When pain is misleading: diagnostic pitfalls in endometriosis. A multidisciplinary consensus of gynecologist, urologist, and neurologist

Chronic pelvic pain (CPP) in women is a frequent clinical challenge, which is often attributed to endometriosis. However, relying solely on this diagnosis can result in misdiagnosis, ineffective treatment, and decreased quality of patient’s life. Patients with CPP often have not only gynecological pathology, but also diseases of other organs and systems, which are characterized by a long course. Thus, the medical aspect of the problem is often combined with its social significance and requires a comprehensive approach.The article reviews the current literature, 5 clinical cases that illustrate alternative causes of pelvic pain are described. The evidence base on the pathogenesis of sensitization, the role of neuroinflammation and pelvic floor dysfunction are presented. The aim of this review was to analyze the cognitive errors in clinical thinking of doctors that lead to the overdiagnosis of endometriosis in pelvic pain, and to describe other possible causes: neuropathic pain, myofascial syndrome, interstitial cystitis, central sensitization.Cognitive biases, such as the habituation effect and focusing on a single diagnosis, have been shown to hinder adequate diagnosis. Central sensitization and cross-sensitization often explain the ineffectiveness of hormone therapy. The CSI-9 questionnaire, manual pelvic floor examination, and diagnosis of neuropathies are key elements of a correct diagnostic algorithm.Comprehensive management of women with CPP requires a multidisciplinary approach: the integration of a gynecologist, urologist, neurologist, physiotherapist, psychotherapist allows to increase the accuracy of diagnosis and the effectiveness of treatment. The combination of hormonal therapy with physical, psychoemotional and drug intervention at the level of the central nervous system is the optimal solution for most patients with resistant pain.