Androgens, Endometriosis and Pain

Susan Evans, Susan F Evans, M Louise Hull, Mark R Hutchinson, Paul E Rolan, Paul Rolan
Frontiers in reproductive health · 2021 · vol. 3 , pp. 792920 · doi:10.3389/frph.2021.792920 · PMID:36303965 · PMC9580713 · W4200425398
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⚙ AI-generated summary by claude@2026-06, 2026-06-09 ⓘ

This paper explores the inverse relationship between androgen levels and pelvic pain in women, proposing androgens may be protective against endometriosis-associated pain and dysmenorrhea.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-09 ⓘ

This paper expands on prior presentations and publications investigating how circulating androgens relate to dysmenorrhea-related pelvic pain, period pain, and headache, using high-sensitivity LC-MS to measure 10 steroid hormones at two points in a single menstrual cycle (Day 1–2 vs Day 7–10) in young women with and without oral contraceptive use. The authors report a strong inverse correlation between the Free Androgen Index and days per month of pelvic and period pain in oral-contraceptive non-users, with evidence of weaker or context-dependent relationships for estrogen and limited correlation signals under oral contraceptive use, and they frame a limitation that pain measures do not necessarily track with endometriosis lesion burden. They further synthesize evidence that inflammation may lower androgen levels, and propose a neuroimmune/inflammation-centered model linking dysmenorrhea, chronic pelvic pain, and endometriosis, while discussing supporting data from autoimmune and other inflammatory conditions and observations from transgender hormone transitions. Relevance to endometriosis: the paper focuses on androgen–pain biology but explicitly discusses endometriosis in its inflammation-based hypothesis, including claims of reduced testosterone in women with endometriosis and infertility and a proposed role for inflammation in impaired clearance of endometrial cells, making it directly relevant to endometriosis mechanisms and chronic pelvic pain.

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Abstract

The intriguing relationship between androgens, endometriosis and chronic pain continues to unfold. Determining this relationship is of crucial importance to gynecologists managing people with these conditions, as common treatments dramatically alter her hormonal profiles, with both intended and unintended consequences. Although they may be present in the same individual, there is a recognized disconnect between pain or pain-related symptoms, and the presence or extent of endometriosis lesions. Reduced androgen levels provide a potential mechanism to link the development of endometriosis lesions and the presence of chronic pain. This research paper expands the presentation of our research at the World Endometriosis Congress in 2021, subsequently published in the Journal of Pain Research which demonstrated a strong inverse relationship between androgen levels and days per month of pelvic and period pain. Here we extend and further explore the evidence for a role for androgens in the etiology and management of dysmenorrhea and pelvic pain in women, both with and without endometriosis. We explore the potential for inflammation to induce low androgen levels and consider ways in which clinicians can optimize levels of androgens when treating women with these conditions. This article prompts the question: Is it estrogens that predispose people to a life of pain, or androgens that are protective?

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Condition tags

endometriosisdysmenorrhea

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