Pain Beyond Endometriosis: The Mimicry of Gynecological Pain and the Role of Myofascial Syndrome. Hormones, Fascia, Neurons — A Perspective on Pathophysiology and Therapy | Ukrainian Medical Journal

Bilodid O.O.,Gordiichuk O.O.

Main
Publications
Pain Beyond Endometriosis: The Mimicry of Gynecological Pain and the Role of Myofascial Syndrome. Hormones, Fascia, Neurons — A Perspective on Pathophysiology and Therapy

Pain Beyond Endometriosis: The Mimicry of Gynecological Pain and the Role of Myofascial Syndrome. Hormones, Fascia, Neurons — A Perspective on Pathophysiology and Therapy

March 24, 2025

102

Obstetrics and Gynecology

Neurology and Psychiatry

Bilodid O.O.

Gordiichuk O.O.

УДК: 611.96:616-009.7

DOI: 10.32471/umj.1680-3051.264244

Keywords :

multidisciplinary approach,

Specialities :

Obstetrics and Gynecology

Neurology and Psychiatry

Resume

Chronic pelvic pain is a complex interdisciplinary problem often associated with endometriosis. However, not all cases of pelvic pain are directly linked to endometriotic lesions. In many patients, myofascial pelvic pain syndrome plays a crucial role in pain pathogenesis, characterized by muscle hypertonicity, trigger points, and fascial dysfunctions. Due to gynecological pain mimicry, myofascial pelvic pain syndrome often remains undiagnosed, leading to ineffective hormonal treatment or repeated surgical interventions. This article explores the pathophysiological mechanisms linking endometriosis and myofascial syndrome, including the role of hormonal imbalance, inflammatory mediators, and neural sensitization. Differential diagnosis is discussed, incorporating trigger point palpation, functional tests (Freiberg’s, Pace’s, Thomas test), and instrumental methods such as electromyography and biofeedback. Emphasis is placed on an individualized treatment approach, combining hormonal therapy, muscle relaxants, NSAIDs, neuropathic analgesics, and non-pharmacological interventions (myofascial release, physiotherapy, cognitive-behavioral therapy, neuromuscular rehabilitation). A multidisciplinary strategy is proposed as the key to effective pain management in patients with a combination of endometriosis and myofascial syndrome.

References

1. Mackey S. (2024) The 2024 ACPA-Stanford Resource Guide for Chronic Pain Management: A comprehensive, free resource for people in pain Newly revised release of the American Chronic Pain Association-Stanford Resource Guide to Chronic Pain Management.
2. Lu Y., Cheng J., Fan B. et al. (2018) ICD-11 Chinese compilation of chronic pain classification. Zhongguo Tengtong Yixue Zazhi., 24: 801–805.
3. Jarrell J.F., Vilos G.A., Allaire C. et al. ((2005)) Consensus Guidelines for the Management of Chronic Pelvic Pain. J. Obstetr. Gynaecol. Canada, 27(9): 869–887.
4. Travell J.G., Simons D.G. (2010) Myofascial Pain and Dysfunction: The Trigger Point Manual. International Pelvic Pain Society (IPPS).
5. Myers T.W. (2020) Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists. 4th ed. Elsevier.
6. Standring H. (2020) Gray’s Anatomy: The Anatomical Basis of Clinical PracticeStandring, S. (Ed.). Gray’s Anatomy: The Anatomical Basis of Clinical Practice. 42nd ed. Elsevier.
7. Gyhagen M., Åkervall S., Milsom I. (2015) Clustering of pelvic floor disorders 20 years after one vaginal or one cesarean birth. Int. Urogynecol. J., 26: 1115–1121.
8. Sharkey J. (2021) Fascia and Tensegrity The Quintessence of a Unified Systems Conception. Int. J. Anat. Applied Physiol. DOI: 10.19070/2572-7451-2100032.
9. Wallace Sh.L., Miller L.D., Mishra K. (2019) Pelvic floor physical therapy in the treatment of pelvic floor dysfunction in women Wolters Kluwer Health, 31. http://www.co-obgyn.com.
10. International Continence Society Guidelines on Pelvic Floor Rehabilitation International Continence Society (ICS). Guidelines on Pelvic Floor Rehabilitation http://www.ics.org.
11. Gedeon Richter Plc. Data on fi le. Randomized, open-label, 2-way crossover bioequivalence study of dienogest 2 mg fi lm-coated tablet and visanne (reference) following a 2 mg dose in healthy subjects under fasting conditions. Final Integrated Clinical and Statistical Report, Version 01, 2 October 2015.
12. Grover A., Pawar E., Singh G.K. et al. (2022) Aceclofenac, a preferential COX-2 inhibitor — appraisal of safety and tolerability. J. Evolution Med. Dent. Sci., 11(07): 690698.
13. http://www.eshre.eu/Annual-Meeting/ESHRE2022.
14. Römer T. (2018) Long-term treatment of endometriosis with dienogest: retrospective analysis of efficacy and safety in clinical practice. Arch. Gynecol. Obstet., 298(4): 747–753.
15. Hayashi A., Tanabe A., Kawabe S. et al. (2012) Dienogest increases the progesterone receptor isoform B/A ratio in patients with ovarian endometriosis. J. Ovarian Res., 5(1): 31.
16. patient-info.co.uk/sawis-2-mg-tablets-93850/summary-of-medicine-characteristics.
17. Takagi H., Sakamoto J., Sasagawa T. (2019) Long-term treatment of endometriosis with dienogest for up to five years. Clin. Exp. Obstet. Gynecol., 46(3): 398–402.
18. Park J.C., Kim D.J. (2023) P-320 Change of bone mineral density after long-term use of dienogest with calcium and vitamin D supplementation after surgical treatment of endometrioma. Human Reproduction, 38(Suppl. 1): dead093.678.
19. Othman E.R., Al-Hendy A., Mostafa R. et al. (2024) Oral GnRH Antagonists in Combination with Estradiol and Norethindrone Acetate for Pain Relief Associated with Endometriosis: A Review of Evidence of a Novel Class of Hormonal Agents. Int. J. Womens Health, 16: 309–321. doi.org/10.2147/IJWH.S442357.
20. Xin L., Ma Y., Ye M. et al. (2023) Efficacy and safety of oral gonadotropin-releasing hormone antagonists in moderate-to-severe endometriosis-associated pain: a systematic review and network meta-analysis. Arch. Gynecol. Obstet., 308: 1047–1056.
21. Donnez J., Dolmans M.-M. (2021) GnRH Antagonists with or without Add-Back Therapy: A New Alternative in the Management of Endometriosis? Int. J. Mol. Sci., 22: 11342.
22. Harada T., Osuga Y., Suzuki Y. et al. (2022) Relugolix an oral gonadotropin-releasing hormone receptor antagonist, reduces endometriosis-associated pain compared with leuprorelin in Japanese women: a phase 3, randomized, double-blind, noninferiority study. Fertil Steril, 117(3): 583–592.
23. GnRH-Antagonists in the Treatment of Endometriosis — Does the brain work better? Wolfgang Kupker, MD by Endofound Org, Posted on May 2, 2024.
24. Becker Ch.M., Johnson N.P., As-Sanie S. et al. (2024) Two-year efficacy and safety of relugolix combination therapy in women with endometriosis-associated pain: SPIRIT open-label extension study. Human Reproduction. doi: 10.1093/humrep/dead263.