Combined hysteroscopic and laparoscopic findings in patients with chronic pelvic pain.

STUDY OBJECTIVE: To document the abnormal findings at hysteroscopy and laparoscopy in patients with chromic pelvic pain.

DESIGN: Prospective evaluation at surgery of women treated consecutively between January 1, 1991, and December 30, 1992.

SETTING: A private practice.

PATIENTS: One hundred forty-one women with pelvic pain (average age 35 yrs).

INTERVENTIONS: Laparoscopy was performed in all patients, and hysteroscopy in all but one, who had had a hysterectomy. Endometrial and endocervical biopsies were performed.

MEASUREMENTS AND MAIN RESULTS: In 42 (30%) of 140 patients with a primary diagnosis of chronic pelvic pain hysteroscopic evaluation with endometrial and endocervical biopsies revealed an abnormality. Findings at hysteroscopy included leiomyomas in 25 patients (18%), intrauterine polyps in 9 (6.4%), and cervical stenosis in 4 (2.9%). Three women (2.1%) had intrauterine scarring and one (0.7%) had a bicornuate uterus. Endometrial biopsies showed adenomatous hyperplasia with atypia, and cystic hyperplasia in one patient each. Endocervical biopsies revealed cervical dysplasia in four women (2. 89%). An abnormal finding was documented on laparoscopic examination in all 141 patients. These included endometriosis in 113 patients (80%), adhesions in 67 (48%), leiomyomas in 59 (42%), and enlarged globular uterus in 34 (24%). In addition, appendiceal abnormalities were present in three women (2.1%) and hernia in two (1.4%).

CONCLUSIONS: Hysteroscopic abnormalities were found in 30% and laparoscopic abnormalities in 100% of patients who had a primary diagnosis of chronic pelvic pain.