Untreated Pelvic Pain Common Among Young Women
A high proportion of reproductive-age women may be experiencing pelvic pain that goes untreated, according to the results of a new study. More than 400 women who were scheduled to undergo surgery or imaging for such reasons as infertility, menstrual irregularities, tubal sterilization, or pelvic pain, were surveyed by researchers from the National Institutes of Health and the University of Utah School of Medicine, Salt Lake City.
As the researchers expected, reports of pain were highest for women diagnosed with endometriosis. However, one-third of those without any pelvic condition also reported a high degree of ongoing pain or pain recurring during the menstrual cycle.1
“Our study suggests that many reproductive-age women are experiencing but not reporting some form of pelvic pain,” said Karen Schliep, PhD, of the Division of Intramural Population Health Research at NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development, in a press release from the NIH.2 “If they aren’t doing so already, gynecologists may want to ask their patients if they’re experiencing pain, as well as the type and precise location of the pain, and offer treatment as appropriate.”
The researchers enrolled 473 women ages 18 to 44 years at 14 surgical centers in Salt Lake City and San Francisco. The women were set to undergo either laparoscopy or a laparotomy. The women were seeking care or treatment for pain, for a mass or lump in the pelvic region, infertility, menstrual irregularities, or for tubal sterilization.
In an interview before their surgery, the women were asked about the kind of pain they had experienced in the past 6 months, along with its severity. In all, the women were asked if they had more than 17 specific types of pain related to sexual intercourse, their menstrual period, urination or bowel elimination, or other pain, such as muscle or joint pain or migraine headaches. In addition, they were asked to indicate on diagrams of the pelvic area and of a standing female figure where they felt pain.
More than 30% of the women reported that they were experiencing chronic pain and cyclic pain—coinciding with an interval during their monthly menstrual cycle—lasting 6 months or more. This 30% included not only women with pelvic disorders, but also those without any pelvic condition. In addition, regardless of the reason they had surgery or of their diagnosis after the operation, only 3% of the total study population reported having none of the 17 types of pain, while over 60% reported 6 or more types of pain.
Endometriosis Most Common Diagnosis
Among the study participants, approximately 40% were diagnosed with endometriosis and 31% with other conditions, including uterine fibroids, ovarian cysts, and tumors. The remaining 29% had not been diagnosed with any pelvic conditions.
Women diagnosed with endometriosis experienced the most chronic pain, at slightly more than 49%, compared with about 31% of women without any pelvic condition (P < 0.001). “Additionally, women with endometriosis compared with women with a normal pelvis experienced more chronic pain (44.2% versus 30.2%, P = 0.04). Deep pain with intercourse, cramping with periods, and pain with bowel elimination were much more likely reported in women with versus without endometriosis (all P < 0.002),” wrote the researchers. Similarly, a higher percentage of women with endometriosis reported vaginal (22.6% versus 10.3%, P < 0.01), right labial (18.4 versus 8.1%, P < 0.05) and left labial pain (15.3 versus 3.7%, P < 0.01) along with pain in the right/left hypogastric and umbilical abdominopelvic regions (P < 0.05 for all). Among women with endometriosis, no clear and consistent patterns emerged regarding pain characteristics and endometriosis staging or anatomic location.
“Interpretation of our findings requires caution given that we were limited in our assessment of pain characteristics by endometriosis staging and anatomic location due to the majority of women having minimal (stage I) disease (56%) and lesions in peritoneum-only location (51%). Significance tests for pain topology related to gynecologic pathology were not corrected for multiple comparisons,” noted the researchers.
Implications of the Study
Although the study suggests that women with endometriosis appear to have higher pelvic pain and pain in the vaginal and abdominopelvic area than women with other gynecologic disorders or a normal pelvis, “pelvic pain is commonly reported among women undergoing laparoscopy, even among women with no identified gynecologic pathology.” Future research should explore causes of pelvic pain among women who seek out gynecologic care but with no apparent gynecologic pathology.
The study authors also called for future research on the type and location of pain associated with endometriosis. “Given our and other’s research showing little correlation between pelvic pain and rASRM staging among women with endometriosis, further development and use of a classification system that can better predict outcomes for endometriosis patients with pelvic pain for both surgical and nonsurgical treatment is needed.” Results of such studies might lead to better diagnosis and treatment of the disorder.
About the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD): The NICHD sponsors research on development, before and after birth; maternal, child, and family health; reproductive biology and population issues; and medical rehabilitation. For more information, visit the Institute’s website at http://www.nichd.nih.gov.