The effectiveness of hysterectomy for chronic pelvic pain
S D Hillis1, P A Marchbanks, H B Peterson
1Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Objective:
To evaluate the effectiveness of hysterectomy in treating chronic pelvic pain, and to identify risk factors for persistent pelvic pain.
Methods:
A group of 308 women who had hysterectomy for chronic pelvic pain of at least 6 months' duration was followed-up for 1 year after surgery, as part of a large, prospective, multicenter cohort study. Persistent pain was defined as a trichotomous variable, and ordinal logistic regression was used to identify independent predictors of the trichotomous outcome.
Results:
Overall, 74% of women experienced complete resolution of pelvic pain, 21% reported continued but decreased pain, and 5% reported either unchanged or increased pain after hysterectomy. In unadjusted analyses, women at increased risk for persistent pain (eg, continued but decreased, and unchanged or increased) included those who were under age 30 (36 versus 22%, P < .05), had a history of pelvic inflammatory disease (41 versus 25%, P < .05), were uninsured or covered under Medicaid (41 versus 22%, P < .001), had no identified pelvic pathology (38 versus 23%, P < .05), or had a history of at least two pregnancies (31, 27, and 15% for those with at least four, two or three, and one or none, respectively; P < .05). After adjustment, an increased probability of persistent pain was observed among women who had no identified pelvic pathology (odds ratio [OR] 1.9, 95% confidence interval [CI] 1.0-3.6), were uninsured or covered under Medicaid (OR 2.3, 95% CI 1.2-4.3), or had experienced at least two pregnancies (OR 2.3, 95% CI 1.0-5.3).
Conclusion:
Most women with chronic pelvic pain have long-term improvement after hysterectomy. However, up to 40% of women in specific subgroups may continue to experience long-term pain.
