Neurobiological changes in women with endometriosis and endometriosis-independent chronic pelvic pain

L. Maulitz, Susanne Nehls, Elmar Stickeler, Atanas Ignatov, Tomáš Kupec, A. Henn, Natalia Chechko, S.N. Tchaikovski
In: Geburtshilfe und Frauenheilkunde · 2024 · vol. 84(10) , pp. e243–e244 · doi:10.1055/s-0044-1791026 · W4403328425
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This research investigated neurobiological changes in women diagnosed with endometriosis and those experiencing endometriosis-independent chronic pelvic pain.

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This prospective study investigated neurobiological differences in women with symptomatic endometriosis compared to those with endometriosis-independent chronic pelvic pain and healthy controls. Researchers utilized MRI-based voxel- and surface-based morphometry alongside thermal pain perception assessments to evaluate gray matter volume and cortical thickness across fifty-three patients and twenty-five controls. The results revealed that women with endometriosis exhibited increased gray matter volume in the left cerebellum, lingual gyrus, and calcarine gyrus, whereas the pain-only group showed decreased volume in the right cerebellum relative to controls. These distinct structural patterns support the existence of a unique "endometriosis brain" phenotype, even when pain intensity and mental burden are comparable between groups. This paper is centrally about endometriosis — specifically examining its association with distinct neurobiological changes in gray matter volume compared to other causes of chronic pelvic pain.

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Introduction

Endometriosis is a chronic disease affecting women of reproductive age that presents with pain and infertility often accompanied by mental disorders. However, neurobiological changes induced by endometriosis remain underinvestigated.

Materials and methods

Fifty-three women with suspicion of symptomatic endometriosis and 25 pain-free women were recruited into this prospective study. Sociodemographic, clinical and psychological characteristics were collected using questionaries and a structured clinical interview. Thermal pain perception and voxel- and surface-based morphometry were assessed using thermode and MRI, respectively. Thereafter, the patients underwent a laparoscopy, where endometriosis was either histologically confirmed and removed or ruled out. Correspondingly, patients were assigned into groups with endometriosis (n=27) or endometriosis-independent chronic pelvic pain (CPP) (n=26) and compared to the controls.

Results

Despite comparable pain intensity and mental burden, both patient groups demonstrated distinct neurobiological patterns. Compared to the CPP group, women with endometriosis exhibited increased gray matter volume (GMV) in the left cerebellum, lingual gyrus and calcarine gyrus. Patients with CPP had decreased GMV in the right cerebellum as compared to controls. Dysmenorrhea severity correlated positively with GMV in the left inferior parietal lobule, whereas depressive symptoms were associated with decreased GMV in the right superior medial gyrus. Dyspareunia correlated negatively with cortical thickness in the left inferior temporal gyrus and left middle temporal gyrus.

Discussion

Our results suggest involvement of the cerebellum in pain perception and pathogenesis of endometriosis. Changes in GMV in patients with endometriosis differ from those in women with endometriosis-independent CPP supporting the hypothesis on the “endometriosis brain”. Publication History Article published online: 01 October 2024 © 2024. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

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endometriosischronic_pelvic_pain

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