The comorbidities of dysmenorrhea: a clinical survey comparing symptom profile in women with and without endometriosis
Received 6 July 2018
Accepted for publication 9 October 2018
Published 13 December 2018 Volume 2018:11 Pages 3181—3194
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 3
Editor who approved publication: Dr Michael A Überall
Susan F Evans,1 Tiffany A Brooks,2 Adrian J Esterman,3,4 M Louise Hull,5 Paul E Rolan6
1School of Medicine, University of Adelaide, Adelaide, SA, Australia; 2School of Psychology, University of South Australia, Adelaide, SA, Australia; 3School of Nursing and Midwifery, University of South Australia, Adelaide, SA, Australia; 4James Cook University, Cairns, QLS, Australia; 5Robinson Research Institute, School of Pediatrics and Reproductive Health, University of Adelaide, Adelaide, SA, Australia; 6School of Medicine, University of Adelaide, Adelaide, SA, Australia
Purpose: Dysmenorrhea is a common disorder that substantially disrupts the lives of young women. The frequency of 14 associated symptoms both within and outside the pelvis was determined.
Patients and methods: Symptom questionnaires were completed by 168 women with dysmenorrhea, allocated to three groups based on their diagnostic status for endometriosis confirmed (Endo+), endometriosis excluded (Endo−), or endometriosis diagnosis unknown (No Lap). Those with endometriosis confirmed were further divided into current users (Endo+ Hx+) and non-users of hormonal treatments (Endo+ Hx–). Users of hormonal treatments were further divided into users (Endo+ Hx+ LIUCD+) and non-users (Endo+ Hx+ LIUCD–) of a levonorgestrel-releasing intra-uterine contraceptive device (LIUCD). The frequency and number of symptoms within groups and the effect of previous distressing sexual events were sought.
Results: Women with and without endometriosis lesions had similar symptom profiles, with a mean of 8.5 symptoms per woman. Only 0.6% of women reported dysmenorrhea alone. The presence of stabbing pelvic pains was associated with more severe dysmenorrhea (P=0.006), more days per month of dysmenorrhea (P=0.003), more days per month of pelvic pain (P=0.016), and a diagnosis of migraine (P=0.054). The symptom profiles of the Endo+ Hx+ and Endo+ Hx– groups were similar. A history of distressing sexual events was associated with an increased number of pain symptoms (P=0.003).
Conclusion: Additional symptoms are common in women with dysmenorrhea, and do not correlate with the presence or absence of endometriosis lesions. Our study supports the role of central sensitization in the pain of dysmenorrhea. The presence of stabbing pelvic pains was associated with increased severity of dysmenorrhea, days per month of dysmenorrhea, days per month of pelvic pain, and a diagnosis of migraine headache. A past history of distressing sexual events is associated with an increased number of pain symptoms.
Keywords: dysmenorrhea, endometriosis, headache, bladder pain syndrome, chronic pain, pelvic pain, levonorgestrel-releasing intra-uterine device, stabbing pain
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