The Severity of Pain Does not Predict Endometriosis or its Stage, Study Confirms

Current frameworks that guide practice toward surgery for pelvic pain should be reviewed.

Key Points

Highlights: 

• Pelvic pain is a factor that can predict whether or not a woman will undergo surgery but it cannot predict whether she has endometriosis, or how severe it might be.

Importance:

• This finding underscores the importance of reviewing current frameworks guiding practice toward surgery for pelvic pain.

What's done here:

• Researchers analyzed 471 women who were referred to a public gynecology clinic due to pelvic pain, and were followed for three years.
• One fifth of pain patients (n=102, 21.6%) had laparoscopic or laparotomic surgery. Of these 52 had endometriosis (n=37 stage 1 or 2, n=15 stage 3 or 4).
• The women completed a surgery every six months: their demographics, medical history, and quality of life were assesed.
• The pain symptoms were measured on a Likert scale every six months.

Key results:

• The intensity of pelvic pain and lower parity are predictors for surgery.
• No predictors for endometriosis were identified in this study.
• Higher age is a predictor of the stage of endometriosis.

Limitations:

• There were some missing responses to a number of variables in the study, which could have an impact on the findings.
• The proportion of the women who had surgery and those who had endometriosis was small, so the results should be interpreted with caution.

Lay Summary

The intensity of pain a woman experiences could predict whether or not she would undergo laparoscopic surgery. However, it could not predict whether she has endometriosis or in case she did, the severity of her disease. This is according to a study published in "The Australian and New Zealand Journal of Obstetrics and Gynaecology".

“These findings indicate the need to review current frameworks guiding practice toward surgery for pelvic pain”, wrote Isabelle Conroy and the co-authors of the study.

The association between pelvic pain and endometriosis is challenging. Only 30 to 50% of women with pelvic pain end up being diagnosed with endometriosis.

In order to identify potential predictors for undergoing surgery and identifying endometriosis and its severity, the team of researchers assessed 471 women who were referred to a public gynecology clinic due to pain. The women were followed for three years and completed a surgery every six months, which assessed their demographics, medical history, and quality of life. Their pain symptoms were also measured on a Likert scale every six months.

The researchers found that of the 471 women, 102 (21.6%) had laparoscopic or laparotomic surgery. Of these 52 had endometriosis with 37 having stage 1 or 2 disease and 15 having advanced stage disease. 

Using statistical analyses, the researchers identified the intensity of pelvic pain and lower parity (the number of times a woman gives birth) to be predictors of surgery. However, they could not identify any factors that could predict whether or not a woman had endometriosis. The only factor that could predict the severity of endometriosis was higher age.

Endometriosis affects around one in 10 women of reproductive age. Although the most common symptom of endometriosis is pain, the disease can be completely asymptomatic in many women but still cause complications such as infertility. Currently, the gold standard for diagnosing and treating endometriosis is laparoscopic surgery. 

Research Source: https://pubmed.ncbi.nlm.nih.gov/34028794/