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 chronic 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 (0.1%) 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.