Women affected by hEDS present significant gynecologic symptoms that are often disabling, such as menorrhagia, dysmenorrhea, deep and intromission dyspareunia. Endometriosis may be incorrectly diagnosed on the basis of these symptoms, thereby leading to inappropriate treatment. The obstetric outcomes were mostly reassuring in this population. Furthermore, hormones may play a modulatory effect in this syndrome, and their influence merits further study.
In the subset of patients who deteriorate during the perimenstrual period, CHC (combined hormonal contraceptives) was also correlated with an increase in symptoms. The study analysis of contraception suggests that, in some women at least, the hEDS symptoms responsible for increased disability might improve with the use of POP. The findings suggest that, when menstrual disorders are treated and alleviated either by CHC or by POP (Progestin-only contraceptives), EDS symptoms improve and women report less fatigue. In the subset of patients who deteriorate during the perimenstrual period, CHC was also correlated with an increase in symptoms.
A prospective trial would be useful to determine the precise nature of the role of estrogens and progestins on various symptoms of hEDS. This study also reveals that the prevalence of obstetric complications is not substantially greater compared to the healthy population and lower in comparison with the previously mentioned large, recently-published study. This discrepancy may result from the different methodologies used in the two studies, or from a difference in the protocols for management of pregnancies from one country to another.