A high proportion of reproductive-age women may be experiencing pelvic pain that goes untreated, according to a recent study.
The researchers with the National Institutes of Health in Bethesda, Md., and the University of Utah School of Medicine, Salt Lake City, surveyed more than 400 women who were scheduled to undergo surgery or imaging for reasons such as infertility, menstrual irregularities, tubal sterilization or pelvic pain. As the researchers expected, reports of pain were highest for women diagnosed with endometriosis, a disorder in which tissue that normally lines the inside of the uterus grows outside of the uterus. However, one-third of those without any pelvic condition also reported a high degree of ongoing pain or pain recurring during the menstrual cycle.
The study, published Aug. 11 on the website of the journal Human Reproduction, was conducted by 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.
“Our study suggests that many reproductive-age women are experiencing but not reporting some form of pelvic pain,” Schliep said in a news release. “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. Similarly, women should let their doctors know if they’re in pain.”
For the study, researchers enrolled 473 women ages 18-44 at 14 surgical centers in Salt Lake City and San Francisco. The women were set to undergo either laparoscopy, a surgical procedure which involves inserting a camera at the end of a tube through a tiny incision in the abdomen, or a laparotomy, which involves making a larger incision in the pelvic region. Participants were seeking care or treatment for pain, for a mass or lump in the pelvic region, infertility, menstrual irregularities or for tubal sterilization.
In a preop interview, the women were asked about the kind of pain they had experienced in the past six months and its severity. In all, the women were asked whether 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. The women also 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 they were experiencing chronic pain and cyclic pain — coinciding with an interval during their monthly menstrual cycle — lasting six months or longer. This 30% included not only women with pelvic disorders, but also those without any pelvic condition. Regardless of the reason they had surgery or of their diagnosis after the operation, the study found only 3% of the total study population reported having none of the 17 types of pain, while more than 60% reported six or more types of pain.
Among the study participants, approximately 40% were diagnosed with endometriosis, and 31% with other conditions, including uterine fibroids, ovarian cysts and tumors. Nearly 29% had not been diagnosed with any pelvic conditions.
The study found women diagnosed with endometriosis experienced the most chronic pain, at slightly more than 44%, compared with about 30% of women without any pelvic condition. Similarly, women with endometriosis were more likely to experience pain during intercourse, menstrual cramping and pain with bowel elimination, research showed. They also were more likely to report vaginal pain and pain in the pelvic-abdominal area.
Future research on the type and location of pain associated with endometriosis is needed, the researchers said. Results of such studies might lead to better diagnosis and treatment of the disorder. The authors also called for additional research on the causes of pain in women not diagnosed with any pelvic condition.
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