Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive brain stimulation procedure that is being evaluated to possibly treat chronic pelvic pain in women with endometriosis.

The procedure is approved by the U.S Food and Drug Administration (FDA) for the treatment of depression and anxiety when standard therapies do not work. It has been shown to be effective for various types of pain, including neuropathic (nerve) pain.

How rTMS works

rTMS uses a magnet to activate specifically targeted regions of the brain. During a typical rTMS session, an electromagnetic coil is positioned over the patient’s head, near the targeted area of the brain. Short electromagnetic pulses are administered repeatedly through the coil in rapid succession. These pulses are similar in type and strength to those generated during magnetic resonance imaging (MRI).  The magnetic pulses easily pass through the skull and produce small electrical currents that stimulate nerve cells in the targeted brain region.

During the procedure, patients are required to remove any magnetic-sensitive objects, such as jewelry. Because the rTMS machine produces a loud clicking sound with each pulse, much like an MRI machine, patients are typically asked to wear earplugs during treatment for their comfort and for hearing protection. Each session lasts 30 to 60 minutes. Patients are in a seated position and no anesthesia is required.

During the first rTMS session, several measurements are taken to ensure that the electromagnetic coil is properly positioned over the patient’s head. The motor threshold, which is the minimum amount of power necessary to make the patient’s thumb twitch, is also determined for each person undergoing the procedure.

RTMS and clinical trials

A pilot, open-label, prospective clinical trial called ENDOSTIM (NCT03204682) assessed the feasibility and efficacy of rTMS to reduce pain and improve quality of life in endometriosis patients with chronic pelvic pain. Study results were published in the Journal of Clinical Medicine. All 12 women enrolled underwent one daily session of rTMS for five consecutive days, receiving 1.500 pulses at 10 Hertz (Hz). Tolerance, change in pain levels, and life quality parameters were evaluated at day eight and four weeks post-treatment. Nine of the 12 women reported at least a “modest” reduction in both pain intensity and pain interference. The rTMS procedure was well-tolerated.

Randomized controlled trials are needed to further evaluate the safety and efficacy of the procedure in women with endometriosis.

Other details

The most common side effect reported with rTMS in other studies is headaches. Some patients may experience painful scalp sensations or facial twitching because of rTMS pulses, which can be taken care of by making adjustments in positioning the electromagnetic coil and changing the stimulation settings to reduce discomfort.

The procedure cannot be conducted in people with any type of non-removable metal in their heads (with the exception of braces or dental fillings), aneurysm clips or coils, stents in the neck or brain, deep brain stimulators, electrodes to monitor brain activity, metallic implants in the ears and eyes, shrapnel or bullet fragments in or near the head, facial tattoos with metallic or magnetic-sensitive ink, or other metal devices or objects implanted in or near the head.


Last updated: July 30, 2019


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