Many things have been written as to whether patients with endometriosis have higher risk of developing other diseases.

One of these diseases is adenomyosis. Adenomyosis is the condition in which cells from the lining of the womb (endometrium) are found with the muscular wall of the uterus (myometrium). We recognise 2 types, focal and diffuse. Some believe that adenomyosis and endometriosis are, actually, the same disease¹. Although the association between the 2 conditions seems plausible, there is no solid scientific evidence to prove this, neither has it been proven that it exists a correlation between the type of endometriosis and type of adenomyosis².

There appears to be an association with chronic fatigue syndrome³, chronic pain syndromes⁴, anxiety and depression⁵. It could also be that women with endometriosis have a higher risk of developing migraines⁶ as well as endocrine problems (e.g., thyroid disease)⁷. A systematic review and meta-analysis identified an association between endometriosis and certain auto-immune diseases⁸, however, the exact mechanism remains unknown. Interestingly, a recent study reported that women diagnosed with endometriosis are at higher risk of stroke⁹, however, the absolute numbers remain small.

We know that endometriosis often causes dyspareunia (pain during sexual intercourse). As anticipated, its presence affects negatively the quality of the sex life of patients¹⁰, as well as their male partners¹¹.

As regards conditions associated with chronic pain, they (like endometriosis) cause pain through changes in the peripheral as well as central nervous system. Let us have a look at the following:

Interstitial Cystitis (Painful Bladder Syndrome): The patients present with frequent urination and pain in the region below the belly button (pelvis) when the bladder fills up with urine¹². In both diseases, there is inflammation as well as changes in pain perception at the level of the central nervous system.

Irritable Bowel Syndrome (IBS): It is associated with pain in the abdomen, bloating, diarrhoea, constipation or change between the two. In women with endometriosis, IBS can be present in as high as 60% of cases¹³. Changes in the peripheral as well as central nervous system may be involved in both the diseases¹⁴.

Abdominal or Pelvic Myalgia:

Pain in the abdominal or pelvic wall muscles, associated with increased muscle tone and contractions¹⁵. It appears to be a common finding in women with endometriosis¹⁶. It is not clear if endometriosis itself causes changes in the muscular level or this could be a result of the patients adopting certain body postures to avoid or limit the pain felt. Regular physiotherapy sessions are likely to be beneficial in those cases¹⁷.

Vulvodynia:

Pain in the external genitalia region, often with no clear aetiology¹⁸. Vulvodynia and endometriosis can co-exist in up to 11% of cases¹⁹, through a combination of changes in the peripheral as well as central nervous systems. Endometriosis of the vulva and perineum is rare²⁰, may present following obstetric trauma during vaginal birth and requires a high degree of suspicion from the clinician performing the clinical examination.

In conclusion, we can say that endometriosis often co-exists with other diseases, making accurate diagnosis and management even more challenging. It is , as previously stated, important for healthcare professionals with knowledge of the disease to work in teams sharing their knowledge and expertise in order to offer the best possible care to their patients.

References:

1. Maruyama S, Imanaka S, Nagayasu M, Kimura M, Kobayashi H. Relationship between adenomyosis and endometriosis; Different phenotypes of a single disease? Eur J Obstet Gynecol Reprod Biol. 2020 Oct;253:191-197.
2. Alborzi S, Askary E, Khorami F, Poordast T, Abdulwahid Hashim Alkhalidi B, Hamedi M, Alborzi S, Shahraki HR. A Detailed Study in Adenomyosis and Endometriosis: Evaluation of the Rate of Coexistence Between Uterine Adenomyosis and DIE According to Imaging and Histopathology Findings. Reprod Sci. 2021 Aug;28(8):2387-2397.
3. Boneva RS, Lin JM, Unger ER. Early menopause and other gynecologic risk indicators for chronic fatigue syndrome in women. Menopause. 2015 Aug;22(8):826-34.
4. Smorgick N, Marsh CA, As-Sanie S, Smith YR, Quint EH. Prevalence of pain syndromes, mood conditions, and asthma in adolescents and young women with endometriosis. J Pediatr Adolesc Gynecol. 2013 Jun;26(3):171-5.
5. Laganà AS, La Rosa VL, Rapisarda AMC, Valenti G, Sapia F, Chiofalo B, Rossetti D, Ban Frangež H, Vrtačnik Bokal E, Vitale SG. Anxiety and depression in patients with endometriosis: impact and management challenges. Int J Womens Health. 2017 May 16;9:323-330.
6. Tietjen GE, Bushnell CD, Herial NA, Utley C, White L, Hafeez F. Endometriosis is associated with prevalence of comorbid conditions in migraine. Headache. 2007 Jul-Aug;47(7):1069-78.
7. Gemmill JA, Stratton P, Cleary SD, Ballweg ML, Sinaii N. Cancers, infections, and endocrine diseases in women with endometriosis. Fertil Steril. 2010 Oct;94(5):1627-31.
8. Shigesi N, Kvaskoff M, Kirtley S, Feng Q, Fang H, Knight JC, Missmer SA, Rahmioglu N, Zondervan KT, Becker CM. The association between endometriosis and autoimmune diseases: a systematic review and meta-analysis. Hum Reprod Update. 2019 Jul 1;25(4):486-503. doi: 10.1093/humupd/dmz014. PMID: 31260048; PMCID: PMC6601386.
9. Farland LV, Degnan WJ 3rd, Bell ML, Kasner SE, Liberman AL, Shah DK, Rexrode KM, Missmer SA. Laparoscopically Confirmed Endometriosis and Risk of Incident Stroke: A Prospective Cohort Study. Stroke. 2022 Jul 21:101161STROKEAHA122039250. doi: 10.1161/STROKEAHA.122.039250. Epub ahead of print. PMID: 35861076.
10. Tirlapur SA, Kuhrt K, Chaliha C, Ball E, Meads C, Khan KS. The ‘evil twin syndrome’ in chronic pelvic pain: a systematic review of prevalence studies of bladder pain syndrome and endometriosis. Int J Surg. (2013) 11:233–7.
11. Ferrero S, Esposito F, Abbamonte LH, Anserini P, Remorgida V, Ragni N. Quality of sex life in women with endometriosis and deep dyspareunia. Fertil Steril. 2005 Mar;83(3):573-9. doi: 10.1016/j.fertnstert.2004.07.973. PMID: 15749483.
12. Hämmerli S, Kohl Schwartz AS, Geraedts K, Imesch P, Rauchfuss M, Wölfler MM, Haeberlin F, von Orelli S, Eberhard M, Imthurn B, Leeners B. Does Endometriosis Affect Sexual Activity and Satisfaction of the Man Partner? A Comparison of Partners From Women Diagnosed With Endometriosis and Controls. J Sex Med. 2018 Jun;15(6):853-865. doi: 10.1016/j.jsxm.2018.03.087. Epub 2018 Apr 26. PMID: 29706579.
13. Schomacker ML, Hansen KE, Ramlau-Hansen CH, Forman A. Is endometriosis associated with irritable bowel syndrome? A cross-sectional study. Eur J Obstetr Gynecol Reprod Biol. (2018) 231:65–9.
14. Wouters MM, Balemans D, Van Wanrooy S, Dooley J, Cibert-Goton V, Alpizar YA, et al. Histamine receptor H1-mediated sensitization of TRPV1 mediates visceral hypersensitivity and symptoms in patients with irritable bowel syndrome. Gastroenterology. (2016) 150:875–87.e9.
15. Frawley H, Shelly B, Morin M, Bernard S, Bø K, Digesu GA, et al. An International Continence Society (ICS) report on the terminology for pelvic floor muscle assessment. Neurourol Urodyn. (2021) 40:1217–60.
16. Phan VT, Stratton P, Tandon HK, Sinaii N, Aredo JV, Karp BI, et al. Widespread myofascial dysfunction and sensitisation in women with endometriosis-associated chronic pelvic pain: a cross-sectional study. Eur J Pain. (2021) 25:831–40.
17. Awad E, Ahmed HAH, Yousef A, Abbas R. Efficacy of exercise on pelvic pain and posture associated with endometriosis: within subject design. J Phys Ther Sci. 2017 Dec;29(12):2112-2115. doi: 10.1589/jpts.29.2112. Epub 2017 Dec 7. PMID: 29643586; PMCID: PMC5890212.
18. Bornstein J, Goldstein AT, Stockdale CK, Bergeron S, Pukall C, Zolnoun D, et al. 2015 ISSVD, ISSWSH, and IPPS consensus terminology and classification of persistent vulvar pain and vulvodynia. J Sex Med. (2016) 13:607–12.
19. Graziottin A, Murina F, Gambini D, Taraborrelli S, Gardella B, Campo M. Vulvar pain: the revealing scenario of leading comorbidities in 1183 cases. Eur J Obstetr Gynecol Reprod Biol. (2020) 252:50–5.
20. Maillard C, Cherif Alami Z, Squifflet JL, Luyckx M, Jadoul P, Thomas V, Wyns C. Diagnosis and Treatment of Vulvo-Perineal Endometriosis: A Systematic Review. Front Surg. 2021 May 11;8:637180. doi: 10.3389/fsurg.2021.637180. PMID: 34046423; PMCID: PMC8148344.