Khashcha I. I.

CLINICAL EFFECTIVENESS OF A MULTIMODAL APPROACH TO THE MANAGEMENT OF CHRONIC PELVIC PAIN IN WOMEN WITH ENDOMETRIOSIS

---

Show/Download

About the author:

Khashcha I. I.

Heading:

LITERATURE REVIEWS

Type of article:

Scientific article

Annotation:

Endometriosis is a common chronic gynecological condition that is often accompanied by chronic pelvic pain, impaired reproductive function, and a significant reduction in women’s quality of life. The complexity of clinical manifestations, the prolonged time to diagnosis, and the high recurrence rate highlight the importance of improving approaches for timely diagnosis and effective treatment of this pathology. The aim of this study is to summarize current data on the pathogenesis, clinical manifestations, diagnosis, and treatment of endometriosis, with a particular focus on the effectiveness of combined and personalized strategies for managing chronic pelvic pain and improving patients’ quality of life. Research shows that endometriosis is frequently associated with chronic pelvic pain and various functional impairments, with the clinical manifestations depending on the form and severity of the disease. It has been established that pain development is linked to a complex interaction among inflammatory, immune, and neuropathic processes that contribute to heightened nervous system sensitivity. Effective diagnosis of endometriosis requires a comprehensive approach that combines clinical examination with instrumental methods, such as transvaginal ultrasonography and MRI, while accounting for comorbid conditions. It has also been demonstrated that combined treatment – integrating pharmacological therapy with surgical intervention and multidisciplinary patient management – is significantly more effective than individual treatment methods in controlling chronic pelvic pain, reducing recurrences, and improving quality of life. Individualizing treatment based on each patient’s characteristics has been shown to achieve better long-term outcomes. Chronic pelvic pain in endometriosis arises from the complex interplay of inflammatory, immune, and neural mechanisms, making personalized and comprehensive treatment essential. The most effective approach is an integrated strategy that combines medication, surgical interventions, and support from a team of specialists, tailored to each patient’s unique characteristics. Future research should aim to better understand pain mechanisms, test individualized therapy combinations, and develop new methods for early diagnosis and prediction of treatment effectiveness. This will improve therapy outcomes, reduce the risk of recurrences, and ensure long-term improvement in women’s quality of life.

Tags:

Bibliography:

1. As-Sanie S, Mackenzie SC, Morrison L, Schrepf A, Zondervan KT, Horne AW, et al. Endometriosis: a review. JAMA. 2025;334(1):64-78. DOI: https://doi.org/10.1001/jama.2025.2975
2. Perricos A, Wenzl R. Recent advances in endometriosis pathophysiology and pharmacological treatment. Int J Mol Sci. 2024;25(12):6575. DOI: https://doi.org/10.3390/ijms25126575
3. Choi S, Tran JP. A review of treatment options for chronic pelvic pain from endometriosis. Pain Manag. 2025;15(10):767-777. DOI: https://doi.org/10.1080/17581869.2025.2542713
4. Chen Y, Waseem S, Luo L. Advances in the diagnosis and management of endometriosis: a comprehensive review. Pathol Res Pract. 2025;266:155813. DOI: https://doi.org/10.1016/j.prp.2025.155813
5. Tijani EO, Ajayi LO, Tijani OS, Oyedayo PA, Ayodeji FA. Current and emerging therapies for endometriosis-associated pain: a review. Middle East Fertil Soc J. 2025;30(9). DOI: https://doi.org/10.1186/s43043-025-00221-0
6. Venetis C, Keller E, Chambers GM. Freeze-all embryos during treatment with assisted reproduction: health economic aspects. Best Pract Res Clin Obstet Gynaecol. 2023; 86:102303. DOI: https://doi.org/10.1016/j.bpobgyn.2022.102303
7. Ottolina J, Villanacci R, D’Alessandro S, He X, Grisafi G, Ferrari SM, et al. Endometriosis and adenomyosis: modern concepts of their clinical outcomes, treatment, and management. J Clin Med. 2024;13(14):3996. DOI: https://doi.org/10.3390/jcm13143996
8. Baskozos G. Introduction to a special issue on big data and pain. Pain Rep. 2023;8(6):e1115. DOI: https://doi.org/10.1097/PR9.0000000000001115
9. Mick I, Freger SM, van Keizerswaard J, Gholiof M, Leonardi M. Comprehensive endometriosis care: a modern multimodal approach for the treatment of pelvic pain and endometriosis. Ther Adv Reprod Health. 2024;18:26334941241277759. DOI: https://doi.org/10.1177/26334941241277759
10. Horne AW, Missmer SA. Pathophysiology, diagnosis, and management of endometriosis. BMJ. 2022;379:e070750. DOI: https://doi.org/10.1136/bmj-2022-070750
11. Coxon L, Demetriou L, Vincent K. Current developments in endometriosis-associated pain. Cell Rep Med. 2024;5(10):101769. DOI: https://doi.org/10.1016/j.xcrm.2024.101769
12. Pastoor H, Mousa A, Bolt H, Bramer W, Burgert TS, Dokras A, et al. Sexual function in women with polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod Update. 2024;30(3):323-340. DOI: https://doi.org/10.1093/humupd/dmad034
13. Coutinho CM, Sotiriadis A, Odibo A, Khalil A, D’Antonio F, Feltovich H, et al. ISUOG practice guidelines: role of ultrasound in the prediction of spontaneous preterm birth. Ultrasound Obstet. Gynecol. 2022;60:435-456. DOI: https://doi.org/10.1002/uog.26020
14. Gudisa R, Harchand R, Rudramurthy SM. Nucleic-acid-based molecular fungal diagnostics: a way to a better future. Diagnostics. 2024;14(5):520. DOI: https://doi.org/10.3390/diagnostics14050520
15. Zuo SW, Napoe GS. Evaluation and management of urethral and periurethral masses in women. Cur Opin Obstet Gynecol. 2023;35(6):517- 524. DOI: https://doi.org/10.1097/GCO.0000000000000914
16. Bălălău OD, Ciupitu IA, Bogheanu DM, Ghiocel-Zariosu AI, Balalau C, Ples L, et al. Management of pelvic pain caused by endometriosis. J Mind Med Sci. 2023;10(1):79-84. DOI: https://doi.org/10.22543/2392-7674.1390
17. Simancas-Racines D, Jiménez-Flores E, Montalvan M, Horowitz R, Araujo V, Reytor-González C. Endometriosis as a systemic and complex disease: toward phenotype-based classification and personalized therapy. Int J Mol Sci. 2026;27(2):908. DOI: https://doi.org/10.3390/ijms27020908
18. Vercellini P, Salmeri N, Bandini V, Viganò P, Somigliana E. Endometriosis and chronic pelvic pain management: between a rock (denial) and a hard place (overdiagnosis). Acta Obstet Gynecol Scand. 2025;104(11):2200-2201. DOI: https://doi.org/10.1111/aogs.70043
19. Karp BI, Stratton P. Endometriosis-associated chronic pelvic pain. Med. 2023;4(3):143-146. DOI: https://doi.org/10.1016/j.medj.2023.02.006
20. Donnez J, Dolmans MM. GnRH antagonists with or without add-back therapy: a new alternative in the management of endometriosis? Int J Mol Sci. 2021;22(21):11342. DOI: https://doi.org/10.3390/ijms222111342
21. Dekhtiar YM, Kostyev FI, Zalyva KA. Features of treatment of idiopathic overactive bladder without detrusor overactivity. Likarska Sprava. 2019;(7-8):35-40. DOI: https://doi.org/10.31640/JVD.7-8.2019(5)
22. Dekhtiar YM, Kostyev FI, Zalyva KA, Dekhtiar YN. Features of treatment of patients with idiopathic overactive bladder without detrusor overactivity. Likarska Sprava. 2019;(7-8):35-40.
23. Savchenko US. Prevention of premature skin aging through the use of bioactive forms of vitamin C with hyaluronate. Am J Med Sci Pharm Res. 2025;7(8):51-55. DOI: https://doi.org/10.37547/tajmspr/Volume07Issue08-08
24. Gradil G. Lethal case of viral-bacterial pneumonia with relative lymphopenia: retrospective evaluation. Inter Col. 2019;6(2):106-111. DOI: https://doi.org/10.35339/ic.6.2.106-111
25. Garmendia JV, De Sanctis CV, Hajdúch M, De Sanctis JB. Endometriosis: an immunologist’s perspective. Int J Mol Sci. 2025;26(11):5193. DOI: https://doi.org/10.3390/ijms26115193

Publication of the article:

«Bulletin of problems biology and medicine», 2026 Issue 2, 181, 136-141 pages, index UDC 618.19:616.71-06

DOI:

10.29254/2077-4214-2026-2-181-136-141