[Severe dysmenorrhea and endometriosis].

Area of Science:

• Gynecology
• Pain Medicine
• Neurology

Background:

• Severe dysmenorrhea (grade 3) is prevalent in endometriosis patients from menarche.
• Young girls with severe dysmenorrhea often exhibit central hypersensitivity, contributing to chronic pelvic pain and comorbidities.
• Severe dysmenorrhea is considered a potential precursor to endometriosis.

Purpose of the Study:

• To explore the link between severe dysmenorrhea and endometriosis.
• To discuss the role of central hypersensitivity in pelvic pain associated with endometriosis.
• To outline multimodal treatment strategies for severe dysmenorrhea and endometriosis-related pain.

Main Methods:

• Literature review and synthesis of existing studies on dysmenorrhea, endometriosis, and pain management.
• Analysis of the pathophysiology of central hypersensitivity and neuropathic pain in this context.
• Discussion of various treatment modalities, including hormonal therapy, analgesics, antidepressants, antiepileptics, physiotherapy, TENS, CBT, and surgical options.

Main Results:

• Severe dysmenorrhea is strongly associated with central hypersensitivity, a key factor in chronic pelvic pain.
• While endometriosis lesions can worsen pain, neuropathic pain is often linked to central sensitization rather than direct nerve compression.
• Hormonal treatments inducing amenorrhea can suppress nociceptive influxes and prevent worsening of central hypersensitivity.

Conclusions:

• Controlling severe primary dysmenorrhea is crucial for pelvic pain management and endometriosis prevention.
• Multimodal treatment, including hormonal therapy, analgesics, and central sensitisation-targeting medications, is essential.
• Physiotherapy, TENS, and cognitive-behavioral therapies are recommended first-line treatments, with surgery and other interventions considered for specific cases.