Prevalence of Endometriosis During Abdominal or Laparoscopic Hysterectomy for Chronic Pelvic Pain

Mowers, Erika L.; Lim, Courtney S.; Skinner, Bethany; Mahnert, Nichole; Kamdar, Neil; Morgan, Daniel M.; As‐Sanie, Sawsan

doi:10.1097/01.ogx.0000499755.80840.50

Cited by 13 publications

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“…The endometriosis rate in our study of 51% is consistent with rates reported in pain populations 21 . Higher-powered studies and reviews which question study definitions of CPP, report a lower rate (30%) of endometriosis amongst women with CPP 22 .…”

Section: Discussionsupporting

confidence: 91%

Pelvic Pain: what are the symptoms and predictors for surgery, endometriosis and endometriosis severity?

Conroy

Mooney

Kavanagh

et al. 2021

Preprint

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BackgroundChronic pelvic pain (CPP) is a common condition which significantly impacts the quality of life and wellbeing of many women.Laparoscopy with histopathology is recommended for investigation of pelvic pain and identification of endometriosis with concurrent removal. Never-the-less, the association between endometriosis and pelvic pain is challenging, with endometriosis identified in only 30-50% of women with pain.AimsTo explore the predictors for undergoing surgery, for identifying endometriosis and endometriosis severity in a cohort of women with CPP.Materials and MethodsThis study forms part of the Persistent Pelvic Pain project, a prospective observational cohort study (ANZCTR:ACTRN12616000150448). Women referred to a public gynaecology clinic with pain were randomised to one of 2 gynaecology units for routine care and followed for 36-months with 6-monthly surveys assessing demographics, medical history, quality of life, and pain symptoms measured on a Likert scale. Operative notes were reviewed, and endometriosis staged.ResultsOf 471 women recruited, 102 women underwent laparoscopy or laparotomy, of whom 52 had endometriosis (n=37 stage I-II; n=15 stage III-IV). Gynaecology unit, pelvic pain intensity and lower parity were all predictors of surgery (Odds ratio (OR) 0.342; 95%CI 0.209-0.561; OR 1.303; 95%CI: 1.079-1.573; OR 0.767; 95%CI: 0.620-0.949 respectively). There were no predictors identified for endometriosis diagnosis and the only predictor of severity was increasing age (OR 1.155; 95%CI: 1.047-1.310).ConclusionsPain intensity and gynaecology unit were key predictors of undergoing laparoscopy, however, pain severity did not predict endometriosis diagnosis or staging. These findings indicate the need to review current frameworks guiding practice towards surgery for pelvic pain.

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Section: Discussionsupporting

confidence: 91%

Pelvic Pain: what are the symptoms and predictors for surgery, endometriosis and endometriosis severity?

Conroy

Mooney

Kavanagh

et al. 2021

Preprint

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“…The significance of musculoskeletal, or myofascial, pain in chronic pelvic pain conditions is becoming increasingly established . An estimated 25%‐40% of women undergoing diagnostic laparoscopic surgery for pelvic pain do not have an obvious structural diagnosis, suggesting their pain is not due to organ disease but may be due to myofascial dysfunction . Therefore, consideration of myofascial pain as a contributing cause of a patient's pelvic pain early in the workup may allow the patient to avoid unnecessary surgical procedures and, instead, pursue more appropriate conservative treatments.…”

Section: Introductionmentioning

confidence: 99%

Joint Hypermobility among Female Patients Presenting with Chronic Myofascial Pelvic Pain

Hastings

Forster

Witzeman

2019

PM&R

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Background Female chronic pelvic pain is estimated to affect up to 24% of adult women, many of whom have a component of myofascial pelvic pain. Although an association of joint hypermobility and pelvic pain has been hypothesized, limited data are available that estimate the prevalence of joint hypermobility in this population. Objective To estimate the prevalence of generalized hypermobility spectrum disorder (G‐HSD) among female patients with chronic myofascial pelvic pain and examine the association between G‐HSD and other frequent pelvic pain‐associated complaints. Study Design Retrospective case control. Setting Tertiary referral center within a university‐affiliated public health system. Patients Adult women who were diagnosed with myofascial pelvic pain during a 1‐year period (n = 77 with G‐HSD and n = 241 without G‐HSD). Methods Data were abstracted via chart review of patients meeting inclusion criteria. Outcomes The primary outcome of this study was the prevalence of G‐HSD among patients with persistent myofascial pelvic pain. Secondary outcomes included the prevalence of dyspareunia, provoked vestibulodynia, stress urinary incontinence, irritable bowel syndrome, hip pain, low back pain, and fibromyalgia in patients with persistent myofascial pelvic pain with and without G‐HSD. Results Twenty‐four percent (N = 77; 95% CI: 19.6, 29.4) of myofascial pelvic pain patients also met criteria for G‐HSD. After adjusting for confounders, the odds in favor of having G‐HSD was 3.55 higher (95% CI: 1.50, 8.40) (P = .004) in females with dyspareunia; 7.46 higher (95% CI: 2.41, 23.1) (P < .001) with low back pain; 3.76 higher (95% CI: 1.35, 10.5) (P = .02) with stress urinary incontinence; 4.72 higher (95% CI: 2.00, 11.2) (P < .001) with irritable bowel syndrome; and 3.12 higher (95% CI: 1.36, 7.13) (P = .007) with hip pain. There was no significant association identified between provoked vestibulodynia or fibromyalgia and G‐HSD. Conclusion The estimated prevalence of G‐HSD is higher in chronic myofascial pelvic pain patients than in the general population with statistically significant associations with several comorbid conditions. Characterizing these associations is the first step in developing effective, evidence‐based screening recommendations. Level of Evidence III

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“…55,56 Pelvic pain is a common symptom, and women with chronic pelvic pain do have a higher incidence of endometriosis, although histologic evidence of endometriosis is not always appreciable upon surgical examination. 57 Numerous etiologies of endometriosis have been proposed over time, including retrograde menstruation, metaplastic changes, and development from embryonic duct remnants. [58][59][60][61] Endometrial glandular epithelium typically resembles tight clusters of small cells with scant cytoplasm and cytologically bland nuclei with finely granular chromatin without prominent nucleoli ( Fig.…”

Section: Endometriosismentioning

confidence: 99%

Abdominopelvic washings in gynecologic pathology: A comprehensive review

Schulte

Lastra

2016

Diagnostic Cytopathology

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Abdominopelvic washings (APW) performed during gynecologic surgeries have become a common specimen evaluated by cytopathologists. Their role in staging of female genital tract tumors has changed significantly since they were first described, and continue to evolve. The ability of these washings to detect microscopic disease, even in the absence of gross disease, warrants the critical role that these washings play in the staging of certain female gynecologic tract tumors, allowing for optimal staging and subsequent treatment of the patient. Irrespective of the underlying pathology, the gamut of cytomorphologic findings that may be observed in APW is extensive, and ranges from benign lesions that may act as mimickers of malignancy, to both common and rare malignancies. This review discusses the changing role of APW in the staging of gynecologic tumors, and highlights the salient cytomorphologic features of these lesions, with emphasis in their correct identification, including cautionary notes to avoid over or misinterpretation. Diagn. Cytopathol. 2016;44:1039-1057. © 2016 Wiley Periodicals, Inc.

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Prevalence of Endometriosis During Abdominal or Laparoscopic Hysterectomy for Chronic Pelvic Pain

Abstract: (Abstracted from Obstet Gynecol 2016;127:1045–1053) Chronic pelvic pain is common in reproductive-aged women. A large number of women with chronic pelvic pain or endometriosis undergo hysterectomy: 10% to 32% for chronic pelvic pain and 5% to 19% for endometriosis.

Cited by 13 publications

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Pelvic Pain: what are the symptoms and predictors for surgery, endometriosis and endometriosis severity?

Pelvic Pain: what are the symptoms and predictors for surgery, endometriosis and endometriosis severity?

Joint Hypermobility among Female Patients Presenting with Chronic Myofascial Pelvic Pain

Abdominopelvic washings in gynecologic pathology: A comprehensive review

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