Bringing Endometriosis to the Road of Contemporary Pain Science

BJOG An International Journal of Obstetrics & Gynaecology, Journal Year: 2025, Volume and Issue: unknown

Published: Feb. 5, 2025

ABSTRACT Background Endometriosis pain is mainly understood based on peripheral lesion characteristics and an outdated perspective equating nociception with pain. This limited view may divert understanding of interventions beyond logic, leading clinicians to see approaches targeting other processes as supplementary, limiting the effective addressing treatment failure. Integrating critical advancements in endometriosis can promote more comprehensive knowledge. Objectives article provides a conceptual framework focusing overlooked or less clearly linked areas concerning interplay between factors influencing It explores complexity nociceptive processing, association neuromerically connected structures, role brain perception. Further, it emphasizes adopting mechanism‐based that integrates neurobiological aspects apparatus related systems, shaped by psychosocial contributing possible negative spiral those living endometriosis. Conclusion Aware such broader incentivize balanced effort inquire into lesion‐related mechanisms domains potentially impacting

Language: Английский

Endometriosis

JAMA, Journal Year: 2025, Volume and Issue: unknown

Published: May 5, 2025

Importance Endometriosis is a chronic, estrogen-dependent, inflammatory disease defined by endometrial-like tissue (lesions) outside the uterine lining. It affects up to 10% of women worldwide, and 9 million in US, during reproductive years. Observations has varying clinical presentations; however, 90% people with endometriosis report pelvic pain, including dysmenorrhea, nonmenstrual dyspareunia, 26% infertility. Risk factors for include younger age at menarche, shorter menstrual cycle length, lower body mass index, nulliparity, congenital obstructive müllerian anomalies such as obstructed hemivagina. Although definitive diagnosis requires surgical visualization lesions, suspected can be made based on symptoms, supported physical examination findings imaging transvaginal ultrasound and/or magnetic resonance imaging; normal do not exclude diagnosis. The often delayed, averaging 5 12 years after onset most consulting 3 or more clinicians prior Hormonal medications, combined oral contraceptives progestin-only options, are first-line treatment should offered symptomatic premenopausal who currently desire pregnancy. In network meta-analysis (n = 1680, 15 trials), hormonal treatments contraceptives, progestins, gonadotropin-releasing hormone (GnRH) agonists led clinically significant pain reduction compared placebo, mean differences ranging between 13.15 17.6 points (0-100 visual analog scale) little difference effectiveness among options. However, 11% 19% individuals have no medications 25% 34% experience recurrent within months discontinuing treatment. Surgical removal usually laparoscopy, considered if therapies ineffective contraindicated. Second-line GnRH antagonists, third-line aromatase inhibitors. Hysterectomy lesions may when initial ineffective. approximately patients undergo hysterectomy additional surgery, lysis adhesions, treat pain. Conclusions Relevance common cause affecting reproductive-age women. suppression estrogen-progestin progestins seeking immediate performed contraindicated, medical relieve symptoms.

Language: Английский

Endometriosis: cannabidiol therapy for symptom relief

Trends in Pharmacological Sciences, Journal Year: 2024, Volume and Issue: unknown

Published: Nov. 1, 2024

Endometriosis is a common, chronic, incurable condition the hallmark of which presence lesions (tissue resembling endometrium) in sites outside womb, with symptoms including chronic debilitating pain and fatigue. However, current therapeutic options are limited. Recent advances our understanding mechanisms that contribute to development experience endometriosis as well surveys patients have increased interest testing recently approved formulations containing cannabidiol (CBD) this patient group. In review, we summarise data from samples animals models focussed on pathophysiology endometriosis, pathways where CBD has activity. We consider available CBD-containing products, their pharmacokinetics (PK), use ongoing clinical trials other conditions.

Language: Английский