title: Persistence of dysmenorrhea and nonmenstrual pain after optimal endometriosis surgery may indicate adenomyosis.
abstract: OBJECTIVE
  To evaluate whether persistence of pelvic pain after excision of endometriosis was associated with adenomyosis as defined by a thickened uterine junctional zone (JZ) on magnetic resonance (MR) imaging.
  
  
  METHODS
  Prospective clinical trial.
  
  
  METHODS
  Government research hospital.
  
  
  METHODS
  Fifty-three women with chronic pelvic pain.
  
  
  METHODS
  Preoperative 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 nonmenstrual pain severity before surgery and 3 months later.
  
  
  METHODS
  Comparison of JZ thickness and pain severity before and 3 months after surgery in women with endometriosis controlling for medical treatment.
  
  
  RESULTS
  Forty of the 53 patients had biopsy-proven endometriosis, and 6 of these 40 women with endometriosis had a thickened JZ. Overall, dysmenorrhea at 3 months was positively correlated with preoperative JZ thickness (r = 0.47, P=.01). Dysmenorrhea pain severity showed no significant decrease in those patients whose JZ measured >or=11 mm compared with those with JZ <8 mm (P<.0001; VAS decreased 4.3 +/- 0.6), or >or=8 and <11 mm (P<.02; VAS decreased 4.8 +/- 1.3). Nonmenstrual pain severity was correlated with JZ thickness (r = 0.51, P=.004) at 3 months with a significant decrease in nonmenstrual pain only in women with a JZ <8 mm (VAS decreased 4.0 +/- 0.7, P<.0001). The association between dysmenorrhea and nonmenstrual pain reduction and thinner JZ remained after controlling for medical treatment.
  
  
  CONCLUSIONS
  Following surgical excision of endometriosis, chronic pelvic pain was significantly more likely to persist with JZ thickness >11mm on preoperative MR imaging. This suggests that myometrial JZ abnormalities or adenomyosis may contribute to chronic pelvic pain in women with endometriosis.
authors.affiliation: National Institutes of Health, Bethesda, Maryland 20892-1109, USA.
authors.forename: Jason D
authors.initials: JD
authors.lastname: Parker
authors.forename: Mark
authors.initials: M
authors.lastname: Leondires
authors.forename: Ninet
authors.initials: N
authors.lastname: Sinaii
authors.forename: Ahalya
authors.initials: A
authors.lastname: Premkumar
authors.forename: Lynnette K
authors.initials: LK
authors.lastname: Nieman
authors.forename: Pamela
authors.initials: P
authors.lastname: Stratton
mesh_terms: D000328:Adult; D004412:Dysmenorrhea / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control*; D004715:Endometriosis / Q000150:complications* / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D017699:Pelvic Pain / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control*; D020849:Raloxifene Hydrochloride / Q000627:therapeutic use; D012008:Recurrence; D020845:Selective Estrogen Receptor Modulators / Q000627:therapeutic use; D012720:Severity of Illness Index; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D020845:Selective Estrogen Receptor Modulators; D020849:Raloxifene Hydrochloride