Introduction: Endometriosis affects 5% to 10% of reproductive age women and may be associated with severely painful and debilitating symptoms as well as infertility. Endometriosis involves hormonal fluctuations, angiogenesis, neurogenesis, vascular changes and neuroinflammatory processes. The neuroinflammatory component of endometriosis makes it a systemic disorder, similar to other chronic epithelial inflammatory conditions.
Areas covered: Inflammatory mediators, mast cells, macrophages, and glial cells play a role in endometriosis which can result in peripheral sensitization and central sensitization. There is overlap between chronic pelvic pain and endometriosis, but the two conditions are distinct. Effective treatment is based on a personalized approach using a variety of pharmacologic and other treatment options.
Expert opinion: Hormonal therapies are a first-line approach, but endometriosis is a challenging condition to manage. 'Add-back' hormonal therapy has been effective. Painful symptoms are likely caused by the interplay of multiple factors and there may be a neuropathic component. Analgesics and anticonvulsants may be appropriate. A holistic approach and multimodal treatments are likely to be most effective. In addition to pharmacologic treatment, there are surgical and alternative medicine options. Endometriosis may also have a psychological component.
Keywords: Add-back therapy; chronic pelvic pain; endometriosis; hormonal therapy; inflammatory response; neuroinflammation.
Endometriosis affects up to 10% of women of reproductive age and has variable symptoms that can include pain, fatigue, and infertility. It is not known what causes endometriosis or how to prevent it. It is a chronic inflammatory condition and involves many factors: hormonal changes during the monthly cycle, the creation of growths or lesions outside the uterus (which can become painful), creation of new blood vessels and nerves, as well as neuroinflammation. Neuroinflammation involves inflamed nerves which is associated with a specific type of pain. Endometriosis is not the same thing as chronic pelvic pain, but it is possible to have both conditions. It is not known if endometriosis can cause chronic pelvic pain later in life, but this cannot be ruled out. Since endometriosis varies widely among women in terms of pain and other symptoms, size and distribution of lesions, and progress of the disease, treatment options are often personalized to meet the specific needs of the patient. Hormonal therapies are a first-line approach and there are several different hormonal approaches and agents. Pain relievers may be added. Endometriosis may be associated with depressed mood or other psychological symptoms that can be addressed using cognitive behavioral therapy. Surgery is also an option but it goes beyond the scope of this paper.