Analysis of Risk Factors Associated With Persistent Noncyclic Pelvic Pain Despite Hormonal Treatment in Patients With Endometriosis

Abstract

Purpose: To identify risk factors that predict the persistence of noncyclical pelvic pain in patients with endometriosis despite receiving hormone therapy. Methods: This retrospective study examined 164 patients with histopathologically confirmed deep infiltrating endometriosis (DE) and/or ovarian endometrioma (OV). Clinical data obtained through preoperative face-to-face interviews were analyzed to identify risk factors for persistent pain despite receiving hormonal treatment (defined as visual analog-scale score [VAS] score > 30). All patients received preoperative hormonal treatment with progestins, combined oral contraceptives, or gonadotropin-releasing hormone agonists for at least three months prior to surgery. Results: Multivariable analysis identified several risk factors: OV (odds ratio [OR]: 4.11, 95% confidence interval [CI]: 1.67–10.1, p = 0.002) versus no OV, noncyclical chronic pelvic pain (VAS score ≤ 60: OR: 12.0, 95% CI: 4.17–34.6; VAS score > 60: OR: 7.03, 95% CI: 2.25–21.9, p < 0.001) versus no pain, severe dyspareunia (VAS score > 60) (OR: 6.73, 95% CI: 4.17–34.6, p = 0.002) versus no dyspareunia, and a previous cesarean section (OR: 9.53, 95% CI: 1.54–59.0, p = 0.02) versus no previous cesarean section. Conclusions: Patients with ovarian endometrioma, noncyclical chronic pelvic pain, severe dyspareunia, and a history of cesarean section are at an increased risk for persistent pain despite hormonal treatment.