Endometriosis occurs in around 4-5% of women in the United States of America. In infertile women (that is, women unable to get pregnant after 12 months of unprotected sex) that number jumps up to almost 50%. The disease accounts for a significant proportion of patients who come to their doctors with pelvic pain and pain is a defining characteristic of the disease. However, pain is caused by a number of different ways in the human body. What has always been poorly understood with the pelvic pain in endometriosis is where it comes from. Now a new diagnostic test could answer that question and help guide appropriate treatment for patients with pelvic pain in nerves caused by endometriosis
Symptoms of Endometriosis
Endometriosis is associated with a number of symptoms including:
- Infertility – many patients are unable to get pregnant after 12 months of unprotected sex
- Heavy bleeding during periods
- Heavy bleeding between periods
- Pain with intercourse
- Painful periods
- Pain with bowel movements or urination
The most prominent feature is often the pain. Mother-of-one Sarah Lochner told the Independent “I was constantly in pain”. This is the sad reality for the tens of thousands living with endometriosis
But where does this pain come from? Is it caused by an inflammatory process like when we fall and twist an ankle? In this process the twisted ankle and damaged tissue cause the release of chemicals that signal to the brain that the area is hurt and needs healing. The molecules cause signals to be sent to the nerves and into the brain telling us we are hurt.
Or is the pelvic pain in nerves? Often if the nerves themselves are damaged they can release pain signals when there is no damage to the body. This happens in many patients after a big trauma like a car accident that caused damage to the nerves.
Treatment for Pelvic Pain caused by Endometriosis
What treatment options do people with endometriosis have? One radical treatment is the total removal of the uterus – called a hysterectomy – but this is not without its risks and many women have not finished their families, leaving it as a non-starter. Other options include pain relief medications that include:
- Non-steroidal anti-inflammatory drugs (like ibuprofen)- these work well if the pain is inflammatory in nature. But if the pain is in the nerves it has little effect
Another option is a nerve block. Traditionally a hypogastric nerve block is used and can achieve quick and reliable pain relief for women suffering from nerve pain.
Pelvic Pain: A New Test?
Until now it has been almost impossible to tell what type of pain woman with endometriosis pelvic pain are suffering from. Now a new test trialed by researchers at the University of Rome and published in the Journal of Minimally Invasive Gynecology may be able to tell the difference. Before it was guesswork, and nerve blocks had to be performed before you knew whether the pain was caused by nerves, but with this test, doctors can identify which treatment is most ideal for the sufferer when the diagnosis is made – limiting the trial and error approach to treatment at the moment.