Pathogenesis of Endometriosis: The Origin of Pain and Subfertility

Abstract

Endometriosis (EM) and adenomyosis (AM) are common conditions with pain and infertility as the principal symptoms. The pathophysiology of pain in EM and AM comprises sensory and somatoform pain mechanisms. Over time, these may aggravate and lead to individual complex disease patterns if not diagnosed and treated. Despite the known facts, several years often pass between the onset of symptoms and diagnosis. Chronic pain disorders with changes on a neuronal level frequently arise and are linked to depressive disorders, with the process becoming a vicious cycle. Additionally, women with EM and AM suffer from sub- and infertility. Low fecundity rates are caused by anatomical changes in combination with behavioral changes in the sexual activity of women with chronic pain as well as local proinflammatory factors that not only decrease implantation rates but also promote early abortions.

Neurogenic Inflammation in the Context of Endometriosis—What Do We Know?

“…There are various symptom patterns and different patient cohorts due to the different kinds of lesions, organs affected, size and diversity of the patient population [ 14 , 15 , 16 ]. Additionally, non-specific complaints may lead to consultations of various medical disciplines, delaying the diagnosis.…”

“…Additionally, non-specific complaints may lead to consultations of various medical disciplines, delaying the diagnosis. An, on average, 10-year-long delay after the onset of symptoms in diagnosis is common [ 14 , 15 ]. After all, more than 60% of those diagnosed with EM report that their complaints started before the age of 20.…”

“…After all, more than 60% of those diagnosed with EM report that their complaints started before the age of 20. Furthermore, there is a clear correlation between the duration, the intensity of the complaints, and the extent of the EM manifestations [ 14 , 17 ].…”

Патогенез И Методы Лечения Инфертильности При Эндометриозе (Обзор Литературы)

“…Полагают, что у пациенток с эндометриозом I и II стадий по ASRM контролируемая стимуляция яичников (с помощью кломифена цитрата или гонадотропинов) в сочетании с ВМИ может рассматриваться в качестве альтернативы проведению только ВМИ, ЭКО или дальнейшего хирургического лечения [ Очевидно, что при минимальном или легком эндометриозе и вызванном им бесплодии следует рассматривать возможность хирургического лечения и выполнения последующей ВМИ. При средней тяжести и тяжелом эндометриозе хирургическое лечение может приводить к снижению ОР яичников и негативно повлиять на результаты последующего ЭКО [22]. Перед принятием решения о необходимости хирургического лечения эндометриоза у пациенток репродуктивного возраста следует оценивать ОР, а также измерять уровень АМГ минимум через 3 месяца после операции для определения дальнейшей тактики лечения.…”

Phoenixin as a New Target in the Development of Strategies for Endometriosis Diagnosis and Treatment

“…Noteworthy, most women have retrograde menstruation, and only a few develop endometriosis. Therefore, imbalance of the immune and endocrine systems, and the influence of environmental factors that ensure the implantation, growth, and persistence of the endometrium in ectopic sites are currently indicated [1][2][3][4][5].…”