Pain in Women
Our work aims to optimise pain relief and quality of life for women with chronic pain by improving our understanding of the mechanisms generating pain in women and the interaction between hormones and pain.
Women suffer with almost all chronic pain conditions to a much greater extent than men. Additionally, they also suffer from female-specific pains; particularly in their pelvis, including period pain (dysmenorrhoea) and the pains associated with diseases such as endometriosis.
Treatment of pelvic pain requires a multidisciplinary team which consists of gynecologists, visceral surgeons, fertility specialists, counsellors and physiotherapists. Treatment options available to attain pain relief are:
- Hormonal therapy
Painful periods are very common; in fact, as many as nine out of ten women have them. The pain sometimes starts a few days before your period and can last for several days. When your period ends, the pain usually does too. Period pain is usually in the lower part of your abdomen (tummy) and is a cramping kind of pain.
There are two types of painful periods.
- Primary dysmenorrhoea. This is period pain that isn't caused by a specific condition. It usually starts within six to 12 months of your periods first starting when you’re a teenager. The pain usually lasts between eight hours and three days.
- Secondary dysmenorrhoea. This is pain caused by a specific condition, such as endometriosis or fibroids. This type of period pain can start years after your periods have started, often when you’re in your 30s and 40s. The pain may come on at other times during your monthly cycle, as well as when you have your period. It can also get worse, rather than better, as your period goes on.
Painful periods can have a big impact on your quality of life, and lead to time off school or work. They can be physically and mentally hard to manage if your symptoms are severe, and can affect your normal day-to-day life.
Painful intercourse, or dyspareunia, can occur for reasons that range from structural problems to psychological concerns. Dyspareunia is a common but poorly understood problem affecting around 7.5% of sexually active women aged 16-74 years.
Dyspareunia can present as persistent or recurrent genital pain that occurs just before, during or after intercourse. Talk to your doctor if you're having painful intercourse. Treatments focus on the cause, and can help eliminate or lessen this common problem.
Dysuria is the medical term for pain or discomfort when urinating. Often described as a burning sensation, dysuria most commonly is caused by bacterial infections of the urinary tract.
Dysuria is a common symptom of a bladder infection (cystitis) and is very common in women aged 20 to 50. In men over age 50, a bladder infection usually is associated with an enlarged prostate or prostate infection.
Many people have occasional episodes of brief discomfort when they start urinating. Usually this is caused by irritation, and does not need to be treated. However, you should see your health care professional if pain while urinating lasts longer, is severe or if it continues to happen.
Painful bowel movements, or dyschezia, is a common problem and is often the result of a minor, treatable problem such as constipation or haemorrhoids. Dyschezia can also relate to endometriosis, ulcerative colitis, or sexually transmitted infections. It is a good idea to see your GP if your pain is severe, your pain does not improve after a few days, or you have rectal bleeding.
CHRONIC PELVIC PAIN
Chronic pelvic pain is more intense than ordinary period pain and lasts longer. It affects around 1 in 6 women.
- endometriosis - a common condition affecting 5-10% of women of reproductive age; endometriosis is a long-term condition that can have a significant impact on your life, but there are treatments that can help.
- fibroids – non-cancerous tumours that grow in or around the womb; fibroids can be painful if they twist or deteriorate, but uncomplicated fibroids aren't usually painful
- adenomyosis – endometriosis that affects the muscle of the womb, causing painful, heavy periods
- chronic pelvic inflammatory disease (PIS) – a bacterial infection of the womb, fallopian tubes or ovaries, which often follows a chlamydia or gonorrhoea infection and needs immediate treatment with antibiotics
- irritable bowel syndrome (IBS) – a common long-term condition of the digestive system that can cause stomach cramps, bloating, diarrhoea and constipation
- inflammatory bowel disease (IBD) – a term used to describe 2 chronic conditions, ulcerative colitis and Crohn's disease, which affect the gut
Chronic pain is defined as pain lasting for more than 6 months. In the UK alone, approximately 7.8 million people live with chronic pain with, at any time, over a third of households containing someone in pain. Women suffer with almost all chronic pain conditions to a much greater extent than men. Additionally, they also suffer from female-specific pains; particularly in their pelvis, including period pain (dysmenorrhoea) and the pains associated with diseases such as endometriosis. Unfortunately, it is frequently difficult to treat chronic pain and attempts at finding new drugs have not usually been successful. Our work focuses on two aspects of pain specific to women. Firstly, we are interested in better understanding the mechanisms generating and maintaining pain in gynaecological pain conditions such as dysmenorrhoea and endometriosis. Secondly, we are investigating the relationship between steroid hormones and pain. In the long-term we hope to be able to optimise both analgesia and quality of life for women with chronic pain whatever its original cause.
Endometriosis CaRe Oxford is a nationally and internationally acclaimed centre of expertise in clinical care and research into endometriosis, and is part of the Nuffield Department of Women's and Reproductive Health (WRH) of the University of Oxford. Our research studies all focus around improving our understanding of endometriosis, working towards a non-surgical method of diagnosis (‘biomarker’) and identifying new, better treatments.
Aim - To revolutionise the understanding of endometriosis-associated pain (EAP) and bladder pain syndrome (BPS), identify meaningful subgroups of patients, develop better preclinical models and ultimately facilitate drug development.
TRiPP is focused on two specific types of chronic pain: endometriosis-associated pain and bladder pain syndrome. The main hypothesis of TRiPP is that the pain symptoms experienced by women with these conditions are generated and maintained by mechanisms similar to those found in other chronic pain conditions, but occur in combination with specific pathological lesions and symptoms. We believe that reconceptualising these conditions in the context of the multi system dysfunction known for other chronic pain conditions rather than as end-organ pathologies has the potential to revolutionise our understanding of the conditions, allow us to identify meaningful subgroups of patients, develop better preclinical models and thus ultimately facilitate drug development in this field. Read more…
Aim – To identify the underlying mechanisms of endometriosis and uterine fibroids and their associated symptoms to improve the outcome of affected women.
In the FENOX (Fibroids and Endometriosis in Oxford) study, we aim to improve our understanding of the underlying mechanisms of endometriosis and uterine fibroids and their associated symptoms by means of longitudinal observation and laboratory analyses. To achieve this, samples and clinical data will be collected from women undergoing surgery. These samples will be used in state-of-the-art biomedical assays to improve our understanding of the underlying biology of these symptoms in women with endometriosis and/or fibroids, which will lead to a better understanding of the conditions, stratification of patient groups and tailored therapies, and the development of novel drug targets and biomarkers for diagnosis and treatment. Read more…
PATIENT ORGANISATIONS & USEFUL LINKS
There are a number of pain- and endometriosis-related patient organisations that are available to offer information, guidance and support.
Endometriosis UK offers a number of support groups through the UK and online. Support groups offer valuable support and information. Find out more about support groups and see upcoming support group meetings by clicking here.
In addition to support groups, Endometriosis UK runs a helpline to provide support and advice: 0808 808 2227. Find out more about the helpline and the opening hours by clicking here. Because it may be difficult to talk to someone in person or over the phone, an online community is available with thousands of members sharing their experience of endometriosis on forums. Find out more about the online community by clicking here.
If you're in distress and need someone to talk to, you can call the Samaritans' 24 hour emotional support line in full confidence: 116 123.
Below is a selection of other organisations and useful links:
- International Pelvic Pain Society
- Pelvic Pain Support Network
- World Endometriosis Research Foundation
- World Endometriosis Society
The Endometriosis and Fertility Clinic
- Royal College of Obstetricians and Gynaecologists - Endometriosis Information Leaflet
For more information on patient organisations and useful links, click here.