Chronic pelvic pain accounts for 10 percent of all gynecology visits; most women with chronic pelvic pain have endometriosis, a condition in which endometrial glands and stroma grow on pelvic surfaces outside the uterus. Chronic stress and depression blunt the ACTH and cortisol response curves following Corticotropic-Releasing Hormone stimulation. Patients with chronic pelvic pain experience both and are at risk of having an altered response. Stratton and her team of surgeons have continued to describe other causes of chronic pain in women with endometriosis, such as adenomyosis, appendiceal disease, or obdurator hernia. ? ? Of the women surveyed by the Endometriosis Association, 4,334 Endometriosis Association members reported surgically diagnosed endometriosis. In a subset of these women (1,160) reporting primarily having pelvic pain (95%), many women had tried 3+ medical treatments (46%) and had at least 3 surgical procedures (42%). Despite reporting various treatments as helpful, women used many different types and endured symptoms for an average of two decades, indicating the profound effect of endometriosis on womens health. ? ? 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.? ? Sinaii and Stratton 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.? ? In the coming year, we will continue examining aspects of the health of women with endometriosis by analyzing the Endometriosis Association Survey, continue efforts to define the pain outcomes in endometriosis clinical trials, and conduct analyses of endocrine responses in women with chronic pelvic pain related to endometriosis to determine whether there may be altered stress responses in chronic pelvic pain.
