Department of Obstetrics & Gynecology, Northshore University HealthSystem, Evanston, IL, USA.
Pritzker School of Medicine, University of Chicago, Chicago, IL, USA.
Mol Pain. 2021 Jan-Dec;17:17448069211035217. doi: 10.1177/17448069211035217.
Although elevated estradiol levels facilitate chronic pelvic pain in animal models, it remains to be determined whether sex steroid levels are altered in a cross-section of women with chronic pelvic pain (CPP) and those at-risk for developing CPP. We sought to determine if sex steroid levels are increased in women with menstrual pain and whether those changes were more extreme in two groups of women with worsened pelvic pain profiles: a) dysmenorrhea plus evidence of bladder pain sensitivity and b) bladder pain syndrome. Serum samples were collected during the mid-luteal phase to measure estradiol, progesterone, testosterone, and sex hormone-binding globulin. We also compared quantitative sensory testing profiles to evaluate how sex steroid differences influence proposed pain sensitivity mechanisms. Women with combined dysmenorrhea and bladder sensitivity had higher estradiol concentrations than controls (487 [IQR 390 - 641] vs 404 [336 - 467] pmol/L, = 0.042). Bladder pain syndrome participants had greater sex hormone-binding globulin than controls (83 [71 - 108] vs 55 [42 - 76 nmol/L; = 0.027). Levels of pain sensitivity and mood were different across the groups, but the only significant relationship to sex steroids was that sex hormone-binding globulin was correlated to somatic symptoms ( = 0.26, = 0.03). These findings show women potentially at-risk for CPP and women with diagnosed CPP exhibit altered circulating levels of sex steroids. Because these hormonal differences appear to be independent of mood or pain sensitivity, the role of sex steroids in the emergence of CPP may be via sensitization of visceral afferents.
虽然在动物模型中，雌二醇水平升高会导致慢性盆腔疼痛，但仍需确定患有慢性盆腔疼痛（CPP）的女性和易患 CPP 的女性的性激素水平是否发生改变。我们试图确定月经疼痛的女性是否存在性激素水平升高，以及这些变化在两组盆腔疼痛特征恶化的女性中是否更为明显：a）痛经加膀胱疼痛敏感性证据和 b）膀胱疼痛综合征。在黄体中期采集血清样本以测量雌二醇、孕酮、睾酮和性激素结合球蛋白。我们还比较了定量感觉测试结果，以评估性激素差异如何影响拟议的疼痛敏感性机制。同时患有痛经和膀胱敏感性的女性的雌二醇浓度高于对照组（487 [IQR 390 - 641] vs 404 [336 - 467] pmol/L， = 0.042）。膀胱疼痛综合征患者的性激素结合球蛋白高于对照组（83 [71 - 108] vs 55 [42 - 76 nmol/L； = 0.027）。不同组之间的疼痛敏感性和情绪水平存在差异，但与性激素唯一显著相关的是性激素结合球蛋白与躯体症状相关（ = 0.26， = 0.03）。这些发现表明，有潜在 CPP 风险的女性和已诊断为 CPP 的女性表现出循环性激素水平改变。由于这些激素差异似乎独立于情绪或疼痛敏感性，因此性激素在 CPP 出现中的作用可能是通过内脏传入纤维的敏化。
