MedCentralEndometriosis-Associated Pain

Endometriosis affects 190 million women globally with severe pelvic pain that doesn’t correlate with disease severity—patients with minimal disease may report excruciating pain while those with extensive lesions report little. Surgery rarely offers lasting relief and pain often returns.

⚖️ PROFESSIONAL IMPACT

• Multidisciplinary coordination required: Endometriosis is systemic with IBS comorbidity, not purely gynecologic, demanding teams including urology, GI, physical therapy, pain psychology, and pain medicine.
• Visceral-somatic neural convergence: This creates chronic overlapping pain disorders as reproductive organs, bladder, and bowel share pathways with skin, muscles, and fascia, sensitizing nearby organs and lowering pain thresholds.
• Current treatments provide only brief relief: Hormonal suppression and surgery offer temporary improvement, with endometriosis and pain frequently recurring post-operatively when lesions remain or disease was severe.
• No diagnostic biomarkers exist: Diagnosis requires surgical visualization with no blood tests available, and pain severity fails to predict disease extent, complicating assessment and treatment planning.

🎯 ACTION ITEMS

• Document comprehensive pain history including onset, menstrual relationship, severity patterns, location, triggers, and sexual/social dynamics
• Coordinate with gynecology, urology, GI, and pain psychology specialists rather than referring solely to gynecology
• Counsel patients that ESHRE guidelines recommend NSAIDs plus hormonal contraceptives, progestogens, or GnRH agonists/antagonists as first-line
• Explain surgery is option but rarely curative, with pain commonly returning if lesions persist

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