Stovall, D. W., Bowser, L. M., Archer, D. F., & Guzick, D. S. (1997). Endometriosis-associated pelvic pain: evidence for an association between the stage of disease and a history of chronic pelvic pain. Fertility and Sterility, 68(1), 13-18. https://doi.org/10.1016/s0015-0282(97)81468-9
Stovall DW, Bowser LM, Archer DF, Guzick DS. Endometriosis-associated pelvic pain: evidence for an association between the stage of disease and a history of chronic pelvic pain. Fertil Steril. 1997;68(1):13-18. doi:10.1016/s0015-0282(97)81468-9
Stovall, Dale W., et al. "Endometriosis-associated pelvic pain: evidence for an association between the stage of disease and a history of chronic pelvic pain." Fertility and Sterility, vol. 68, no. 1, 1997, pp. 13-18.
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Later-stage endometriosis is linked to lasting pelvic pain
Later-stage endometriosis was linked to lasting pelvic pain years after treatment in a study of 48 women at one tertiary care center. About 6 out of 10 women still had pelvic pain at follow-up. All had chronic pelvic pain and had received medical therapy, conservative surgery, or both.
Key Findings
Follow-up averaged 15.7 ± 3.1 years. Twenty-one of 48 women (43.8%) reported no pain, and 27 (56.2%) still had pelvic pain.
Of the 27 women with persistent pain, 21 (78%) placed their most severe pain in the same location as at diagnosis.
Stage did not match pain severity at first presentation (P > 0.05). At follow-up, stage was associated with persistent pain (P < 0.01), with more pain tending to occur in advanced disease.
Of 21 pain-free women, 11 (52.4%) had carried a pregnancy to at least 20 weeks. Of 27 women with persistent pain, 5 (18.5%) had (P < 0.05).
Among 14 women whose disease was mainly ovarian, 10 (71.4%) had mainly lateral pain. Other disease sites showed no clear link to pain location.
Interpretation
This cohort study followed 48 women with staged endometriosis and chronic pelvic pain at one tertiary care center over a long-term follow-up period. Disease stage at diagnosis was linked with pain that persisted at follow-up. Pain-free women were more likely to have carried a pregnancy to at least 20 weeks than women with ongoing pain. The authors note their study had limited power to detect a link between treatment type and pain relief. The findings support larger studies of disease stage, pregnancy, and long-term pelvic pain.
RRM Context
The surgical arm used ablation of implants, and the drug arm used danazol. The authors cite trials in which symptoms came back in at least half of patients within 12 months of stopping drug therapy. Restorative reproductive medicine treats endometriosis as a chronic, root-cause condition and favors excision over ablation. This cohort reports no excision outcomes.
Our editorial summary of this paper, not the article's abstract.
Abstract
Objective
To track the severity and location of pelvic pain associated with endometriosis throughout the reproductive-age years and to evaluate the association between these pain parameters and the stage of disease.
Design
Historical prospective study.
Setting
Tertiary care center.
Patients
Forty-eight women with endoscopically staged endometriosis and chronic pelvic pain who had undergone medical and/or conservative surgical therapy.
Interventions
Each participant was administered a questionnaire that included a determination of the severity and location of her pain.
Main Outcome Measures
The stage of disease, the area of the pelvis that contained the bulk of disease, the severity of pain, and the location of the most severe pain were recorded.
Results
The mean duration from the initial diagnosis until follow-up was 15.7 +/- 3.1 years, Twenty-one (43.8%) subjects denied any symptoms of pain on follow-up evaluation. Of the 27 patients with persistent pain, 21 (78%) identified the location of their most severe pain as being the same as at initial diagnosis. The stage of disease at initial diagnosis was significantly associated with a higher degree of pain at follow-up.
Conclusions
These data suggest that endometriosis-associated chronic pelvic pain commonly persists throughout the reproductive years and that endometriosis stage is directly related to the persistence of pelvic pain.
