Chronic Pelvic Pain: Dysmenorrhea and Endometriosis

Chronic pelvic pain (CPP) affects up to 20% of reproductive aged women.1 Endometriosis is the most common reproductive system diagnosis in women who undergo investigation for CPP. Endometriosis is a chronic disease that is difficult to completely eradicate. Over the course of the reproductive years, women with endometriosis will often require several pharmacological and/or surgical treatments. This chapter will focus on the clinical diagnosis and management of endometriosis, including evidence and specific recommendations for each therapeutic option. Since menstrual pain is the most prevalent symptom of endometriosis, we will also briefly discuss primary dysmenorrhea and other causes of secondary dysmenorrhea. As is the case with most chronic pain disorders, the degree of anatomic pathology in women with endometriosis often fails to explain the severity of the pain and associated symptoms. Recent research suggests that endometriosis can alter neural processing, fostering the development and maintenance of chronic pain.2 This chapter will also summarize relevant research studies highlighting the interactions of the reproductive, immunological, and central nervous systems (CNS) in this disorder.