Investigations into the lived experience and aetiology of dysmenorrhoea and pelvic pain in young women

Abstract

Almost every woman will experience dysmenorrhoea at some time in her life, although the severity, duration and persistence of dysmenorrhoea vary widely. This thesis investigates the lived experience of women with severe dysmenorrhoea through observational studies of women’s symptoms, through laboratory studies investigating aetiologies for dysmenorrhoea, and by linking these studies to develop conclusions with strong translational relevance. While dysmenorrhoea may be associated with the more extensively researched medical condition endometriosis, this thesis is intentionally painfocused rather than endometriosis lesion-focused to ensure maximal translational potential to address the unmet needs of women with pain. In summary, this thesis addresses the differences between the one in five young women who suffer severe menstrual pain, and those women who are unaffected by pain. It investigates whether there is evidence for activation of the innate immune system in pelvic pain, and specifically Toll-Like Receptors (TLRs), and whether the hormonal environment influences this immune activation. It concludes with the novel hypothesis that a common aetiological factor linked to activation of Toll-Like Receptors within the uterus underlies the pain experience in women with dysmenorrhoea, chronic pelvic pain and endometriosis.