Endometriosis and the Brain: How Chronic Pain Affects Mental Health and Neurology"

Endometriosis is a systemic condition affecting many women of childbearing age. The most common symptoms include chronic pelvic pain, painful periods, painful intercourse, and even painful defecation. Science is still uncertain about the origins of this disease, but research suggests that a contributing factor might be retrograde menstruation, where menstrual blood flows backward through the Fallopian tubes and into the pelvis instead of exiting the body. Endometriosis is often misdiagnosed as other conditions, but when officially diagnosed via laparoscopic surgery, pathology reveals endometrial-like tissue growing outside the uterus. While endometriosis is considered a disorder of the reproductive system, the condition extends beyond the pelvis and may potentially alter gene expression in the brain [1].

A new term in the scientific literature, ‘endometriosis brain,’ has been proposed in conjunction with endometriosis. Many patients diagnosed with endometriosis are highly likely to also be diagnosed with anxiety or depression. While frequent episodes of chronic pain can affect mental health, endometriosis may also be associated with alterations in brain structure, function, and neuron connectivity [2]. Research suggests that the pelvic pain experienced in endometriosis may be both inflammatory and neuropathic due to the sensitization of the central nervous system. As a result, individuals with endometriosis may experience pain more intensely due to altered pain perception.

More research is needed to fully understand how endometriosis and chronic pain affect brain chemistry, but certain mechanisms involving neuropeptides and growth factors have been identified. Brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF) have both been found to be elevated in patients diagnosed with endometriosis. BDNF and NGF promote the proper functioning of neurons and help maintain the nervous system, but when present in high amounts, they can increase nerve fiber density around endometrial lesions, leading to heightened pain perception [3]. This persistent stimulation of endometrial lesions may remodel neuron synapses, resulting in accelerated conduction along nerve fibers and affecting how the cerebral cortex perceives pain.

The current medical standards for the treatment of endometriosis include hormone therapy, pain medication, and surgery. Balancing hormones is key, as this can prevent or slow the growth of endometrial tissue outside the uterus. Other modalities under research include the use of psychotherapy and acupuncture as potential ways to reduce pain by decreasing connectivity between the anterior hippocampus and the somatosensory cortex in the brain [4]. While still under investigation, alternative and complementary therapies to traditional medications are showing promise in managing the pain associated with endometriosis.

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Author: Dr. Kellyann Tomko, ND

References

1. Taylor HS, Kotlyar AM, Flores VA. Endometriosis is a chronic systemic disease: clinical challenges and novel innovations. Lancet. 2021 Feb 27;397(10276):839-852. doi: 10.1016/S0140-6736(21)00389-5. PMID: 33640070.

2. Maulitz L, Stickeler E, Stickel S, Habel U, Tchaikovski SN, Chechko N. Endometriosis, psychiatric comorbidities and neuroimaging: Estimating the odds of an endometriosis brain. Front Neuroendocrinol. 2022 Apr;65:100988. doi: 10.1016/j.yfrne.2022.100988. Epub 2022 Feb 22. PMID: 35202605.

3. Liu D, Liu M, Yu P, Li H. Brain-derived neurotrophic factor and nerve growth factor expression in endometriosis: A systematic review and meta-analysis. Taiwan J Obstet Gynecol. 2023 Sep;62(5):634-639. doi: 10.1016/j.tjog.2023.07.003. PMID: 37678988.

4. Beissner F, Preibisch C, Schweizer-Arau A, Popovici RM, Meissner K. Psychotherapy With Somatosensory Stimulation for Endometriosis-Associated Pain: The Role of the Anterior Hippocampus. Biol Psychiatry. 2018 Nov 15;84(10):734-742. doi: 10.1016/j.biopsych.2017.01.006. Epub 2017 Jan 16. PMID: 28258747.

Disclaimer:

This information is generalized and intended for educational purposes only. Due to potential individual contraindications, please see your primary care provider before implementing any strategies in these posts.