Endometriosis in Patients With Chronic Pelvic Pain: Is Staging Predictive of the Efficacy of Laparoscopic Surgery in Pain Relief?

Abstract

Endometriosis is among the most important causes of chronic pelvic pain (CPP) in women of reproductive age; it reportedly is present in as many as one third of women having diagnostic laparoscopy for pain. This prospective study examined the relationship between the stage of disease and the severity and type of CPP in 95 women with endometriosis who had experienced pelvic pain for at least 6 months and who underwent operative laparoscopy. Using the American Fertility Society (AFS) 1985 revised scoring system, 27 women (group 1) had minimal or mild endometriosis with an AFS score less than 16, whereas 68 (group 2) had moderate or severe disease with an AFS score of 16 or greater. Pain severity was assessed before and 6 months after surgery using a visual pain scale. Dysmenorrhea was reported by 78% of patients in group 1 and deep dyspareunia by 33%. The respective figures for women in group 2 were 96% and 79%. The 2 groups did not differ significantly in the frequency of nonmenstrual pain. In women in group 2, deep dyspareunia was significantly associated with the presence of dense pelvic adhesions. On regression analysis, preoperative pain scores for dysmenorrhea and deep dyspareunia were significantly higher in women in group 2 than in women in group 1, but there was no such difference in nonmenstrual pain. Observations after laparoscopic surgery indicated that deep dyspareunia was the most treatment-resistant of these symptoms. Dysmenorrhea improved after surgery in 43% of group 1 cases and 66% of group 2 cases. Deep dyspareunia improved in 33% and 67% of cases, respectively. Correlational studies suggested that the only correlation was between dysmenorrhea and deep dyspareunia. Postoperative change in nonmenstrual pain did not correlate with changes in pain scores for either dysmenorrhea or deep dyspareunia. Laparoscopic surgery appears to provide some relief to a majority of women with all types of CPP resulting from endometriosis. Surgery is indicated for all stages of endometriosis when diagnostic laparoscopy confirms this diagnosis in women having chronic pelvic pain.