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Review
. 2021 Dec 3:3:792920.
doi: 10.3389/frph.2021.792920. eCollection 2021.

Androgens, Endometriosis and Pain

Susan F Evans  1 , M Louise Hull  1   2 , Mark R Hutchinson  1   3 , Paul E Rolan  1
Affiliations
Review

Androgens, Endometriosis and Pain

Susan F Evans et al. Front Reprod Health. .

Abstract

The intriguing relationship between androgens, endometriosis and chronic pain continues to unfold. Determining this relationship is of crucial importance to gynecologists managing people with these conditions, as common treatments dramatically alter her hormonal profiles, with both intended and unintended consequences. Although they may be present in the same individual, there is a recognized disconnect between pain or pain-related symptoms, and the presence or extent of endometriosis lesions. Reduced androgen levels provide a potential mechanism to link the development of endometriosis lesions and the presence of chronic pain. This research paper expands the presentation of our research at the World Endometriosis Congress in 2021, subsequently published in the Journal of Pain Research which demonstrated a strong inverse relationship between androgen levels and days per month of pelvic and period pain. Here we extend and further explore the evidence for a role for androgens in the etiology and management of dysmenorrhea and pelvic pain in women, both with and without endometriosis. We explore the potential for inflammation to induce low androgen levels and consider ways in which clinicians can optimize levels of androgens when treating women with these conditions. This article prompts the question: Is it estrogens that predispose people to a life of pain, or androgens that are protective?

Keywords: androgen; aromatase inhibitor; chronic pain; endometriosis; hormonal; immune; testosterone; women.

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Conflict of interest statement

SE receives royalties from book authorship, is a shareholder in Alyra Biotech Pty Ltd a company developing non-hormonal immune therapies for pelvic pain and Havah Therapeutics Pty Ltd a company developing testosterone therapies for women with breast cancer; and has patents pending: PCT/AU2018/051383 and PCT/AU2020/050551, Alyra Biotech Pty Ltd. PR is a shareholder in Havah Therapeutics, Alyra Biotech, Lipotek and iX Biopharma, a consultant to Bionomics and Novartis, and has received payment for educational presentations from Novartis and Seqirus. MRH is Director of the Australian Research Council Centre of Excellence for Nanoscale BioPhotonics CE140100003 and the recipient of an ARC Future Fellowship FT180100565, and reports grants from Australian Research Council, National Health and Medical Research Council, Meat and Livestock Australia, Air Force Office of Scientific Research, Defence Science Technology Group, and National Institutes of Health. His research program is supported by Novartis, Abbott, Pfizer and Regeneus, but these activities fall outside the submitted work. The remaining author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The relationship between inflammation, dysmenorrhea, endometriosis, the uterine-CNS neuroimmune circuit and their associated symptoms. Adapted with permission from Evans (29). Dissertation. Investigations into the lived experience and etiology of dysmenorrhoea and pelvic pain in young women.
See this image and copyright information in PMC

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