Peak ACTH levels were significantly higher among those with chronic pain alone, or those with pain and endometriosis than normal controls. ACTH response curves differed from controls in women with pain, significantly differing with higher levels at 30 and 45 minutes. Cortisol response curves were similar for both groups. Of 18 women with chronic pelvic pain, 10 had a normal and 8 had an altered ACTH response. Mean depression and anxiety scores did not differ between normal and abnormal responders with chronic pelvic pain. Women with chronic pelvic pain and endometriosis, and to a lesser degree those with chronic pelvic pain alone, experience heightened ACTH secretion without corresponding changes in cortisol levels in response to Corticorelin Injection, similar to the pattern observed with fibromyalgia and chronic stress. This atypical ACTH response may indicate a relative immunodeficiency and could account for some of the immunologic changes and co-morbidities observed in these women.? ? To better understand endometriosis, chronic pelvic pain and its treatment, we have analyzed a survey of 4,334 Endometriosis Association members reporting surgically diagnosed endometriosis. We have investigated whether the first doctor seen and adolescent onset of symptoms impact the diagnostic process of endometriosis. Almost all respondents reported pelvic pain with 50% first consulting a gynecologist and 45% a generalist for symptoms of endometriosis. Women and girls who reported seeing a gynecologist first for symptoms of endometriosis were more likely to have a shorter time to diagnosis, see fewer physicians, and report a better experience overall with their physicians. The majority reported onset of symptoms during adolescence, who reported a longer time and a worse experience while obtaining a diagnosis.? ? We have also considered the relationship between disease severity and patient characteristics in endometriosis by analyzing questionnaires from 1,000 women in the Oxford Endometriosis Gene (OXEGENE) Study. Women were assigned to Group I (rAFS Stage I-II, n=423) or Group II (rAFS Stages III-IV, n=517). The most common symptoms leading to a diagnosis were dysmenorrhea and pelvic pain. Dyspareunia and depression were more common in Group I. In Group II, sub-fertility and an ovarian mass more commonly led to a diagnosis. Sub-fertility remained more common in Group II throughout reproductive life, but birth and miscarriage rates were similar. This study shows differences in characteristics of women with different stages of endometriosis, which may aid future clinical and epidemiological studies. Remarkably, the time to diagnosis was similar between women with different stages of disease.
