Persistence of dysmenorrhea and non-menstrual pain after optimal endometriosis surgery may indicate adenomyosis

October 2006

This prospective clinical trial shows that women without significant decrease in pain after complete surgical excision of endometriosis should be considered for MRI to ascertain whether adenomyosis might be the actual cause of pain.

Fifty-three women with chronic pelvic pain underwent pre-operative MR imaging to measure uterine JZ thickness, surgical excision, and pathologic diagnosis of endometriosis. Those with biopsy-proven endometriosis were randomized to raloxifene or placebo. Visual analog scale (VAS) was used to rate dysmenorrhea and non-menstrual pain severity before surgery and 3 months later.

Comparison of JZ thickness and pain severity before and 3 months after surgery was undertaken in women with endometriosis controlling for medical treatment.

The authors found that women with endometriosis may have myometrial junctional zone (JZ) abnormalities, possibly indicative of adenomyosis that contribute significantly to chronic pelvic pain. Dysmenorhoea and non-menstrual pain showed no significant decrease in women whose JZ measured 11mm or more compared with those whose JZ measured 8mm or less [1].

Comments Professor Ivo Brosens: “It is well-known that adenomyosis and endometriosis frequently coexist, but in most instances the association is diagnosed after hysterectomy. Different pharmacological therapies as well as new interventional therapies such as uterine artery embolization and MRI-guided focused ultrasound surgery exist or are in development” [2].

Sources

1. Parker JD, Leondires M, Sinaii N, Premkumar A, Nieman LK, Stratton P. Persistence of dysmenorrhea and nonmenstrual pain after optimal endometriosis surgery may indicate adenomyosis. Fertil Steril 2006;86(3):711-5
2. Ivo Brosens: Faculty of 1000 Medicine, 27 Sep 2006 http://www.f1000medicine.com/article/id/30736/evaluation