School of Psychology, Deakin University, Geelong, Australia.
Innovation in Mental and Physical Health and Clinical Treatment (IMPACT) Institute, School of Medicine, Deakin University, Geelong, Australia.
Pain Med. 2021 Jul 25;22(7):1511-1521. doi: 10.1093/pm/pnaa362.
Primary dysmenorrhea and secondary dysmenorrhea due to endometriosis share overlapping symptoms and likely demonstrate aspects of central sensitization. The present study aimed to identify distinct phenotypes of women who have dysmenorrhea with and without endometriosis to shed light on the unique mechanisms contributing to the pathogenesis of each condition.
An online survey was used to investigate the relationship between ratings of menstrual pain severity, menstrual symptoms (abdominal cramps, abdominal discomfort, low back pain, headache, body aches, bloating, nausea, diarrhea, increased bowel movements), widespread pain, and functional pain disability in a community sample of 1,354 women (aged 18-50) with menstrual pain in Australia.
Compared with women without endometriosis, those with endometriosis had statistically significant higher menstrual pain severity (P<0.01), symptom severity and fatigue (all symptoms P<0.001, although only cramps and bloating were clinically significant), widespread pain sites (P<0.001), and functional pain disability (P<0.001, although this difference was not clinically significant). When examining symptoms by pain severity, women with severe menstrual pain were more likely to experience symptoms than women with less severe pain, regardless of the presence of endometriosis. Similar predictors of functional pain disability emerged for women with and without endometriosis, such as body aches, nausea, fatigue, and widespread pain, respectively, suggesting the presence of central sensitization in both groups. Logistic regression revealed that after accounting for menstrual pain severity (odds ratio [OR], 1.61) and duration (OR, 1.04), symptoms of bloating (OR, 1.12), nausea (OR, 1.07), and widespread pain sites (OR, 1.06) significantly predicted the presence of endometriosis.
The findings suggest that phenotypes specific to endometriosis can be identified.
原发性痛经和由子宫内膜异位症引起的继发性痛经具有重叠的症状，可能表现出中枢敏化的某些方面。本研究旨在确定患有痛经和无子宫内膜异位症的女性的不同表型，以阐明每种疾病发病机制的独特机制。
本研究使用在线调查来研究澳大利亚 1354 名有月经痛的社区女性（年龄 18-50 岁）的月经痛严重程度评分、月经症状（腹部绞痛、腹部不适、腰痛、头痛、全身疼痛、腹胀、恶心、腹泻、排便增多）、广泛性疼痛和功能性疼痛残疾之间的关系。
与没有子宫内膜异位症的女性相比，有子宫内膜异位症的女性月经痛严重程度显著更高（P<0.01）、症状严重程度和疲劳（所有症状 P<0.001，尽管只有痉挛和腹胀有临床意义）、广泛性疼痛部位（P<0.001）和功能性疼痛残疾（P<0.001，尽管这种差异没有临床意义）。当按疼痛严重程度检查症状时，无论是否存在子宫内膜异位症，疼痛严重的女性比疼痛较轻的女性更有可能出现症状。对于有无子宫内膜异位症的女性，相似的功能性疼痛残疾预测因素出现，例如全身疼痛、恶心、疲劳和广泛性疼痛，这表明两组均存在中枢敏化。逻辑回归表明，在考虑月经痛严重程度（比值比 [OR]，1.61）和持续时间（OR，1.04）后，腹胀（OR，1.12）、恶心（OR，1.07）和广泛性疼痛部位（OR，1.06）的症状显著预测子宫内膜异位症的存在。
研究结果表明，可以确定特定于子宫内膜异位症的表型。
