Use of hysteroscopy in addition to laparoscopy for evaluating chronic pelvic pain

This study assessed whether hysteroscopy can provide information concerning the cause of chronic pelvic pain. We prospectively evaluated the findings in 547 consecutive patients who had laparoscopy to evaluate chronic pelvic pain at a large, referral-based clinic and outpatient suite of a suburban hospital. Forty-eight had previous hysterectomies. The remaining 499 had hysteroscopy during the same surgery and met the following qualifications: chronic pelvic pain, dysmenorrhea, dyspareunia, dysuria, back pain, pelvic pressure or dyschezia for a duration greater than six months and previous failed medical therapy. When endometriosis was the primary diagnosis at laparoscopy, hysteroscopy revealed abnormalities in 62 (32.5%) of 191 patients. At hysteroscopy, 46 of 105 patients (43.8%) with single or multiple leiomyomas of significant sizes diagnosed laparoscopically were noted to have pathology within the uterine cavity. Ten of 11 patients (90.9%) found to have ovarian cysts underwent hysteroscopy. Four (40%) had uterine abnormalities; the most common was cervical stenosis. Pelvic adhesions were found in 118 patients (21.6%). Eighty-nine underwent hysteroscopy, and 24 (27%) had intrauterine abnormalities. Ninety-six patients (17.5%) who underwent laparoscopic evaluation had endometriosis and pelvic adhesions. Ninety-three of these underwent hysteroscopy, and abnormalities were noted in 26 (28.0%). In eight women (1.5%) no abnormality was found at laparoscopy. Two underwent hysteroscopy, and no abnormality was noted in either woman. Hysteroscopy provides useful, adjunctive information and may improve the diagnosis and treatment of chronic pelvic pain.