 42 million in India. Managing the patient's pain symptoms associated with endometriosis appears to be the cornerstone in endometriosis disease management. The ideal medical treatment in endometriosis would be suppressing estradiol enough to alleviate symptoms of endometriosis but maintain sufficient levels to mitigate hypoestrogenic side effects.
View Article and Find Full Text PDFExploring the Interplay Between Catastrophizing and Endometriosis Pain Through Two-Wave and Intensive Longitudinal Data.
Pain Med
December 2024
Department of Gynecology, State University of Rio de Janeiro, Avenida Boulevard 28 de Setembro, 77, Vila Isabel, Rio de Janeiro, RJ, 20551-030, Brazil.
Background: Endometriosis, characterized by the presence of endometrial-like tissue outside the uterus, results in chronic pelvic pain. However, lesion characteristics alone cannot fully explain the complexity of endometriosis-related pain. Pain catastrophizing, a cognitive process that influences pain perception, has traditionally been studied through cross-sectional or two-wave designs, which struggle to capture its dynamic interplay with endometriosis pain.
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