The connection between endometriosis and secondary dysmenorrhea

Endometriosis (EMS) is a prevalent gynecological condition characterized by the presence of endometrial tissue outside the uterus, often leading to secondary dysmenorrhea (SD), chronic pelvic pain and infertility. This review explores the intricate connection between EMS- associated pain and SD, focusing on the pathophysiological mechanisms underlying dysmenorrhea in EMS. Key contributors to pain include inflammation, aberrant immune responses, neurogenic inflammation, peritoneal irritation, peripheral sensitization, central sensitization and cross-organ sensitization. Understanding the pain pathways in EMS highlights the complexity of symptom manifestation and underscores the necessity for a multidisciplinary approach to management. Clinical manifestations, including chronic pelvic pain, dyspareunia, infertility, gastrointestinal and bladder symptoms, fatigue and malaise, are discussed, emphasizing the diverse impact of EMS on women's health. Various treatment modalities, ranging from pharmacological interventions to surgical and complementary approaches, are outlined to provide comprehensive management strategies for EMS-related menstrual pain/SD. This review aims to enhance understanding and facilitate the effective management of EMS-associated SD, ultimately improving the quality of life for affected individuals.