Endometrioseschmerz beherrschen

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AI-generated summary by claude@2026-06+body, 2026-06-12

This review outlines endometriosis pathophysiology and complexity, discussing pain management, nutritional advice, psychological support, and physiotherapy alongside hormonal and surgical treatments.

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The paper examines the pain pathophysiology of endometriosis, describing both nociceptive pain and nociplastic central sensitization that contribute to a wide spectrum of symptoms, including classical cyclical complaints and atypical acyclic or radiating pain plus non-specific bladder and intestinal symptoms and depression. It presents a high-level overview arguing that, because patients consult multiple specialties for overlapping symptom presentations, management should be multimodal and interdisciplinary alongside standard hormonal and surgical therapies typically supervised by gynecologists. The authors’ central finding is that incorporating pain management, dietary counseling, psychological support, and physiotherapy into the treatment plan can improve complex symptom burden and quality of life in chronic symptomatic disease, while the stated limitation is that the contribution is an overview rather than results from new human or animal studies. This paper is centrally about endometriosis — it focuses on multimodal interdisciplinary approaches to manage complex endometriosis-associated pain mechanisms and symptoms.

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Abstract

BackgroundEndometriosis is associated with various types of intense pain. 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 depression are frequent as are classic cyclical complaints such as severe dysmenorrhea, cyclical lower abdominal pain, dyspareunia, dysuria and dyschezia. In cases of a diverse range of symptoms, patients often consult not just gynecologists but specialists from other disciplines (e.g., internal medicine, gastroenterology, orthopedics, pain therapy, psychology).AimsOverview about the pathophysiology and complexity of the disease and the resulting treatment options. A multimodal interdisciplinary concept might be able to take into consideration all aspects of the complex disease.MethodsInterdisciplinary concepts should be involved in the treatment of endometriosis patients along with hormonal and surgical therapy, which are generally under the supervision of a gynecologist. Pain management, dietary changes, psychological support, as well as physiotherapy should be included. The present article is intended to provide an overview of possible treatment strategies for chronic, symptomatic endometriosis.ConclusionThe use of multimodal treatment strategies regarding the complex pathophysiological aspects of this disease might be helpful in significantly improving the quality of life of endometriosis patients.
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Abstract

Background Endometriosis is associated with various types of intense pain. 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 depression are frequent as are classic cyclical complaints such as severe dysmenorrhea, cyclical lower abdominal pain, dyspareunia, dysuria and dyschezia. In cases of a diverse range of symptoms, patients often consult not just gynecologists but specialists from other disciplines (e.g., internal medicine, gastroenterology, orthopedics, pain therapy, psychology). Aims Overview about the pathophysiology and complexity of the disease and the resulting treatment options. A multimodal interdisciplinary concept might be able to take into consideration all aspects of the complex disease.

Methods

Interdisciplinary concepts should be involved in the treatment of endometriosis patients along with hormonal and surgical therapy, which are generally under the supervision of a gynecologist. Pain management, dietary changes, psychological support, as well as physiotherapy should be included. The present article is intended to provide an overview of possible treatment strategies for chronic, symptomatic endometriosis.

Conclusion

The use of multimodal treatment strategies regarding the complex pathophysiological aspects of this disease might be helpful in significantly improving the quality of life of endometriosis patients. Similar content being viewed by others Literatur Aredo JV, Heyrana KJ, Karp BI et al (2017) Relating chronic pelvic pain and endometriosis to signs of sensitization and myofascial pain and dysfunction. Semin Reprod Med 35:88–97 As-Sanie S, Harris RE, Napadow V et al (2012) Changes in regional gray matter volume in women with chronic pelvic pain: a voxel-based morphometry study. Pain 153:1006–1014 Ata B, Yildiz S, Turkgeldi E et al (2019) The endobiota study: comparison of vaginal, cervical and gut Microbiota between women with stage 3/4 endometriosis and healthy controls. Sci Rep 9:2204 Ballweg ML (2004) 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 18:201–218 Barcena De Arellano ML, Mechsner S (2014) The peritoneum—an important factor for pathogenesis and pain generation in endometriosis. J Mol Med 92:595–602 Becker CM, Gattrell WT, Gude K et al (2017) Reevaluating response and failure of medical treatment of endometriosis: a systematic review. Fertil Steril 108:125–136 Bergeron S, Morin M, Lord M‑J (2010) Integrating pelvic floor rehabilitation and cognitive-behavioural therapy for sexual pain: what have we learned and were do we go from here? Sex Relatsh Ther 25:289–298 Berman BM, Langevin HM, Witt CM et al (2010) Acupuncture for chronic low back pain. N Engl J Med 363:454–461 Borrelli G, Carvalho K, Kallas E et al (2013) Chemokines in the pathogenesis of endometriosis and infertility. J Reprod Immunol 98:1–9 Bouaziz J, Bar OA, Seidman DS et al (2017) The clinical significance of endocannabinoids in endometriosis pain management. Cannabis Cannabinoid Res 2:72–80 Brandes I, Neuser M, Kopf A et al (2017) Endometriosis-associated pain in patients with and without hormone therapy. J Endometr Pelvic Pain Disord 9:200–205 Campo S, Campo V, Benagiano G (2012) Adenomyosis and infertility. Reprod Biomed Online 24:35–46 Chapron C, Marcellin L, Borghese B et al (2019) Rethinking mechanisms, diagnosis and management of endometriosis. Nat Rev Endocrinol 15:666–682 Chapron C, Pietin-Vialle C, Borghese B et al (2009) Associated ovarian endometrioma is a marker for greater severity of deeply infiltrating endometriosis. Fertil Steril 92:453–457 Cousins FL, Gargett CE (2018) Endometrial stem/progenitor cells and their role in the pathogenesis of endometriosis. Best Pract Res Clin Obstet Gynaecol 50:27–38 Davidson MJ, Bryant A, Frawley H (2014) Perineal muscle stiffness in women with and without vulvodynia: reliability of measurement and differences in muscle stiffness. Neurourol Urodyn 33:Abstract 46 De Graaff A, D’hooghe T, Dunselman G et al (2013) The significant effect of endometriosis on physical, mental and social wellbeing: results from an international cross-sectional survey. Hum Reprod 28:2677–2685 De Ziegler D, Borghese B, Chapron C (2010) Endometriosis and infertility: pathophysiology and management. Lancet 376:730–738 Finas D, Hüppe M, Diedrich K et al (2005) Chronischer Unterbauchschmerz am Beispiel der Endometriose – Problempatientin in der Gynäkologie? Geburtshilfe Frauenheilkd 65:156–163 Greene R, Stratton P, Cleary SD et al (2009) Diagnostic experience among 4,334 women reporting surgically diagnosed endometriosis. Fertil Steril 91:32–39 Häuser W (2021) Endometriose und chronische überlappende Schmerzsyndrome. Schmerz. https://doi.org/10.1007/s00482-021-00535-8 He W, Liu X, Zhang Y et al (2010) Generalized hyperalgesia in women with endometriosis and its resolution following a successful surgery. Reprod Sci 17:1099–1111 Henzl MR, Buttram V, Segre EJ et al (1977) The treatment of dysmenorrhea with naproxen sodium: a report on two independent double-blind trials. Am J Obstet Gynecol 127:818–823 Hoffman D (2015) Central and peripheral pain generators in women with chronic pelvic pain: patient centered assessment and treatment. Curr Rheumatol Rev 11:146–166 Hudelist G et al (2012) Diagnostic delay for endometriosis in Austria and Germany: causes and possible consequences. Hum Reprod 27(12):3412–3416. https://doi.org/10.1093/humrep/des316 Ibrahim MG, Sillem M, Plendl J et al (2017) Myofibroblasts are evidence of chronic tissue microtrauma at the endometrial–myometrial junctional zone in uteri with adenomyosis. Reprod Sci 24:1410–1418 Johnson NP, Hummelshoj L, Adamson GD et al (2017) World Endometriosis Society consensus on the classification of endometriosis. Hum Reprod 32:315–324 Köhler G, Faustmann TA, Gerlinger C et al (2010) A dose-ranging study to determine the efficacy and safety of 1, 2, and 4 mg of dienogest daily for endometriosis. Int J Gynecol Obstet 108:21–25 Lasco A, Catalano A, Benvenga S (2012) Improvement of primary dysmenorrhea caused by a single oral dose of vitamin D: results of a randomized, double-blind, placebo-controlled study. Arch Intern Med 172:366–367 Leitlinie der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) (2020) „Diagnostik und Therapie der Endometriose“, https://eref.thieme.de/cockpits/0/0/coAWMF015-045/0. Zugegriffen: 10.03.2021 Leyendecker G, Wildt L (2019) Evolutionäre Aspekte in der Pathogenese und Pathophysiologie von Adenomyose und Endometriose. J Gynäkol Endokrinol AT 29:110–121 Lund I, Lundeberg T (2016) Is acupuncture effective in the treatment of pain in endometriosis? J Pain Res 9:157–165 Mariani M, Viganò P, Gentilini D et al (2012) The selective vitamin D receptor agonist, elocalcitol, reduces endometriosis development in a mouse model by inhibiting peritoneal inflammation. Hum Reprod 27:2010–2019 Mechsner S (2016) Endometriose. Schmerz 30:477–490 Mira TA, Buen MM, Borges MG et al (2018) Systematic review and meta-analysis of complementary treatments for women with symptomatic endometriosis. Int J Gynecol Obstet 143:2–9 Mira TA, Giraldo PC, Yela DA et al (2015) Effectiveness of complementary pain treatment for women with deep endometriosis through Transcutaneous Electrical Nerve Stimulation (TENS): randomized controlled trial. Eur J Obstet Gynecol Reprod Biol 194:1–6 Miyashita M, Koga K, Izumi G et al (2016) Effects of 1,25-Dihydroxy vitamin D3 on endometriosis. J Clin Endocrinol Metab 101:2371–2379 Ng N, Wahl K, Orr NL et al (2020) Endometriosis and negative perception of the medical profession. J Obstet Gynaecol Can 42:248–255 Nodler JL, Divasta AD, Vitonis AF et al (2020) Supplementation with vitamin D or ω‑3 fatty acids in adolescent girls and young women with endometriosis (SAGE): a double-blind, randomized, placebo-controlled trial. Am J Clin Nutr 112:229–236 Rubin R (2019) Botulinum toxin to treat endometriosis pain. JAMA 322:716–716 Seo J‑W, Lee D‑Y, Yoon B‑K et al (2017) Effects of long-term postoperative dienogest use for treatment of endometriosis on bone mineral density. Eur J Obstet Gynecol Reprod Biol 212:9–12 Shakiba K, Bena JF, Mcgill KM et al (2008) Surgical treatment of endometriosis: a 7‑year follow-up on the requirement for further surgery. Obstet Gynecol 111:1285–1292 Sillem M, Juhasz-Böss I, Klausmeier I et al (2016) Osteopathy for endometriosis and chronic pelvic pain—a pilot study. Geburtshilfe Frauenheilkd 76:960 Stein C, Clark JD, Oh U et al (2009) Peripheral mechanisms of pain and analgesia. Brain Res Rev 60:90–113 Stratton P, Khachikyan I, Sinaii N et al (2015) Association of chronic pelvic pain and endometriosis with signs of sensitization and myofascial pain. Obstet Gynecol 125:719–728 Strowitzki T, Marr J, Gerlinger C et al (2010) Dienogest is as effective as leuprolide acetate in treating the painful symptoms of endometriosis: a 24-week, randomized, multicentre, open-label trial. Hum Reprod 25:633–641 Vercellini P, Somigliana E, Vigano P et al (2009) Surgery for endometriosis-associated infertility: a pragmatic approach. Hum Reprod 24:254–269 Weinschenk S (2015) Neuraltherapie in der Gynäkologie. Gynäkologe 48:20–27 Wienhard J, Tinneberg H (2003) Alternative treatment possibilities of complaints due to endometriosis. Zentralbl Gynakol 125:286–289 Yaraghi M, Ghazizadeh S, Mohammadi F et al (2019) Comparing the effectiveness of functional electrical stimulation via sexual cognitive/behavioral therapy of pelvic floor muscles versus local injection of botulinum toxin on the sexual functioning of patients with primary vaginismus: a randomized clinical trial. Int Urogynecol J Pelvic Floor Dysfunct 30:1821–1828 Author information Authors and Affiliations Corresponding author Ethics declarations Interessenkonflikt S. Mechsner gibt an, dass kein Interessenkonflikt besteht. Für diesen Beitrag wurden von der Autorin keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien. Rights and permissions About this article Cite this article Mechsner, S. Endometrioseschmerz beherrschen. Schmerz 35, 159–171 (2021). https://doi.org/10.1007/s00482-021-00543-8 Received: Revised: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s00482-021-00543-8

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Condition tags

dysmenorrheadyspareuniaendometriosischronic_pelvic_pain

MeSH descriptors

Dyspareunia Dyspareunia Dyspareunia Endometriosis Endometriosis Constipation Dysmenorrhea Female Humans Pelvic Pain Pelvic Pain Pelvic Pain Quality of Life

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