title: Menstruation pulls the trigger for inflammation and pain in endometriosis.
abstract: Endometriosis is a chronic, hormone-dependent, inflammatory disease, characterized by the presence and growth of endometrial tissue outside the uterine cavity. It affects 5-10% of the female population of reproductive age and is frequently associated with moderate to severe pain, subfertility, and a marked reduction in health-related quality of life. Here, we propose a new pathophysiological concept of endometriosis, summarizing recent findings in one unifying picture. We propose menstruating tissue as the trigger for inflammatory pain in endometriosis through the activation of innate immune cells and peripheral nerve endings. We speculate how innovative treatment modalities beyond hormonal treatment will improve patients' lives.
authors.affiliation: Global Drug Discovery, Bayer Pharma AG, Müllerstraße 178, 13353 Berlin, Germany.
authors.forename: Alexis
authors.initials: A
authors.lastname: Laux-Biehlmann
authors.affiliation: Leuven University Fertility Center, University Hospitals, UZ Gasthuisberg, 3000 Leuven, Belgium.
authors.forename: Thomas
authors.initials: T
authors.lastname: d'Hooghe
authors.affiliation: Global Drug Discovery, Bayer Pharma AG, Müllerstraße 178, 13353 Berlin, Germany. Electronic address: Thomas.Zollner@Bayer.com.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Zollner
mesh_terms: D004715:Endometriosis / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000503:physiopathology; D008597:Menstrual Cycle / Q000276:immunology / Q000378:metabolism / Q000502:physiology*; D059226:Nociceptive Pain / Q000503:physiopathology*
keywords: endometriosis; inflammatory pain; neurogenic inflammation; retrograde menstruation; sensory nerves