The role of endometriosis in chronic pelvic pain pathophysiology, diagnosis, and treatment strategies.

Background: Endometriosis is a chronic gynecological disorder whereby endometrial-like tissue is found outside the uterus, which is often accompanied by chronic pelvic pain (CPP). It is linked to inflammation, fibrosis, and adhesion and these factors add to pain and poor quality of life. The pathophysiology, early diagnosis and relevant treatment strategies of CPP are essential in enhancing patient outcomes and minimizing long-term morbidity related to CPP. Objective: The proposed study will discuss the pathophysiology of endometriosis, consider diagnostic modalities, and determine treatment modalities to reduce chronic pelvic pain and enhance quality of life in patients with endometriosis. Study design: A prospective study. Place and duration of study: Department Of Gynae-Obs Frontier Corps Teaching Hospital Peshawar. From Jan 2024 To june 2024 Methods: Among  the 100 women presenting with chronic pelvic pain (18-45 years of age), a prospective study was carried out. The diagnostic analysis involved laparoscopy, histopathological confirmation, MRI and pelvic ultrasound. The severity of pain was measured on a visual analog scale. Medical therapy (hormonal suppression) and surgical removal of endometriosis lesions were used as treatment methods. The patients were monitored six months after treatment to determine whether they had improved their pain scores and the general improvement of symptoms. The statistical analysis was done in order to find out significance. Results: 100 patients have been included and their average age is 32.5 +- 5.8 years. In 95 patients (79.2) endometriosis was confirmed laparoscopic ally. The level of pain was significantly lower after treatment as mean VAS scores before treatment (7.8 +- 1.2) were lower, compared to mean VAS scores after treatment (3.4 +- 1.5) (p < 0.001). The reduction in pain, which was done surgically, was greater than that caused by medical therapy alone (mean reduction 5.1 +- 1.3 vs. 3.8 +- 1.4, p = 0.02). There were no reported major complications and the quality of life as reported by patients had improved significantly after intervention. Conclusion: Endometriosis is one of the leading causes of chronic pelvic pain in reproductively aged women. Pain and quality of life are effectively alleviated through correct diagnosis with imaging and laparoscopy, and specific medical and surgical treatment. It is crucial to identify the issue at the earliest stage and manage it fully to avoid progression, reduce complications, and maximize long-term outcomes of affected patients. Multidisciplinary strategies also help to increase the success of treatment.