Magazine article Clinical Psychiatry News
Assess Psychological Factors in Chronic Pelvic Pain Cases
FORT LAUDERDALE, FLA. -- About 75% of premenopausal women with chronic pelvic pain gain significant relief from hysterectomy, even when no apparent physiologic cause is found. But what about the other 25%?
"We tend to look at fibroids and endometriosis. It behooves us to look at interstitial cystitis and muscle problems of the pelvic floor." It is important to avoid getting this 20%-25% of patients to hysterectomy, Dr. Charles E. Miller said at a meeting on hysterectomy sponsored by the Cleveland Clinic.
Do not stop at a diagnosis of endometriosis if symptoms suggest otherwise. Consider other etiologies, including irritable bowel disease, interstitial cystitis, and psychological factors, said Dr. Miller, director of minimally invasive gynecologic surgery at Lutheran General Hospital in Park Ridge, Ill.
Each year, about 75,000 of the more than 600,000 hysterectomies performed for benign disease are for relief of chronic pelvic pain. In a study of 99 women who reported persistent pelvic pain for 6 months who reported persistent pelvic pain for 6 months or more, 78% showed improvement a mean 22 months after laparoscopic hysterectomy (Obstet. Gynecol. 1990;75:676-9).
"You will see this number as we go through these slides. About three out of four women are going to gain significant relief with hysterectomy," said Dr. Miller, who is also on the obstetrics and gynecology faculty at the University of Illinois at Chicago. Other researchers confirmed this figure in subsequent studies (Obstet. Gynecol. Surv. 1993;48:357-87; Obstet. Gynecol. 1995;86:941-5).
"We must be able to do more. That is why we look for alternative diagnoses," Dr. Miller said. "Interestingly enough, there are a lot of studies that relate endometriosis and interstitial cystitis, and endometriosis and irritable bowel. So it's not enough to stop at endometriosis if symptoms suggest something else. …