The characteristics of women recommended a laparoscopy for chronic pelvic pain at a tertiary institution

Mirowska-Allen, Kelly; Sewell, Megan; Mooney, Samantha; Maher, Peter; Ianno, Damian; Grover, Sonia

doi:10.1111/ajo.12836

Cited by 10 publications

(6 citation statements)

References 29 publications

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“…Several studies have demonstrated a recurrence of pain within 12–18 months, with many young women then undergoing repeat surgical procedure(s) 9,10 . Predictors for repeat laparoscopy for pelvic pain include younger age and previous pelvic laparoscopy 11,12 . A placebo effect of up to 30% has been reported in the literature, whereas up to 20% of women describe no improvement in symptoms 13 .…”

Section: Introductionmentioning

confidence: 99%

Dysmenorrhea in young people: Experiences from a tertiary center with a focus on conservative management

Sachedina

Bakar²,

Dunford

et al. 2020

J of Obstet and Gynaecol

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AimTo describe the characteristics, management and outcomes of a cohort of young people with dysmenorrhea presenting to a tertiary adolescent gynecology service, managed primarily with medical interventions.MethodsA retrospective cohort study was conducted at the Royal Children's Hospital in Melbourne, Australia. Data were collected from medical records of patients presenting with dysmenorrhea and/or pelvic pain.ResultsOf 154 patients, mean age of presentation was 15.7 years (SD = 2.2) and mean duration of pain was 14.9 months (SD = 10.8). Regular cycles were reported by 64.5%, and heavy menstrual bleeding (HMB) in 67.8%. Patients self‐reporting HMB reported less pain on the day prior to menses than those not reporting HMB (P < 0.005). At follow‐up, therapeutic interventions included nonsteroidal anti‐inflammatory drugs, tranexamic acid and cyclic or continuous combined oral contraceptive pills. Laparoscopies were undertaken in 12 (8.1%) patients, with normal findings in 8 (66.7%). Secondary dysmenorrhea was identified in 10 patients: of these, endometriosis was identified in one patient and unilateral obstructive Müllerian anomalies in six. Overall, 92.2% of patients had improvement in symptoms after treatment.ConclusionLaparoscopy and endometriosis rates in patients presenting to a tertiary center were lower than previously reported, with most patients achieving symptom improvement without laparoscopy.

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Section: Introductionmentioning

confidence: 99%

Dysmenorrhea in young people: Experiences from a tertiary center with a focus on conservative management

Sachedina

Bakar²,

Dunford

et al. 2020

J of Obstet and Gynaecol

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“…A previous PPP publication reporting on the characteristics of women who underwent laparoscopy in the first 211 participants, demonstrated that only severe dysmenorrhoea predicted surgery 20 . Analysis of data by gynaecology unit was not performed to avoid potentially influencing clinician behaviour in the remainder of the study.…”

Section: Discussionmentioning

confidence: 99%

Pelvic pain: What are the symptoms and predictors for surgery, endometriosis and endometriosis severity

Conroy

Mooney²,

Kavanagh

et al. 2021

Aust NZ J Obst Gynaeco

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Background Chronic 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. Aims To explore the predictors for undergoing surgery, for identifying endometriosis and endometriosis severity in a cohort of women with CPP. Materials and Methods This 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 two 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. Results Of 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). Conclusions Gynaecology unit and pain intensity 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 toward surgery for pelvic pain.

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“…10 Women with CPP are more likely to be offered surgery if they experience factors increasing the likelihood of pathology such as severe and prolonged pain. 11 However, the finding of endometriosis does not correlate with any specific pain symptoms, 10 or any cluster of symptoms, 12 and the extent of endometriosis does not correlate with severity of symptoms. 13 Furthermore with diverse symptomatology, there are often significant delays between first presentation and eventual diagnosis of endometriosis.…”

Section: O R I G I N a L A R T I C L Ementioning

confidence: 93%

“…This time period was chosen to encompass the study time of the 'Persistent Pelvic Pain' study which explores the outcomes of women referred for pelvic pain as previously published. 10,11 Women who had multiple surgeries during the study period (n = 25), were only included once. Patients without formal referrals in their file were excluded from the study (n = 8), as were women who had a hysterectomy prior to their initial consult (n = 2).…”

Section: Inclusion Criteria Included Age Between 18 and 50 Years And ...mentioning

confidence: 99%

“…CPP, by contrast, affects an estimated one in five Australian women, 9 and while many of these women are suspected to have endometriosis at some point, most of them do not 10 . Women with CPP are more likely to be offered surgery if they experience factors increasing the likelihood of pathology such as severe and prolonged pain 11 . However, the finding of endometriosis does not correlate with any specific pain symptoms, 10 or any cluster of symptoms, 12 and the extent of endometriosis does not correlate with severity of symptoms 13 .…”

Section: Introductionmentioning

confidence: 99%

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When pain is not the whole story: Presenting symptoms of women with endometriosis

Gordon

Mooney

Conroy³

et al. 2022

Aust NZ J Obst Gynaeco

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Background: Endometriosis affects one in nine Australian women of reproductive age, and is often associated with pain and infertility. However, many women may be asymptomatic, or present with alternative symptoms. Aim:To identify reasons for initial specialist referral among patients with endometriosis. Material and Methods: Patients were identified as having endometriosis intraoperatively based on International Classification of Diseases coding. Operation reports were reviewed and graded for severity of disease. This cohort was then retrospectively audited to identify reasons for initial referral to the general gynaecology, endosurgery, gynae-oncology, reproductive medicine outpatient departments (OPD) at the Mercy Hospital for Women in Melbourne between 1 February 2015 and 31 December 2016.Results: Three hundred patients were identified as having endometriosis at laparoscopy, including 90 women with Stage IV disease. Patients were a mean (SD) age of 33.1 (7.6) years. While pain remained a common reason for referral (61.7% of referrals), 36.7% of women with Grade IV disease did not have pain included in their referral letter. Severe disease was associated with increased age (regression coefficient 0.05; 95% CI: 0.03-0.07, P < 0.01), but not with pain symptoms. Women referred with ovarian cysts or masses were more likely to be diagnosed with severe disease (regression coefficient 0.69; 95% CI: 0.37-1.01, P < 0.01). Conclusion:Although pelvic pain is not a good predictor for a diagnosis of endometriosis, it remains a common symptom among women with the disease.However, more than one in three patients with Grade IV endometriosis presented without mention of pain symptoms, encouraging clinicians to adopt a broader approach to the presenting symptoms of endometriosis.

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The characteristics of women recommended a laparoscopy for chronic pelvic pain at a tertiary institution

Cited by 10 publications

References 29 publications

Dysmenorrhea in young people: Experiences from a tertiary center with a focus on conservative management

Dysmenorrhea in young people: Experiences from a tertiary center with a focus on conservative management

Pelvic pain: What are the symptoms and predictors for surgery, endometriosis and endometriosis severity

When pain is not the whole story: Presenting symptoms of women with endometriosis

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