Persistence
of dysmenorrhea and non-menstrual pain after optimal
endometriosis surgery may indicate adenomyosis
This prospective clinical
trial shows that women without significant decrease
in pain after complete surgical excision of endometriosis
should be considered for MRI to ascertain whether adenomyosis
might be the actual cause of pain.
Fifty-three women with chronic pelvic pain underwent
pre-operative 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 non-menstrual pain
severity before surgery and 3 months later.
Comparison of JZ thickness and pain severity before
and 3 months after surgery was undertaken in women with
endometriosis controlling for medical treatment.
The authors found that women with endometriosis may
have myometrial junctional zone (JZ) abnormalities,
possibly indicative of adenomyosis that contribute significantly
to chronic pelvic pain. Dysmenorhoea and non-menstrual
pain showed no significant decrease in women whose JZ
measured 11mm or more compared with those whose JZ measured
8mm or less [1].
Comments Professor Ivo Brosens: "It is well-known
that adenomyosis and endometriosis frequently coexist,
but in most instances the association is diagnosed after
hysterectomy. Different pharmacological therapies as
well as new interventional therapies such as uterine
artery embolization and MRI-guided focused ultrasound
surgery exist or are in development" [2].
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