A quick refresher on the science behind endometriosis pain.
In endometriosis, estrogen-dependent endometriotic cells and tissues reside outside the endometrial cavity, primarily on the peritoneum, ovaries, rectovaginal septum, and uterosacral ligaments.1-4
Lesions Outside the Endometrial Cavity4,5
By promoting the proliferation of endometriotic lesions and inflammation throughout the pelvic and abdominal cavity, estrogen fuels the
3 types of endometriosis pain1,3,6-9:
- Non-menstrual pelvic pain
Estradiol also specifically fuels these types of pain through its effects on the endometriotic tissue7:
- Estradiol induces COX-2, which increases production of prostaglandin E2 (PGE2)
- PGE2 directly causes pain and inflammation
- PGE2 in turn leads to increased aromatase, resulting in increased local estradiol production
Thus, a positive feedback loop is created.
Given the key role estrogen plays in endometriosis pain, an effective treatment strategy may need to10:
- Suppress menses
- Adequately control estrogen levels throughout ovulatory cycle