Overton, Catherine Elizabeth; (1996) Endometriosis and pain. Doctoral thesis (M.D), UCL (University College London).

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Abstract

he relationship between pain and endometriosis remains an enigma. This thesis investigated the association between pain and endometriosis, its natural history, treatment, and aetiological factors involved. A detailed pain history was taken from women prior to laparoscopy to test the hypothesis that endometriosis could be predicted from the history alone. Severe dysmenorrhoea was found to have a sensitivity and specificity of 41 and 98%. A detailed pain history cannot substitute for laparoscopy in the diagnosis of endometriosis, but may help to reduce the interval from presentation and referral for specialist opinion. All current treatments of endometriosis are contraceptive, with considerable side effects. We proposed that luteal phase progestogen may be beneficial in the treatment of endometriosis, without affecting conception. Luteal phase dydrogesterone (40 and 60 mg) for six months was compared with placebo in the treatment of minimal to mild endometriosis. Treatment did not affect pregnancy rates or the laparoscopic appearances of the disease, but 60 mg dydrogesterone significantly reduced pain compared with placebo. Long-term follow up suggests that the natural history of pain associated with endometriosis is improvement. The lack of correlation between AFS (American Fertility Society) score and pain suggests that either endometriosis does not cause pain, that the current classification is inadequate or that some factor other some other factors such as peritoneal fluid cytokines or proliferation may be involved. Women with endometriosis were compared with women without the disease. Peritoneal fluid cytokines and endometrial gland and stromal cell proliferation in vitro were studied. No relationship was demonstrated between peritoneal fluid cytokine levels or proliferation in vitro with either pain or AFS score. In conclusion, there is only a poor correlation between laparoscopic appearance and pain and some other factor (s) may cause the pain associated with endometriosis.

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