Last year in March when Lena Dunham declared in her Vogue article that she had a hysterectomy in an attempt to stop the pain from endometriosis, the condition was thrust into the spotlight, spreading awareness on the incurable pain experienced by many women. 

According to the Centers for Disease Control and Prevention (CDC), one in 10 women suffer from endometriosis. And that taken into larger context, mean 176 million women worldwide suffer endometriosis. The condition occurs when tissues found on the lining of the uterus grow elsewhere inside the body. It is primarily found on the pelvic peritoneum, on the ovaries, in the recto-vaginal septum, on the bladder and bowel.

Some of the symptoms are chronic pelvic pain, heavy bleeding, painful periods, pain during and after intercourse, as well as infertility and fatigue. Like in Dunham’s case, it does take a toll on the physical and mental well-being. After trying many treatments, from pelvic floor therapies to a series of minor operations, Dunham’s last resort was the hysterectomy procedure.

Medically speaking, there is no cure for the pain that accompanies endometriosis and may even continue during post hysterectomy and menopause. In an attempt to help these women, researchers at the National Institutes of Health, had tested a novel procedure to pause the pain for up to a year. It is nothing other than Botox, known to freeze target muscles and smoothen wrinkles. The study was published this month in Regional Anesthesia and Pain Medicine on July 8 and details how this can be done.   TOP ARTICLES2/5Botox Found To Relieve Endometriosis Pain

Chronic pelvic pain is one of the more prominent symptoms and can recur. Hence, the study targeted 13 women who had muscle spasms in the pelvic region despite surgery and hormonal treatment. The participants were given open-label botulinum toxin injections in the areas affected by muscle spasms, especially the pelvic floor. Their reactions were followed for up to four months in terms of pain intensity, muscle spasm, disability and pain medication.

Before the injection was given, 11 of them had reported moderate pain in more than 4 out of 6 pelvic muscles. Fortunately, within 4 to 8 weeks after the injection, the same 11 women had lesser pain in 3 or less pelvic muscles. “Relief lasted 5–11 months in 7 of the 11 patients followed for up to 1 year. Adverse events were mild and transient,” the result of the study said.

“Many of the women in our study reported that the pain had a profound effect on their quality of life, and this treatment may be able to help them get their lives back,” said coauthor, gynecologist and scientist at the National Institute of Neurological Disorders and Stroke (NINDS), Pamela Stratton, MD in a press release. 

So, how exactly did the quality of life improved for these 7 participants and decreased disability in them ? Botulinum toxins are generally used in Botox treatments and work by obstructing nerve signals to prevent target muscles from contracting. In the past, the toxins have been used to treat certain neurological disorders with overactive muscles, which is where the idea came from to these researchers. 

Since the sample size was small, larger clinical studies will have to be assessed to understand the benefits of using botulinum toxins for endometriosis in the long-term, the researchers said. 

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For some women with endometriosis, the pain doesn’t stop after surgical and hormonal treatments. It can persist, triggered by muscle spasms that ripple through the pelvic floor. Now, a small study suggests that Botox, best known for smoothing wrinkles, could quell those spasms and relieve that pain.

Thirteen women diagnosed with the disorder, in which tissue similar to what lines the uterus grows elsewhere in the body, had the botulinum toxin injected into their pelvic floor, which supports the pelvic organs. The shots targeted areas of muscle spasm that were sites of pain. The women, ages 21 to 51, had been in pain for at least two years.

All reported a reduction in pain four to eight weeks after treatment. Eleven of the 13 rated their post-Botox pain as mild or completely gone, researchers reported online July 8 in Regional Anesthesia & Pain Medicine. Relief lasted from five to 11 months in seven of the 11 women followed for up to a year post injection.

Women in the study “had benefit beyond relief of pain. Some were able to resume having sex without pain. Some were able to function better,” says Barbara Karp, a neurologist at the National Institute of Neurological Disorders and Stroke (NINDS) in Bethesda, Md.

Eight of the 13 women had experienced moderate to very severe disability, according to a questionnaire designed to measure how the pain interferes with day-to-day activities such as walking, standing, sleeping, personal care and sex life. Six of these women’s scores indicated their disability had lessened after the injection.

Endometriosis affects an estimated 5 to 10 percent of reproductive-age women, or 176 million worldwide. Compounding the pain and infertility that accompanies the disorder is the lack of awareness of the condition; past studies have found that women face treatment delays and skepticism that they have a medical issue at all.

Standard treatments include hormone therapies and the surgical removal of tissue lesions located outside of the uterus. But there is no cure. Women who continue to have pain might be reassessed for surgery, change their hormone therapy, try physical therapy or take pain medications like opioids, says gynecologist Pamela Stratton, also at NINDS.

The participants in the study had had surgery and hormone treatments, but their pain persisted. All of the women also had pelvic floor muscle spasms.

Botulinum toxin is produced by the microbe that causes the food poisoning illness botulism. As Botox, it paralyzes certain muscles or blocks nerves. The toxin has been used to smooth wrinkles and to calm overactive muscles in neck spasms and bladder conditions (SN: 4/5/08, p. 213). Karp had experience using botulinum toxin to treat neurological disorders involving overactive muscles. So she, Stratton and their colleagues suspected Botox injections might also diminish the pelvic floor spasms and associated pain.

The results suggest that Botox may be “a promising tool” to treat these spasms, says obstetrician and gynecologist Andrea Rapkin of UCLA’s David Geffen School of Medicine, who was not involved in the study. But she notes the treatment is expensive, and the study size was very small.

Larger studies that compare the treatment to a placebo will be necessary to evaluate how safe and effective the botulinum toxin treatment is for this disorder. Whatever the outcome of those trials, the study “brings to light the fact that there are many aspects to endometriosis pain that have to be evaluated,” Rapkin says, not just that caused by tissue lesions.

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