Cetera Giulia Emily, Merli Camilla Erminia Maria, Vercellini Paolo
Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Academic Center for Research On Adenomyosis and Endometriosis, Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Milan, Italy.
Reprod Sci. 2025 Feb;32(2):289-299. doi: 10.1007/s43032-024-01763-w. Epub 2025 Jan 7.
Recent research has proven that peripheral (PS) and central sensitization (CS), mental health, and myofascial dysfunction all play a role, alongside nociception, in the genesis and in the perpetuation of endometriosis' symptoms. However, such components of pain are still largely ignored in clinical practice, although not considering such contributors may entail serious consequences on women's health, including the choice of unnecessary surgery and leaving the real causes of pain untreated. At the present time, we are facing a paradox by which 25-40% of women who undergo laparoscopic surgery for pelvic pain do not have an obvious diagnosis, while the percentage of women with endometriosis who have signs of CS, of depressive or anxiety disorders, or who have an increased pelvic muscle tone ammounts to 41-55%, 15-88% and 28-73%, respectively. Moving from the widely-accepted stepwise approach suggested for endometriosis management, which consists in the initial prescription of low-dose combined oral contraceptives (COCs) or of a progestin monotherapy, followed by GnRH analogues and, ultimately, by surgery, when COCs and progestins have proven ineffective or are not tolerated or contraindicated, we propose an integration of such model which takes into account the identification and the simultaneous treatment of all pain contributors. Our objective is to encourage physicians' awareness of the need of a multidisciplinary, multimodal approach to endometriosis-related pain, and ultimately to promote a reduction in the number of unnecessary surgeries.
最近的研究已经证明，外周敏化（PS）和中枢敏化（CS）、心理健康以及肌筋膜功能障碍，与伤害感受一起，在子宫内膜异位症症状的发生和持续过程中均发挥作用。然而，在临床实践中，这些疼痛因素仍在很大程度上被忽视，尽管不考虑这些因素可能会给女性健康带来严重后果，包括选择不必要的手术以及让疼痛的真正原因得不到治疗。目前，我们面临着一个悖论：接受腹腔镜手术治疗盆腔疼痛的女性中有25% - 40%没有明确诊断，而患有中枢敏化迹象、抑郁或焦虑症，或者盆腔肌张力增加的子宫内膜异位症女性比例分别为41% - 55%、15% - 88%和28% - 73%。从广泛接受的子宫内膜异位症管理建议的逐步治疗方法出发，该方法包括最初开具低剂量复方口服避孕药（COC）或单一孕激素治疗，随后使用GnRH类似物，最终在COC和孕激素已被证明无效、不耐受或禁忌时进行手术，我们提出对此类模式进行整合，将所有疼痛因素的识别和同时治疗考虑在内。我们的目标是促使医生认识到需要采用多学科、多模式方法来治疗与子宫内膜异位症相关的疼痛，并最终减少不必要手术的数量。
