Impact of Ehlers-Danlos Syndrome on Gynaecological Health

Patients with SED report a high prevalence of gynaecological disorders, including severe dysmenorrhoea, menorrhagia and dyspareunia. Chronic pelvic pain and pelvic floor disorders are also common, impacting quality of life and reproductive function. Menorrhagia is common and may be due to capillary fragility and altered uterine connective tissue. The use of contraceptive hormones is often considered to reduce menstrual symptoms, although their effectiveness varies. A multidisciplinary approach is recommended to tailor treatments to the specific needs of patients.

Epidemiological data on the prevalence of EDS and hypermobility spectrum disorder show an increase in diagnoses, highlighting the importance of better clinical recognition.

Primary dysmenorrhoea is generally linked to excessive production of prostaglandins, leading to uterine hypercontractility and transient myometrial ischaemia. In patients with EDS, several pathophysiological mechanisms could contribute to exacerbated menstrual pain:

• Collagen dysregulation: fragility of uterine connective tissues that can alter myometrial contractility.
• Frequent dysautonomia in SED: may alter uterine vascularisation and amplify pain.
• Nociceptive hypersensitivity: described in patients with SED, increasing pain perception. This project hypothesises that patients with EDS experience more severe and/or more frequent dysmenorrhoea than the general population due to the tissue and neurological alterations specific to this syndrome.

Thus, evidence of increased dysmenorrhoea severity in EDS patients could justify better pain management and gynaecological care for these patients.

Better recognition of gynaecological disorders in EDS could prevent late diagnoses and therapeutic uncertainty.

Better recognition of gynaecological disorders in EDS could help to avoid late diagnoses and therapeutic uncertainty.

The prospects for this research are to show that a significant difference could be observed and to explore the underlying mechanisms (dysautonomia, local inflammation, myometrial abnormalities) in greater depth. The benefits of specialised gynaecological care with the introduction of hormone therapy could also be explored.

Inclusion criteria

• Women aged 18 or over.
• Willing to participate voluntarily in the study via an online questionnaire.
• Of childbearing age.
• Reporting a diagnosis of EDS (all types) or not having EDS (control group) and being part of a database of healthy volunteers.

Exclusion criteria

• Minors (< 18 years old).
• Menopausal women
• People who do not understand French well enough to complete the questionnaire.
• Uncertain diagnosis of EDS (exclusion of participants who suspect EDS but without medical confirmation).