Increased tissue permeability and sympathetic nervous system hypofunction may be the common link between dysmenorrhea, chronic pelvic pain, Mittelschmerz, and Crohn’s disease

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Clinical and experimental obstetrics & gynecology · 2016 · vol. 43(1) , pp. 112–113 · doi:10.12891/ceog3159.2016 · PMID:27048029 · W2335918802
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This case supports the concept that periovulatory events may increase tissue permeability or impair sympathetic nervous system function, potentially linking dysmenorrhea, chronic pelvic pain, Mittelschmerz, and Crohn's disease.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-08 · read from full text ⓘ

This case report explores whether severe one-day periovulatory diarrhea in a woman with Crohn’s disease could be linked to cyclical hormonal changes that increase large-bowel permeability at mid-cycle, with a related hypothesis involving sympathetic nervous system hypofunction. The authors describe treatment with adalimumab that markedly improved Crohn’s disease, and then the administration of dextroamphetamine sulfate during a remaining episode of mid-cycle diarrhea; after pregnancy, the patient reported no diarrhea or frequent defecation for two preceding periovulatory periods. A key finding is that the prominent periovulatory diarrhea pattern ceased around conception, supporting the authors’ proposed mechanism, but the limitation is that this is a single-patient, non-controlled observation without broader data. Relevance to endometriosis: the paper argues that the classic symptoms of Mittelschmerz in women with endometriosis may relate to periovulatory events that drive tissue permeability or impair sympathetic nervous system function, even though the study is a Crohn’s disease case.

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Abstract

PURPOSE: To determine if severe periovulatory diarrhea in a woman with Crohn's disease for just one day may be related to increased permeability of the large bowel related to hormonal changes that occur at this time of menstrual cycle. MATERIALS AND METHODS: Dextroamphetamine sulfate was given to a woman whose Crohn's disease was markedly improved by adalimumab but who still had one day of severe diarrhea at mid-cycle. RESULTS: She did not have any diarrhea or frequent defecation for the first two periovulatory times before she achieved pregnancy. Previously for two years there had not been one month where she did not have the severe periovulatory diarrhea. CONCLUSIONS: This case helps support the concept that the classic symptoms of Mittelschmerz in women with endometriosis may be related to periovulatory events which either cause increased permeability of an already compromised tissue, whether it be pelvic or bowel or other tissues, or these periovulatory events impair sympathetic nervous system function, which is already impaired.
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Abstract

Purpose: To determine if severe periovulatory diarrhea in a woman with Crohn’s disease for just one day may be related to increased permeability of the large bowel related to hormonal changes that occur at this time of menstrual cycle. Materials and Methods: Dextroamphetamine sulfate was given to a woman whose Crohn’s disease was markedly improved by adalimumab but who still had one day of severe diarrhea at mid-cycle. Results: She did not have any diarrhea or frequent defecation for the first two periovulatory times before she achieved pregnancy. Previously for two years there had not been one month where she did not have the severe periovulatory diarrhea. Conclusions: This case helps support the concept that the classic symptoms of Mittelschmerz in women with endometriosis may be related to periovulatory events which either cause increased permeability of an already compromised tissue, whether it be pelvic or bowel or other tissues, or these periovulatory events impair sympathetic nervous system function, which is already impaired.

Keywords

- Sympathetic neural hyperalgesia edema syndrome - Endometriosis - Mittelschmerz - Crohn’s disease

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Condition tags

dysmenorrheachronic_pelvic_painendometriosis

MeSH descriptors

Autonomic Nervous System Diseases Chronic Pain Dysmenorrhea Pelvic Pain Adult Autonomic Nervous System Diseases Autonomic Nervous System Diseases Autonomic Nervous System Diseases Chronic Pain Chronic Pain Chronic Pain Dysmenorrhea Dysmenorrhea Dysmenorrhea Female Humans Pelvic Pain Pelvic Pain Pelvic Pain Permeability

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