Endometriosis is a condition in which tissue resembling that which usually lines the uterus grows elsewhere in the body.
Pain is a primary symptom of endometriosis and some women with the condition experience chronic pelvic pain.
What is chronic pelvic pain?
Pelvic pain is pain that occurs below the belly button and between the hips. Chronic pelvic pain is defined as pain that lasts for six months or longer. It is distinguished from dysmenorrhea, which are periods of pain or cramps that only occur during menstruation. The intensity of chronic pelvic pain can vary throughout the menstrual cycle, but it is usually present for the biggest part of the month.
Chronic pelvic pain can be severe, but some women with endometriosis may experience milder pain. They often describe the pain as sharp and cramping.
Chronic pelvic pain is associated with an increased risk of depression, anxiety, and fatigue.
How endometriosis causes chronic pelvic pain
Chronic pelvic pain is strongly associated with endometriosis; the disease is found in about one-third of women who undergo surgery for chronic pelvic pain. However, endometriosis is not the only cause of chronic pelvic pain. It can also be caused by other conditions, such as pelvic infections or irritable bowel syndrome (IBS). Even when endometriosis is present, it is essential to check for other possible causes of pain.
It is not well understood how endometriosis causes pain and there is a poor correlation between the severity of chronic pelvic pain and the size and number of endometriotic lesions. It is thought that the local inflammation around endometriotic implants contributes to the development of pain. However, the fact that women with more advanced endometriosis do not experience more pain suggests that other mechanisms besides inflammation may contribute to the perception of chronic pelvic pain.
It is known that endometriotic implants are well innervated, which means that the implants contain a lot of nerves that can perceive pain and then transmit the sensation to the brain. The number and localization of nerves within or near the implant may dictate the perception of pain.
Treatment of chronic pelvic pain
There is currently no cure for endometriosis, but there are treatments that can help relieve the symptoms. Three types of treatments are generally used to treat endometriosis-associated pain: pain relief medication, hormonal therapies, and surgery.
Non-steroidal anti-inflammatory drugs (NSAIDs) are used to treat mild pain. However, not all endometriosis patients respond to NSAIDs. For severe pain, opioid-based pain relievers or narcotic analgesics, such as hydrocodone, oxycodone, or hydromorphone may be prescribed.
The growth of endometrial lesions depends on estrogen, and hormonal therapy works by decreasing the level of this hormone. Besides inhibiting the growth of the lesions, hormonal therapy also suppresses the menstrual cycle and often reduces endometriosis-associated pain.
Surgical removal of endometriotic lesions can be efficient in the short term, but frequently the lesions and associated symptoms recur. Laparoscopy is a common surgical procedure in endometriosis and is the least invasive surgical option.
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