Abstract
Endometriosis is a chronic inflammatory condition, which is distinguished by the presence of the endometrial-like glands and stroma outside the uterine cavity. Pain and infertility are the most commonly expressed symptoms, occurring in 60% and 40% of cases, respectively. Women with endometriosis, especially those with pelvic pain, also have a greater vulnerability to several psychiatric disorders. There is, in particular, a tendency to contract affective or anxiety disorders as well as panic-agoraphobic and substance use disorders. Endometriosis with pelvic pain, infertility and psychic vulnerability usually leads to disability and a markedly lower quality of life for women of reproductive age. Thus, the burden of endometriosis is not limited to the symptoms and dysfunctions of the disease; it extends to the social, working and emotional spheres, leading to a severe impairment of global functioning. An analysis of scientific literature revealed a close relationship between specific temperamental traits, the expression of several psychiatric symptoms, chronicity of pain, risk of substance use and lower probability of a positive outcome. Endometriosis symptoms and the impact of related psychological consequences, increased vulnerability and the possible onset of psychiatric symptoms may influence coping strategies and weaken resilience, so triggering a vicious cycle leading to a marked deterioration in the quality of life. A multidisciplinary approach consisting of a medical team composed of gynecologists, psychologists, psychiatrists, experts in Dual Disorder, algologists and sexologists, would guarantee the setting of a target and taking the best decision on a personalized treatment plan. That approach would allow the prompt detection of any psychopathological symptoms and improve the endometriosis-related physical symptoms, bringing a healthier quality of life and a greater likelihood of a positive outcome.
Highlights
Endometriosis is a chronic and progressive disorder with multifactorial etiopathogenesis, characterized by the anomalous presence of endometrial-like glands and stroma outside the uterine cavity, resulting in an estrogen-dependent chronic inflammatory reaction [1,2,3].The ectopic endometrium is usually found on the pelvic peritoneum and in the pelvic organs, and it is affected by lesions proximal to the uterus such as the ovaries, salpinges, the ligaments of the cervix and uterus, and the surrounding pelvic peritoneum defining what is often called pelvic endometriosis
Endometriosis arises in organs and tissues outside or far from the pelvis, including the vagina, vulva, cervix and perineum, the urinary system, the gastrointestinal tract, the thoracic cavity, including the lungs and pleura, the extremities, skin, and central nervous system (CNS), all of which are involved in what is usually called extra-pelvic endometriosis [2,4]
The ectopic endometrium is alternatively located in the context of the myometrium, determining internal endometriosis or adenomyosis [2,4,8]
Summary
Endometriosis is a chronic and progressive disorder with multifactorial etiopathogenesis, characterized by the anomalous presence of endometrial-like glands and stroma outside the uterine cavity, resulting in an estrogen-dependent chronic inflammatory reaction [1,2,3]. Pain is the common thread of all the clinical endometriotic situations, and it can be fulfilled in different ways, depending on lesion localizations and temporary They can be represented by dysuria, dyschezia, dysmenorrhea, dyspareunia, cyclic and non-cyclic pain. CPP is defined as pain that occurs in the pelvic area (below the umbilicus) and lasts for at least six months, while being severe enough to cause functional disability or require medical or, in many cases, surgical treatment [53,54] It may or may not be associated with periods. The nervous system goes through a specific process called ‘wind-up’, so that it becomes set in a persistent state of high responsiveness This regulated, ongoing state of reactivity drops the threshold for all possible causes of pain, and subsequently takes on the role of maintaining pain even after the initial injury might have healed [56,57,58,59]. In any case, a hard task to distinct these aspects (endometriosis itself and pain), since they influence each other shared mechanisms, such as neural and immune-oxidative ones [81,82]
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