Incidence and Management of Pelvic Pain in Patients with Obstructive and Non-Obstructive Müllerian Anomalies

STUDY OBJECTIVE: The incidence, presentation, and management of pelvic pain in patients with Müllerian anomalies has not been well characterized. This study aimed to determine the incidence of pelvic pain at presentation in patients with obstructive versus non-obstructive Müllerian anomalies and to describe management of pelvic pain in these populations. METHODS: This retrospective cohort study included patients with Müllerian anomalies identified at a single academic center from 2008 to 2024. Anomalies were classified as obstructive or non-obstructive using imaging and operative reports in accordance with the 2021 American Society of Reproductive Medicine guidelines. Data collected included demographics, symptoms, hormone use, surgical interventions, and post-treatment pelvic pain. Logistic regression was used to evaluate the association between anomaly type and pelvic pain, adjusting for relevant covariates. RESULTS: Among 148 patients, 76 had obstructive and 72 had non-obstructive anomalies. Patients with obstructive anomalies presented younger (14.5 ± 5.0 vs. 21.1 ± 8.3 years). Pelvic pain was reported by nearly all post-pubertal patients with obstructive anomalies, and was less common among those with non-obstructive anomalies (100.0% vs. 38.9%, p<0.001). Most patients with obstructive anomalies (86.8%) were treated with surgery. Persistent chronic pelvic pain was common in this cohort after surgery, affecting 50% of patients and requiring postoperative hormonal therapy. Among patients with non-obstructive anomalies, 44.4% underwent surgery, and 19.4% reported chronic pelvic pain. CONCLUSIONS: Obstructive Müllerian anomalies are strongly associated with earlier age of onset and presentation with pelvic pain. Persistent pain after surgery underscores the need for long-term, multidisciplinary management and further investigation into underlying mechanisms.