University of Oulu

Saara Vuontisjärvi, Henna-Riikka Rossi, Sauli Herrala, Laure Morin-Papunen, Juha S. Tapanainen, Salla Karjula, Jaro Karppinen, Juha Auvinen, Terhi T. Piltonen, The Long-Term Footprint of Endometriosis: Population-Based Cohort Analysis Reveals Increased Pain Symptoms and Decreased Pain Tolerance at Age 46 Years, The Journal of Pain, Volume 19, Issue 7, 2018, Pages 754-763, ISSN 1526-5900,

The long-term footprint of endometriosis : population-based cohort analysis reveals increased pain symptoms and decreased pain tolerance at age 46 years

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Author: Vuontisjärvi, Saara1,2; Rossi, Henna-Riikka1,2; Herrala, Sauli3;
Organizations: 1Department of Obstetrics and Gynecology, Oulu University Hospital, University of Oulu and PEDEGO Research Unit, Oulu, Finland
2Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
3Center for Life Course Health Research, University of Oulu, Oulu, Finland
4Department of Obstetrics and Gynecology, Helsinki University Hospital, University of Helsinki, Biomedicum Helsinki, Helsinki, Finland
5Finnish Institute of Occupational Health, Oulu, Finland
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 0.8 MB)
Persistent link:
Language: English
Published: Elsevier, 2018
Publish Date: 2019-03-04


Previous studies have shown increased pain sensitivity in fertile-aged women with endometriosis in response to mechanical stimuli. As yet, population-based studies on the association of endometriosis with pain sensation and pain symptoms in late fertile age are lacking. The main objective of this population-based cohort study was to investigate whether a history of endometriosis is associated with altered pain sensation and musculoskeletal pain symptoms at age 46 years. Our data are derived from the Northern Finland Birth Cohort 1966, which contains postal questionnaire data (72% response rate) as well as clinical data assessing pressure-pain threshold and maximal pain tolerance. The study population consisted of 284 women with endometriosis and 3,390 controls. Our results showed that at age 46 women with a history of endometriosis had a 5.3% lower pressure-pain threshold and 5.1% lower maximal pain tolerance compared with controls. The most significant contributors besides endometriosis were anxiety, depression, and current smoking status. Women with endometriosis also reported an increased number of pain sites (0 pain sites, 9.6 vs 17.9%; 5–8 pain sites, 24.8 vs 19.1%, endometriosis vs controls respectively; P < .001), and their pain was more troublesome and intense. The results were adjusted for body mass index, smoking, depressive/anxiety symptoms, education, and use of hormonal contraceptives. These unique data revealed an altered pain sensation and a greater likelihood of reporting musculoskeletal pain at age 46 years among women with a history of endometriosis. The results imply that endometriosis has a long-term footprint on affected women, thus underlying the need for psychological support and medical treatment beyond fertile age.


This population-based cohort study showed decreased pain threshold and maximal pain tolerance in women with endometriosis in the late fertile age of 46 years. The pain was also found to be more bothersome and intense compared with controls.

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Series: Journal of pain
ISSN: 1526-5900
ISSN-E: 1528-8447
ISSN-L: 1526-5900
Volume: 19
Issue: 7
Pages: 754 - 763
DOI: 10.1016/j.jpain.2018.02.005
Type of Publication: A1 Journal article – refereed
Field of Science: 3123 Gynaecology and paediatrics
Funding: The study was funded by The Academy of Finland (project grants 104781, 120315, 129269, 1114194, 268336, SALVE), the Sigrid Jusélius Foundation, the Finnish Medical Foundation, the North Ostrobothnia Regional Fund, Northern Finland Health Care Support Foundation, University Hospital Oulu, Biocenter, University of Oulu, Finland (75617), the European Commission (EURO-BLCS, Framework 5 award QLG1-CT-2000-01643), and the Medical Research Council, UK (PrevMetSyn/SALVE)
Academy of Finland Grant Number: 129269
Detailed Information: 129269 (Academy of Finland Funding decision)
268336 (Academy of Finland Funding decision)
114194 (Academy of Finland Funding decision)
Copyright information: © 2018 by the American Pain Society.