Can Botox Shots Help Ease Endometriosis-Related Pelvic Pain? Everyday Health MenuNewslettersSearch Endometriosis News Endometriosis Can Botulinum Toxin Injections Help Reduce Pelvic Spasm Pain A new study shows promising results for treating endometriosis-related pelvic pain, but further research is needed. By Beth LevineJuly 17, 2019Everyday Health ArchiveFact-CheckedBotulinum toxin may be useful for controlling chronic endometriosis-related pelvic pain. iStock; Shutterstock (2)Many women with endometriosis, a chronic inflammatory condition in which endometrial-like tissue grows outside the uterus on other organs, suffer from pain due to pelvic floor spasms, even after surgical and hormonal treatment. A study conducted at the National Institute of Neurological Disorders and Stroke (NINDS), part of the National Institutes of Health, has discovered that treating these spasms with injections of botulinum toxin at the site can help ease the pain, in part by relaxing the muscles. The small study was published online in Regional Anesthesia & Pain Medicine on July 8, 2019. RELATED: How to Find an Endometriosis Specialist Looking at Injections and Endometriosis-Related Pain It is important to state that the research team used botulinum toxin in this study after endometriosis lesions had been removed, focusing on women who had pain that persisted despite receiving the best standard-of-care treatment for endometriosis. The injections were intended to alleviate pain symptoms only, not treat the disease. None of the women needed surgical treatment at the time of injection. Those women who could tolerate hormones were receiving hormone therapy that generally suppressed their menses while in the study. A note from one of the lead authors of the study, the neurologist and NINDS program director Barbara Karp, MD: “While we did use Botox (onabotulinumtoxinA) brand in this study, there are multiple brands of botulinum toxin marketed in the United States; Botox is only one of them.” RELATED: Adenomyosis: Symptoms, Diagnosis, Causes, and Treatments Women With Endometriosis Who Were Excluded From the Study The study did not include women with endometriosis who had not been treated with surgical removal of lesions. But “it could be considered in women, for example, whose pelvic pain is associated with spasm in pelvic floor muscles on examination and for those are not candidates for surgery. Other sources of pain need to be carefully evaluated and addressed as well,” says Dr. Karp. RELATED: 10 Ways to Relieve Period Cramps Pelvic Floor Pain Can Persist After Endometriosis Treatment While there’s no cure for endometriosis disease, treatments and therapies can help alleviate symptoms. The NIH team focused on women with endometriosis for several reasons. One is that many women with endometriosis still have chronic pelvic pain after their endometriosis has been treated to the extent possible by conventional endometriosis therapies (surgery, hormones, pain medications). “In this study, we found that many of these women have spasm in the muscles of the pelvic floor and that touching and pressing on those areas of spasm reproduces their pain. Botulinum toxin, which reduces muscle spasm, seemed reasonable to try,” says Karp. Another reason is that while others have reported on botulinum toxin use for pelvic pain, there have been very few controlled studies, and those have not specifically addressed women with endometriosis. Two Months After Botox Injection Pelvic Pain Was Reduced Thirteen women received the injections and were followed for four months. By two months after injections, all reported decreased pain, including some who said their pain was now mild to nonexistent. Half reported reduced use of pain medications. Eight reported moderate to severe disability prior to the injections; over the course of the study, six felt an improvement with the injections. RELATED: Endometriosis and Severe Sex Pain: How to Cope How and for How Long Does the Botulinum Toxin Work Botulinum toxin works by blocking the release of a chemical messenger molecule (acetylcholine) from the nerve cells that tells the muscle to contract; it blocks the action of the nerve, not the muscle. If the nerve can’t communicate with the muscle, the muscle relaxes. Karp adds, “Relaxing the muscle is probably not the only way it works. Botulinum toxin also blocks the release of other chemical messages involved in sending pain signals to the brain.”When used for neurological indications such as spasticity or dystonia, the effects of botulinum toxin typically last three months, which is the usual interval between injections for most uses. “The benefit can be longer in some patients and for some pain conditions, as seen in some of the patients we reported,” says Karp. More Study Is Needed for This Off-Label Use Botulinum toxin is currently available off label for this use, and more practitioners are using it. But Karp warns that more study is needed, especially well-controlled clinical trials. “There is much work that remains to be done to fully understand which patients may benefit from this approach to treating chronic pelvic pain in women, how effective it might be, and the full range of side effects. More research is also needed on how to select the dose, muscles for injection, and approach to injection,” she explains. Injections Are Not a Cure-All They Don t Address the Source of Endo Pain “Anything that treats pelvic floor muscle spasms is going to decrease pain but not necessarily help the disease. In my practice, except in certain cases, Botox is no more effective than pelvic and physical therapy,” says Sallie Sarrel, a pelvic floor physical therapist specializing in endometriosis. She adds that the botulinum toxin comes with side effects, whereas pelvic floor therapy (PFT) does not. RELATED: 5 Simple Yoga Moves for Endometriosis and Pelvic Pain Relief What Triggers Pelvic Muscle Spasms Sarrel’s biggest concern is that the injections just treat the spasms but not the reason why the spasms are happening, which can come from a misalignment in the foot, knee, or hip, weakening in the back or pelvis, issues within the fascia, or even a problem with central nervous system upregulation (central sensitization). “We take a complete musculoskeletal approach. Botox only treats the pelvic spasm,” she says. RELATED: These Stars Are Speaking Out About Endometriosis Long-Term Muscle Weakening Is a Consideration Too Sarrel also points out that these injections reduce strength in muscles. “You don’t want your pelvic floor to be weakened. You want length but you also want strength. When you Botox your forehead, it weakens the muscles so they can’t move. Most people don’t want that in the pelvic floor,” she says. “There is a plus to Botox, because you are not using opioids, but Botox makes you dependent on a doctor. PFT teaches you to be independent by using exercise or meditation to doctor yourself,” says Sarrel. NEWSLETTERS Sign up for our Women' s Health Newsletter SubscribeBy subscribing you agree to the Terms of Use and Privacy Policy. 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