RECRUITING

Estradiol-mediated Inflammation and Central Sensitization in the Pathophysiology of Endometriosis-associated Pelvic Pain

Conditions

Endometriosis Pelvic Pain Relugolix Combination Therapy Endo-EPIC (Alternative study acronym/title)

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Study Overview

This clinical trial focuses on testing the efficacy of different digital interventions to promote re-engagement in cancer-related long-term follow-up care for adolescent and young adult (AYA) survivors of childhood cancer.

Description

The purpose of this study is to better understand how hormone suppression with Relugolix Combination-Therapy (CT) affects pelvic pain, inflammation, and pain sensitivity in women with moderate-to-severe endometriosis associated pelvic pain.

Official Title

Estradiol-mediated Inflammation and Central Sensitization in the Pathophysiology of Endometriosis-associated Pelvic Pain

Quick Facts

Study Start:2025-08

Study Completion:2028-09

Study Type:Not specified

Phase:Not Applicable

Enrollment:Not specified

Status:RECRUITING

Study ID

NCT07100782

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Ages Eligible for Study:21 Years to 49 Years

Sexes Eligible for Study:FEMALE

Accepts Healthy Volunteers:No

Standard Ages:ADULT

Inclusion Criteria	Exclusion Criteria
* Premenopausal woman between age 21 and 49 years (inclusive) at the time of consent. Menopause is defined as amenorrhea \>1 year unrelated to hormonal suppression. * History of endometriosis diagnosed by surgery (visual or biopsy confirmed), ultrasound, or MRI within 5 years of study entry * History of self-reported moderate to severe pelvic pain for ≥ 6 months' duration at time of screening visit. Moderate-to-severe pelvic pain will be defined as self-report recall of average non-menstrual pelvic pain score over past 6 months as ≥ 4 on a 0-10 numeric rating scale (NRS) * Willingness to participate in a relugolix CT drug intervention trial * No use of adjunctive pain medications or on stable chronic daily use of adjunctive pain medications (excluding opioids); * Has not used an injectable hormone therapy in the past 6 months (e.g. DepoProvera®, DepoLupron®). * Willingness to 30-60 day washout interval of oral, vaginal, transdermal, intrauterine hormonal therapies prior to study initiation if applicable * Willingness to use 2 forms of non-hormonal contraception during the entire duration of the study period or has had a history of a bilateral tubal occlusion procedure at least 3 months prior to screening (tubal ligation or hysteroscopic occlusion method) * Willing to undergo quantitative sensory testing (QST), fMRI and other study procedures * Ability to read and speak English to allow for written informed consent, phenotyping, and patient-reported outcomes measures * Meet criteria to participate in QST and fMRI. These include: * Normal visual acuity or correctable (with corrective lenses- glasses or contacts) to at least 20/40 for reading instructions in the MRI and visual sensitivity testing * No contraindications to MRI (e.g., metal implants, claustrophobia) * Willingness to refrain from pain medications such as NSAIDs, acetaminophen, and opioids for 12 hours prior to neuroimaging and QST * Willingness to refrain from alcohol and nicotine on day of QST and neuroimaging (alcohol and nicotine consumption is allowed after testing is completed) * Willingness to refrain from physical activity or exercise that would cause muscle and/or joint soreness for 48 hours prior to testing (routine exercise or activity that does not lead to soreness is acceptable) * Able to lie still on their back for 1 hour during MRI	* Contraindication to the use of relugolix CT (high risk of arterial or venous thrombotic, or thromboembolic disorder, known osteoporosis, current or history of breast cancer or other hormone sensitive malignancy, known hepatic impairment or disease, undiagnosed abnormal uterine bleeding, known hypersensitivity to components of relugolix CT). * Concurrent participation in other therapeutic trials * Pregnant, lactating, less than 6 months postpartum, or planning a pregnancy within next 12 months * Planning pelvic or abdominal surgery during study period * Prior major surgery in the past 4 months that involves incisions on the abdomen, chest, head, other than a skin biopsy (hysteroscopy, endometrial biopsy is ok to include). * Planning to initiate a new adjunctive pain treatment during study treatment (e.g. cognitive behavioral therapy, physical therapy, acupuncture). Participants may be enrolled if these treatments are completed prior to trial. * History of hysterectomy and/or bilateral oophorectomy * Clinically significant gynecologic condition such as significant endometrial pathology (e.g. endometrial hyperplasia), persistent ovarian cyst larger than 5 cm, single fibroid 4cm or larger, more than 4 fibroids at least 2cm, or symptomatic submucosal fibroid of any size. Patients may be enrolled in this study if they were previously successfully treated for these conditions. Patients must have undergone pelvic ultrasound or MRI in the past 6 months, and provide results (or release of records to obtain results) * History or current clinical diagnosis of vulvodynia. * History or current evidence of psychosis, current suicide risk or attempt within 2 years of study (note: participants with mood disorders such as depression or anxiety will not be excluded) * Chronic opioid, alcohol, and/or illicit drug use * History of substance abuse within past one year * Unable or unwilling to discontinue opioids analgesics within 48 hours of the dense phenotyping study visits * Medical conditions that may significantly interfere with relugolix CT efficacy, ability to fully comply or would make it unsafe for participants to take part in the study, including but not limited to: morbid obesity with Body Mass Index \> 45, uncontrolled autoimmune/inflammatory diseases, significant cardiopulmonary disease (e.g., angina, congestive heart failure, uncontrolled hypertension, severe cardiac valvular disease, Chronic Obstructive Pulmonary Disease (COPD), chronic asthma), renal or liver disease (e.g. cirrhosis, hepatitis), uncontrolled endocrine or allergic disorders (e.g., hypothyroidism, diabetes, allergic rhinitis), neurologic conditions (e.g., multiple sclerosis, prior stroke, neurological tumor), severe physical impairment (e.g., blindness, deafness, paraplegia); and active malignancy (any malignancy except for localized dermatologic cancer). * Any impairment, activity or situation that in the judgment of the Study Coordinator or Principal Investigator would prevent safe or satisfactory completion of the study protocol. * Individuals receiving or applying for compensation or disability and other aspects associated with potential secondary gain per self-report; * Additional exclusion that prevent participation in QST and fMRI: 1. Severe claustrophobia precluding MRI and evoked pain testing during scanning; 2. Diagnosed peripheral neuropathy 3. Diagnosed or self-reported epilepsy 4. Diagnosed or self-reported visual-evoked migraines

Inclusion Criteria

Exclusion Criteria

* Premenopausal woman between age 21 and 49 years (inclusive) at the time of consent. Menopause is defined as amenorrhea \>1 year unrelated to hormonal suppression.
* History of endometriosis diagnosed by surgery (visual or biopsy confirmed), ultrasound, or MRI within 5 years of study entry
* History of self-reported moderate to severe pelvic pain for ≥ 6 months' duration at time of screening visit. Moderate-to-severe pelvic pain will be defined as self-report recall of average non-menstrual pelvic pain score over past 6 months as ≥ 4 on a 0-10 numeric rating scale (NRS)
* Willingness to participate in a relugolix CT drug intervention trial
* No use of adjunctive pain medications or on stable chronic daily use of adjunctive pain medications (excluding opioids);
* Has not used an injectable hormone therapy in the past 6 months (e.g. DepoProvera®, DepoLupron®).
* Willingness to 30-60 day washout interval of oral, vaginal, transdermal, intrauterine hormonal therapies prior to study initiation if applicable
* Willingness to use 2 forms of non-hormonal contraception during the entire duration of the study period or has had a history of a bilateral tubal occlusion procedure at least 3 months prior to screening (tubal ligation or hysteroscopic occlusion method)
* Willing to undergo quantitative sensory testing (QST), fMRI and other study procedures
* Ability to read and speak English to allow for written informed consent, phenotyping, and patient-reported outcomes measures
* Meet criteria to participate in QST and fMRI. These include:
* Normal visual acuity or correctable (with corrective lenses- glasses or contacts) to at least 20/40 for reading instructions in the MRI and visual sensitivity testing
* No contraindications to MRI (e.g., metal implants, claustrophobia)
* Willingness to refrain from pain medications such as NSAIDs, acetaminophen, and opioids for 12 hours prior to neuroimaging and QST
* Willingness to refrain from alcohol and nicotine on day of QST and neuroimaging (alcohol and nicotine consumption is allowed after testing is completed)
* Willingness to refrain from physical activity or exercise that would cause muscle and/or joint soreness for 48 hours prior to testing (routine exercise or activity that does not lead to soreness is acceptable)
* Able to lie still on their back for 1 hour during MRI

* Contraindication to the use of relugolix CT (high risk of arterial or venous thrombotic, or thromboembolic disorder, known osteoporosis, current or history of breast cancer or other hormone sensitive malignancy, known hepatic impairment or disease, undiagnosed abnormal uterine bleeding, known hypersensitivity to components of relugolix CT).
* Concurrent participation in other therapeutic trials
* Pregnant, lactating, less than 6 months postpartum, or planning a pregnancy within next 12 months
* Planning pelvic or abdominal surgery during study period
* Prior major surgery in the past 4 months that involves incisions on the abdomen, chest, head, other than a skin biopsy (hysteroscopy, endometrial biopsy is ok to include).
* Planning to initiate a new adjunctive pain treatment during study treatment (e.g. cognitive behavioral therapy, physical therapy, acupuncture). Participants may be enrolled if these treatments are completed prior to trial.
* History of hysterectomy and/or bilateral oophorectomy
* Clinically significant gynecologic condition such as significant endometrial pathology (e.g. endometrial hyperplasia), persistent ovarian cyst larger than 5 cm, single fibroid 4cm or larger, more than 4 fibroids at least 2cm, or symptomatic submucosal fibroid of any size. Patients may be enrolled in this study if they were previously successfully treated for these conditions. Patients must have undergone pelvic ultrasound or MRI in the past 6 months, and provide results (or release of records to obtain results)
* History or current clinical diagnosis of vulvodynia.
* History or current evidence of psychosis, current suicide risk or attempt within 2 years of study (note: participants with mood disorders such as depression or anxiety will not be excluded)
* Chronic opioid, alcohol, and/or illicit drug use
* History of substance abuse within past one year
* Unable or unwilling to discontinue opioids analgesics within 48 hours of the dense phenotyping study visits
* Medical conditions that may significantly interfere with relugolix CT efficacy, ability to fully comply or would make it unsafe for participants to take part in the study, including but not limited to: morbid obesity with Body Mass Index \> 45, uncontrolled autoimmune/inflammatory diseases, significant cardiopulmonary disease (e.g., angina, congestive heart failure, uncontrolled hypertension, severe cardiac valvular disease, Chronic Obstructive Pulmonary Disease (COPD), chronic asthma), renal or liver disease (e.g. cirrhosis, hepatitis), uncontrolled endocrine or allergic disorders (e.g., hypothyroidism, diabetes, allergic rhinitis), neurologic conditions (e.g., multiple sclerosis, prior stroke, neurological tumor), severe physical impairment (e.g., blindness, deafness, paraplegia); and active malignancy (any malignancy except for localized dermatologic cancer).
* Any impairment, activity or situation that in the judgment of the Study Coordinator or Principal Investigator would prevent safe or satisfactory completion of the study protocol.
* Individuals receiving or applying for compensation or disability and other aspects associated with potential secondary gain per self-report;
* Additional exclusion that prevent participation in QST and fMRI:
1. Severe claustrophobia precluding MRI and evoked pain testing during scanning;
2. Diagnosed peripheral neuropathy
3. Diagnosed or self-reported epilepsy
4. Diagnosed or self-reported visual-evoked migraines

Contacts and Locations

Study Contact

Kathy Scott

CONTACT

734-998-7022

jrsj@med.umich.edu

Principal Investigator

Sawsan As-Sanie, MD, MPH

PRINCIPAL_INVESTIGATOR

University of Michigan

Andrew Schrepf, PhD

PRINCIPAL_INVESTIGATOR

University of Michigan

Study Locations (Sites)

University of Michigan

Ann Arbor, Michigan, 48109

United States

Collaborators and Investigators

Sponsor: University of Michigan

Sawsan As-Sanie, MD, MPH, PRINCIPAL_INVESTIGATOR, University of Michigan
Andrew Schrepf, PhD, PRINCIPAL_INVESTIGATOR, University of Michigan

Study Record Dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Registration Dates

Study Start Date2025-08

Study Completion Date2028-09

Study Record Updates

Study Start Date2025-08

Study Completion Date2028-09

Terms related to this study

Keywords Provided by Researchers

Relugolix Combination Therapy
Endo-EPIC (Alternative study acronym/title)

Additional Relevant MeSH Terms

Endometriosis
Pelvic Pain