Pathophysiological aspects of pain syndrome in endometriosis: A review

Indira V. Sahautdinova, Aida U. Hamadyanova, Liliana R. Gimazetdinova, Elvina R. Bashirova, Batyrhan S. Fatkullin, Radmila R. Hamidullina
In: Gynecology · 2022 · vol. 24(1) , pp. 18–23 · doi:10.26442/20795696.2022.1.201361 · W4293180548
review OA: gold CC0 ⤵ 2 in-corpus citations
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This review identifies and compares six sequential pathophysiological mechanisms contributing to the persistent pain syndrome in endometriosis, highlighting areas for further clinical investigation.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-08 ⓘ

This 2022 literature review synthesizes current knowledge on the pathophysiological mechanisms underlying pain syndrome in endometriosis, focusing on how inflammatory and nociceptive processes evolve beyond purely lesion burden, using published clinical and mechanistic studies. The authors summarize six interrelated mechanisms that sequentially activate and reinforce each other to produce persistent pain, emphasizing that pain intensity often does not correlate with the volume or morphological stage of affected tissue and may persist after lesion removal; they also note that gaps remain in the described mechanisms and that additional clinical studies are needed. Key components highlighted include cyclic bleeding from ectopic endometrial tissue with associated inflammation, elevated inflammatory mediators (e.g., PGE2, TNF-α, nerve growth factor, interleukins), oxidative stress products that can activate nociceptors, and mediator-induced irritation of nerve endings. This paper is centrally about endometriosis — it reviews mechanisms of chronic pelvic pain pathophysiology in endometriosis.

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Abstract

Endometriosis is a chronic and debilitating disease with chronic pelvic pain and infertility. This pathology affects 1 in 10 women worldwide. Chronic pelvic pain is the main complaint of patients with endometriosis, which causes the most discomfort and has a strong impact on the quality of life. Today, the main generally accepted criterion for the severity of pain is the volume of the affected tissue, but most often it does not correspond to the real pain sensations of the patients. In this review of the literature, we have identified and compared the main pathophysiological mechanisms of the development of pain in endometriosis, which help to answer some urgent questions. We have identified 6 mechanisms that sequentially activate and reinforce each other's action, leading to the formation of persistent pain syndrome. There are still gaps in the pathophysiological mechanisms described by us, which requires additional clinical studies. A better understanding of the pathophysiology of pain in endometriosis will help improve diagnostic capabilities, as well as treatment that will be directed at each link in the pathological process.

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Condition tags

endometriosischronic_pelvic_paininfertility

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Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

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last seen: 2026-06-10T17:14:06.276822+00:00
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