Chronic Pelvic Pain & Endometriosis

Post in Publikationen
by Amelie Hofmann-Werther


  • Understand background, pathogenesis & physiological impact of endometriosis
  • Understand the critical need for timely diagnosis and effective intervention
  • Know where to address to 


Endometriosis Defined

Endometriosis is an estrogen-dependent disease frequently resulting in substantial morbidity, severe chronic or recurrent pelvic pain, multiple surgeries, and impaired fertility.

Clinically Endometriosis is defined as presence of endometrial-like tissue (Endometrium lining like cells) found outside uterus/uterine cavity, resulting in sustained inflammatory reaction. Primarily the pelvic peritoneum, ovaries, and and the lowest abdominal cavity (rectovaginal septum, Pouch of Douglas) are affected.

Affecting 6%–10% of women of reproductive age, the stigmata of endometriosis include chronic pelvic pain in menstrual bleeding (dysmenorrhea), chronic pain while intercourse (dyspareunia), irregular uterine bleeding, and/or infertility.

The prevalence of this condition in women experiencing pain, infertility, or both is as high as 35%–50% Yet endometriosis is often under- or non-diagnosed and associated with a 6 to 7- year mean latency from onset of symptoms to definitive diagnosis

Chronic Pelvic Pain & Endometriosis

Chronic Pelvic Pain & Endometriosis


  • Classic signs: severe dysmenorrhea, deep dyspareunia, chronic pelvic pain, Middleschmertz, cyclical or perimenstrual symptoms
  • Typically develops on pelvic structures, ie, bladder, bowels, intestines, ovaries, and fallopian
  • Less commonly found in distant regions, eg, diaphragm, lungs (inducing catamenial pneumothorax), and rarely, areas far outside abdominopelvic region
  • Ovaries among most common of locations; gastrointestinal tract, urinary tract, soft tissues, and diaphragm follow
  • Degree of disease present has no correlation with severity of pain or symptomatic impairment 


Symptoms vary but typically reflect area of involvement and may include:

  • Dysmenorrhea ( pain in menstrual bleeding)
  • Heavy or irregular bleeding
  • Cylical/noncylical pelvic pain
  • Lower abdominal or back pain
  • Bloating, nausea, and vomiting
  • Dysuria (pain in urinating)
  • Dyspareunia (pain while sexual intercourse) 



  • No single theory sufficiently explains pathogenesis
  • Genetics, biomolecular aberrations in eutopic endometrium, dysfunctional immune response, anatomical distortions, and proinflammatory peritoneal environment may all ultimately be involved
  • 5 key processes of development: adhesion, invasion, recruiting, angiogenesis, proliferation 



  • More than 176 million women globally; 775,000 in Canada and 8.5 million in North America are affected
  • Infertility among chief clinical findings
  • No known prevention of Endometriosis
  • Specific menstrual characteristics may be associated; decreased risk with late age at menarche and shorter menstrual cycles with longer duration of flow
  • Family history cannot be undervalued; near 10-fold increased risk in women with first-degree relatives who have disease endometriosis
  • No particular demographic, personality trait, or ethnic predilection
  • Inverse BMI relationship
  • No definitive association with nutrition, exercise, personality traits, or other lifestyle variables 



  • Adhesions
  • Risk of Adverse Pregnancy Outcome & Preterm Birth
  • Up to 50% of those with endometriosis may suffer from infertility
  • Distorted pelvic anatomy/impaired oocyte release or inhibit ovum pickup and transport
  • Endocrine and anovulatory disorders
  • Characterized as sexual dysfunction manifesting as pain in the reproductive organs before, during, or soon after sexual intercourse
  • Though frequently depicted as psychogenic, dyspareunia (pain while intercourse) is actually often the result of organic, multidisciplinary cause and affects as many as 80% of endometriosis patients.



  • Clinical Diagnosis: Pelvic Examination & Pain Mapping, Medical History
  • Imaging Studies, Ultrasound, MRI
  • Surgical Diagnosis & Staging Surgical Intervention



Surgical Interverntion

  • Laparoscopy/Laparotomy
  • Goals of conservative surgery include removal of disease, lysis of adhesions, symptom reduction and relief, reduced risk of recurrence, and restoration of organs to normal anatomic and physiologic condition
  • Laparoscopic excision has been demonstrated to significantly improve deep dyspareunia as well as quality of sex life


Nonsurgical Therapies

  • Medical treatment and combination therapy may help improve symptoms
  • Gonadotropin-releasing hormone agonists (GnRH), oral contraceptives, Danazol®, Aromatase Inhibitors, and Progestins are mainstays
  • Mirena® intrauterine device shown to be effective in reducing pain and may be considered alternative to hysterectomy in adenomyosis patients
  • Alternative Therapies, for example herbal medicine, physical therapy, diet and nutrition, acupuncture, specific supplements and other complementary approaches may result in reduction of pain



  • Endometriosis is a chronic, costly disease requiring long-term, multidisciplinary treatment
  • Profound personal and economic impact underscores urgent need for continued research and improvement in diagnostic and treatment modalities
  • Timely intervention and appropriate, multifactorial treatments may restore quality of life, preserve or improve fertility, and lead to long-term effective management in absence of permanent cure


For Consultation and individual Treatment Plan set up, please contact www.nicolasandasp.com



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