Botox injections can help to reduce painful pelvic cramps caused by endometriosis, a small clinical trial shows.
Endometriosis occurs when tissue from the uterus spreads to other parts of the pelvis, often causing painful spasms of the pelvic floor muscles. Physiotherapy and pain medication can help, but many of those with endometriosis still experience severe cramps even with these treatments.
at the US National Institutes of Health in Bethesda, Maryland, and her colleagues tested whether botulinum toxin – known more commonly as Botox – could be an alternative treatment.
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They randomly assigned 29 women between the ages of 18 and 55 who had endometriosis-related chronic pelvic pain to receive an injection of Botox or a placebo into their pelvic floor muscles. They used a dose designed to weaken the muscles enough to stop them spasming without completely paralysing them.
Of the participants who received Botox, , compared with just 29 per cent in the placebo group. The participants who received Botox also reported needing less pain medication in the months following treatment.
Side effects were reported by some Botox recipients – including urgent feelings of needing to urinate – but they were rated as mild.
at the University of New South Wales in Australia, who has conducted another , says the treatment can also reduce pain during sex and when going to the toilet. “Patients can get good long-term relief and become more functional,” he says.
However, because the effects of Botox gradually wear off, additional injections are usually needed every six months or so, which can become costly, says Abbott. He also notes that “it is essential that it is only done by trained professionals, since injecting into the wrong place may lead to incontinence”.
Moreover, the treatment only addresses one symptom of endometriosis, rather than addressing the root cause, he says. “We really need new treatments to prevent or reverse endometriosis, but what we currently know about endometriosis is a tiny fraction of what we need to know because of underinvestment by governments.”
In the meantime, Stratton hopes that larger clinical trials will confirm the efficacy of Botox in managing endometriosis cramps. “If daily medications, which carry their own inconvenience and side effects, can be replaced or supplemented with an office procedure every few months with better efficacy and fewer adverse effects, that brings another option to our patients.”
Stratton will present the results of her study at the in Baltimore on 19 October.
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