Endometriosis-associated Pain in Patients with and without Hormone Therapy

Abstract

hormonal changes in the menstrual cycle (7). This condition is associated with different types of pain disorders, including cyclic and non-cyclic CPP, dysmenorrhea, dysuria, dyschezia, and dyspareunia (8). Cyclic pain (e.g., premenstrual, peri-menstrual, postmenstrual and even mid-cyclic pain) and other complaints are hormone related. Dysmenorrhea, in particular, is one such disorder associated with menstruation. Endometriosis-associated dysuria and/or dyschezia mainly have a cyclic pattern of occurrence (usually peri-menstrual). The leading symptom of endometriosis is dysmenorrhea, which generally has a very early onset-often before a girl's first period (8, 9). Disordered and hyperactive uterine movement with an ischemic pain component is the presumed cause. Dysmenorrhea treatment typically consists of an oral contraceptive therapy to suppress ovulation. By definition, classic cyclic pain can no longer occur in this case. However, the withdrawal bleeding that occurs during the break in contraceptive therapy (which women regard as "menstrual bleeding") can be associated with severe pain. Especially cyclic premenstrual CPP may be caused by uterine contractions or activity as well as by endometriosis-associated peritoneal lesions that secrete active metabolites like pain mediators in a hormone-dependent manner (10).

Endometriosis, an Ongoing Pain—Step-by-Step Treatment

“…Hormonal therapy, but bleeding: As described by Brandes et al, even light bleeding is often painful when a patient is on hormonal therapy [15]. Thus, the bleeding should be significantly reduced.…”

“…The median pain score on the VAS was 6. Half of all women reported other types of pain, such as dyspareunia, dysuria and dysuria [15]. This indicates a significant level of suffering.…”