{"paper_id":"4e842edb-c975-4073-82f4-b5ecf2288b74","body_text":"Abstract\nEndometriosis is a chronic inflammatory disease that affects women during their reproductive years. Endometriotic lesions can be disseminated in the myometrium (adenomyosis uteri) or are generally localized in the pelvis and are rarely found in the upper abdomen (endometriosis genitalis externa or extragenitalis). These lesions lead to chronic inflammation.\nThe intense pain caused by endometriosis is manifold. In addition to nociceptive pain, there is also a nociplastic reaction with central sensitization. Atypical symptoms such as acyclic lower abdominal pain, radiating pain, non-specific bladder and intestinal complaints or even depressions are frequent as are classic cyclical complaints such as severe dysmenorrhea, cyclical lower abdominal pain, dyspareunia, dysuria and dyschezia. In cases of a diffuse range of symptoms, patients often consult not just gynaecologists but also specialists from other disciplines (internal medicine, gastroenterology, orthopaedics, pain therapy, psychology, etc.).\nThe origin of pain is complex. Both peripheral and central sensitization of pain mechanisms but also hormonal, psychological and muscular changes play a major role in the pain process.\nAccess this chapter\nTax calculation will be finalised at checkout\nPurchases are for personal use only\nSimilar content being viewed by others\nReferences\nLeyendecker G, Herbertz M, Kunz G, Mall G. Endometriosis results from the dislocation of basal endometrium. Hum Reprod. 2002;17(10):2725–36.\nExacoustos C, Luciano D, Corbett B, De Felice G, Di Feliciantonio M, Luciano A, et al. The uterine junctional zone: a 3-dimensional ultrasound study of patients with endometriosis. Am J Obstet Gynecol. 2013;209(3):248. e1–. e7.\nDueholm M, Lundorf E, Hansen ES, Sørensen JS, Ledertoug S, Olesen F. Magnetic resonance imaging and transvaginal ultrasonography for the diagnosis of adenomyosis. Fertil Steril. 2001;76(3):588–94.\nLeyendecker G, Wildt L. Evolutionäre Aspekte in der Pathogenese und Pathophysiologie von Adenomyose und Endometriose. Journal für Gynäkologische Endokrinologie/Österreich. 2019;29(4):110–21.\nIbrahim MG, Sillem M, Plendl J, Chiantera V, Sehouli J, Mechsner S. Myofibroblasts are evidence of chronic tissue microtrauma at the endometrial–myometrial junctional zone in uteri with adenomyosis. Reprod Sci. 2017;24(10):1410–8.\nCousins FL, Gargett CE. Endometrial stem/progenitor cells and their role in the pathogenesis of endometriosis. Best Pract Res Clin Obstet Gynaecol. 2018;50:27–38.\nGuo S-W. The pathogenesis of adenomyosis Vis-à-Vis endometriosis. J Clin Med. 2020;9(2):485.\nSymons LK, Miller JE, Kay VR, Marks RM, Liblik K, Koti M, et al. The immunopathophysiology of endometriosis. Trends Mol Med. 2018;24(9):748–62.\nBarcena de Arellano ML, Gericke J, Reichelt U, Okuducu AF, Ebert AD, Chiantera V, et al. Immunohistochemical characterization of endometriosis-associated smooth muscle cells in human peritoneal endometriotic lesions. Hum Reprod. 2011;26(10):2721–30.\nMechsner S, Bartley J, Infanger M, Loddenkemper C, Herbel J, Ebert AD. Clinical management and immunohistochemical analysis of umbilical endometriosis. Arch Gynecol Obstet. 2009;280(2):235–42.\nDe Graaff A, D'hooghe T, Dunselman G, Dirksen C, Hummelshoj L, Consortium WE, et al. The significant effect of endometriosis on physical, mental and social wellbeing: results from an international cross-sectional survey. Hum Reprod. 2013;28(10):2677–85.\nGreene R, Stratton P, Cleary SD, Ballweg ML, Sinaii N. Diagnostic experience among 4,334 women reporting surgically diagnosed endometriosis. Fertil Steril. 2009;91(1):32–9.\nBallweg ML. Impact of endometriosis on women's health: comparative historical data show that the earlier the onset, the more severe the disease. Best Pract Res Clin Obstet Gynaecol. 2004;18(2):201–18.\nMechsner S. Endometriose. Schmerz. 2016;30(5):477–90.\nAnaf V, Simon P, El Nakadi I, Fayt I, Buxant F, Simonart T, et al. Relationship between endometriotic foci and nerves in rectovaginal endometriotic nodules. Hum Reprod. 2000;15(8):1744–50.\nBarcena de Arellano ML, Mechsner S. The peritoneum–an important factor for pathogenesis and pain generation in endometriosis. J Mol Med (Berl). 2014;92(6):595–602.\nHoffman D. Central and peripheral pain generators in women with chronic pelvic pain: patient centered assessment and treatment. Curr Rheumatol Rev. 2015;11(2):146–66.\nAredo JV, Heyrana KJ, Karp BI, Shah JP, Stratton P. Relating chronic pelvic pain and endometriosis to signs of sensitization and myofascial pain and dysfunction. Semin Reprod Med. 2017;35(1):88–97.\nNg N, Wahl K, Orr NL, Noga H, Williams C, Allaire C, et al. Endometriosis and negative perception of the medical profession. J Obstet Gynaecol Can. 2020;42(3):248–55.\nAs-Sanie S, Harris RE, Napadow V, Kim J, Neshewat G, Kairys A, et al. Changes in regional gray matter volume in women with chronic pelvic pain: a voxel-based morphometry study. PAIN®. 2012;153(5):1006–14.\nAuthor information\nAuthors and Affiliations\nCorresponding author\nEditor information\nEditors and Affiliations\nRights and permissions\nCopyright information\n© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG\nAbout this chapter\nCite this chapter\nMechsner, S. (2022). Endometriosis in Reproductive Years: The Origin of Pain in Endometriosis and Adenomyosis. In: Oral, E. (eds) Endometriosis and Adenomyosis. Springer, Cham. https://doi.org/10.1007/978-3-030-97236-3_15\nDownload citation\nDOI: https://doi.org/10.1007/978-3-030-97236-3_15\nPublished:\nPublisher Name: Springer, Cham\nPrint ISBN: 978-3-030-97235-6\nOnline ISBN: 978-3-030-97236-3\neBook Packages: MedicineMedicine (R0)","source_license":"CC0","license_restricted":false}