PELVIC PAIN AND PSYCHO-EMOTIONAL STATUS IN WOMEN WITH OVARIAN ENDOMETRIOMA COMBINED WITH PELVIC INFLAMMATORY DISEASES: TREATMENT OPTIONS CHOICE

Abstract

The connection between chronic pelvic pain and t he presence in the body of a pathologicalsource of structural and morphological changes in tissue, e.g. in connection with uterine fi broids, endometriosis, chronic infl ammatory processes of the pelvic organsremains a traditional opinion. Endometriosis, which is characterized by a chronicpelvic pain, aff ects about 10% of women of reproductive age, and the problem ofstudying endometrioid cysts demonstrates its relevance by dominating in the structureof genital endometriosis up to 59%. Chronic pelvic pain causes inappropriate coursesof antibacterial therapy and, as a consequence, dysbiosis, the development of ovarianinsuffi ciency syndrome, and the surgical approach does not always show the desiredresults, often worsening the clinical picture and psycho- emotional status of the patient.Purpose – to assess the severity of the pain syndrome and psychological status in patientswith pelvic pain associated with ovarian endometrioma and to seek eff ective therapeuticoptions.Materials and methods. The study included 40 patients with ovarian endometriosiscombined with pelvic infl ammatory disease (main group) and 40 patients with isolatedendometrioma (comparison group). The control group consisted of 30 patients withoutmanifestations of genital endometriosis. Analysis of somatic and gynecologicalanamnesis the objective and gynecological examination, data from adapted Beck’sDepression Inventory and State- Trait Anxiety Inventory, pain assessment according tothe visual- analog scale (VAS), sonographic examination of the pelvic organs, evaluationof magnetic resonance imaging, endoscopic and histological methods of examination hasbeen carried out.Results. Dyspareunia was noted in one third of patients of the main group; dysuricmanifestations, intestinal disorders in every fourth woman, in a third of women –a combination with manifestations of asthenic- neurotic syndrome, the intensity of painwas presented in a third as severe and unbearable. It should be noted that the percentageof secondary infertility increased by 2.6 times, in two thirds of cases there weremenstrual cycle disorders, where manifestations of algodysmenorrhea and abnormaluterine bleeding dominated. The analysis of psychological questionnaires noted equalpercentage of moderate and mild depressive symptoms in the main group, and also, alongwith a decrease in psychological and emotional adaptation, high rates of situational andpersonal anxiety. The proposed therapeutic options included the use of dienogest fi rst ofall in women with mild to moderate pain syndrome, the possibility of the prolonged use atrisk of recurrence and taking into account the smaller percentage of probable side eff ects.Conclusions. The analysis of the obtained data allowed to indicate to more intense painsyndrome, high frequency of menstrual disorders, secondary infertility and manifestationsof nonspecifi c clinical symptoms in patients with endometriomas combined with thepelvic infl ammatory processes. The psycho- emotional state of women is characterizedby high levels of depressive and anxiety disorders, as well as a pronounced intensity ofpain syndrome in one third of cases. At weak and moderate degree of pelvic pain the drugof choice of the therapeutic program is dienogest, the use of which is expedient in theprolonged perspective, in case of the expressed pain intensity syndrome it is expedient togive a preference to the gonadotropin- releasing hormone agonist.