THE EFFECTIVENESS OF HYSTERECTOMY FOR CHRONIC PELVIC PAIN

Objective: To evaluate the effectiveness of hysterectomy in treating c hronic 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 stu dy. Persistent pain was defined as a trichotomous variable, and ordina l logistic regression was used to identify independent predictors of t he trichotomous outcome. Results: Overall, 74% of women experienced co mplete resolution of pelvic pain, 21% reported continued but decreased pain, and 5% reported either unchanged or increased pain after hyster ectomy. In unadjusted analyses, women at increased risk for persistent pain leg, continued but decreased, and unchanged or increased) includ ed those who were under age 30 (36 versus 22%, P < .05), had a history of pelvic inflammatory disease (41 versus 25%, P < .05), were uninsur ed or covered under Medicaid (41 versus 22%, P < .001), had no identif ied 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, t wo 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% conf idence interval [CI] 1.0-3.6), were uninsured or covered under Medicai d (OR 2.3, 95% CI 1.2-4.3), or had experienced at least two pregnancie s (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.