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Published Online: 1 May 2018

Impact of Pelvic Pain and Endometriosis on Patient-Reported Outcomes and Experiences of Benign Hysterectomy: A Study from the Swedish National Register for Gynecological Surgery

Publication: Journal of Women's Health
Volume 27, Issue Number 5


Background: The study objective was to analyze and compare patient-reported experience measures (PREMs) and patient-reported outcome measures (PROMs) after hysterectomy in women with and without a preoperative complaint of pelvic pain associated with and without a confirmed diagnosis of endometriosis.
Methods: Retrospective nationwide register study. Data on 28,776 hysterectomies performed on benign indication between 2004 and 2016 were retrieved from the Swedish National Register for Gynecological Surgery. Multivariable logistic regression models were used to compare the PREMs and PROMs items. The results are presented as adjusted odds ratios (aORs) and 95% confidence intervals (CI).
Results: Regardless of the occurrence of pelvic pain preoperatively and a diagnosis of endometriosis, 1 year after surgery, the women were satisfied or very satisfied (>90%) with the hysterectomy, and their medical condition was improved or much improved (>95%). The women with a preoperative complaint of pelvic pain and endometriosis more often reported excessively short hospital stays (aOR 1.45, 95% CI 1.17–1.79), more severe complications after discharge (aOR 2.02, 95% CI 1.59–2.66) at the 8-week follow-up and at the 1-year follow-up (aOR 2.31, 95% CI 1.57–3.39), and more dissatisfaction with the operation (aOR 1.83, 95% CI 1.35–2.48) than preoperative pelvic pain-free women without endometriosis at the 1-year follow-up.
Conclusions: The majority of the women were satisfied after their hysterectomy. The women with pelvic pain and endometriosis were at a higher risk of being dissatisfied. Pelvic pain per se seemed to be the main factor affecting the rating in the PREMs and PROMs, and the endometriosis was a significant contributing factor.

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Sourial S, Tempest N, Hapangama DK. Theories on the pathogenesis of endometriosis. Int J Reprod Med 2014;2014:179515.
Laganà AS, Triolo O, Salmeri FM, et al. Natural killer T cell subsets in eutopic and ectopic endometrium: A fresh look to a busy corner. Arch Gynecol Obstet 2016;293:941–949.
Vetvicka V, Laganà AS, Salmeri FM, et al. Regulation of apoptotic pathways during endometriosis: From the molecular basis to the future perspectives. Arch Gynecol Obstet 2016;294:897–904.
Matsuzaki S, Darcha C. Involvement of the Wnt/β-catenin signaling pathway in the cellular and molecular mechanisms of fibrosis in endometriosis. PLoS One 2013;8:e76808.
Dunselman G, Vermeulen N, Becker C, et al. ESHRE guideline: Management of women with endometriosis. Hum Reprod 2014;29:400–412.
Fuldeore MJ, Soliman AM. Prevalence and symptomatic burden of diagnosed endometriosis in the United States: National estimates from a cross-sectional survey of 59,411 women. Gynecol Obstet Invest 2017;82:453–461.
Triolo O, Laganà AS, Sturlese E. Chronic pelvic pain in endometriosis: An overview. J Clin Med Res 2013;5:153–163.
Vercellini P, Somigliana E, Viganò P, Abbiati A, Barbara G, Fedele L. Chronic pelvic pain in women: Etiology, pathogenesis and diagnostic approach. Gynecol Endocrinol 2009;25:149–158.
Romanek-Piva K, Gałczyński K, Adamiak-Godlewska A, Futyma K, Miotła P, Rechberger T. Hysterectomy trends for benign indications over a 15-year period in an academic teaching center in Poland: A retrospective cohort study. Ginekol Pol 2016;87:411–416.
Nanavati AM, Gokral SB. A prospective randomized comparative study of vaginal, abdominal, and laparoscopic hysterectomies. J Obstet Gynaecol India 2016;66(Suppl 1):389–394.
Parazzini F, Ricci E, Bulfoni G, et al. Hysterectomy rates for benign conditions are declining in Lombardy, Italy: 1996–2010. Eur J Obstet Gynecol Reprod Biol 2014;178:107–113.
Lundholm C, Forsgren C, Johansson ALV, Cnattingius S, Altman D. Hysterectomy on benign indications in Sweden 1987–2003: A nationwide trend analysis. Acta Obstet Gynecol Scand 2009;88:52–58.
Gorlero F, Lijoi D, Biamonti M, et al. Hysterectomy and women satisfaction: Total versus subtotal technique. Arch Gynecol Obstet 2008;278:405–410.
Stovall TG, Ling FW, Crawford DA. Hysterectomy for chronic pelvic pain of presumed uterine etiology. Obstet Gynecol 1990;75:676–679.
Hillis SD, Marchbanks PA, Peterson HB. The effectiveness of hysterectomy for chronic pelvic pain. Obstet Gynecol 1995;86:941–945.
Brandsborg B, Nikolajsen L, Hansen CT, Kehlet H, Jensen TS. Risk factors for chronic pain after hysterectomy: A nationwide questionnaire and database study. Anesthesiology 2007;106:1003–1012.
Vercellini P, Barbara G, Abbiati A, Somigliana E, Viganò P, Fedele L. Repetitive surgery for recurrent symptomatic endometriosis: What to do? Eur J Obstet Gynecol Reprod Biol 2009;146:15–21.
Hartmann KE, Ma C, Lamvu GM, Langenberg PW, Steege JF, Kjerulff KH. Quality of life and sexual function after hysterectomy in women with preoperative pain and depression. Obstet Gynecol 2004;104:701–709.
Rizk B, Fischer AS, Lotfy HA, et al. Recurrence of endometriosis after hysterectomy. Facts Views Vis Obgyn 2014;6:219–227.
Nilsson E, Orwelius L, Kristenson M. Patient-reported outcomes in the Swedish National Quality Registers. J Intern Med 2016;279:141–153.
Swedish Society of Obstetrics and Gynecology. The Swedish National Quality Register for Gynecological Surgery. 2011. Available at: Accessed September 10, 2017.
Tay SK, Bromwich N. Outcome of hysterectomy for pelvic pain in premenopausal women. Aust N Z J Obstet Gynaecol 1998;38:72–76.
Pitter MC, Simmonds C, Seshadri-Kreaden U, Hubert HB. The impact of different surgical modalities for hysterectomy on satisfaction and patient reported outcomes. Interact J Med Res 2014;3:e11.
Jones GT. Psychosocial vulnerability and early life adversity as risk factors for central sensitivity syndromes. Curr Rheumatol Rev 2016;12:140–153.
Laganà AS, La Rosa VL, Rapisarda AMC, et al. Anxiety and depression in patients with endometriosis: Impact and management challenges. Int J Womens Health 2017;9:323–330.
Pope CJ, Sharma V, Sharma S, Mazmanian D. A systematic review of the association between psychiatric disturbances and endometriosis. J Obstet Gynaecol Can 2015;37:1006–1015.
Culley L, Law C, Hudson N, et al. The social and psychological impact of endometriosis on women's lives: A critical narrative review. Hum Reprod Update 2013;19:625–639.
Facchin F, Barbara G, Saita E, et al. Impact of endometriosis on quality of life and mental health: Pelvic pain makes the difference. J Psychosom Obstet Gynecol 2015;36:135–141.
Berner E, Qvigstad E, Myrvold AK, Lieng M. Pelvic pain and patient satisfaction after laparoscopic supracervical hysterectomy: Prospective trial. J Minim Invasive Gynecol 2014;21:406–411.
Uccella S, Marconi N, Casarin J, et al. Impact of endometriosis on surgical outcomes and complications of total laparoscopic hysterectomy. Arch Gynecol Obstet 2016;294:771–778.
Sibiude J, Santulli P, Marcellin L, Borghese B, Dousset B, Chapron C. Association of history of surgery for endometriosis with severity of deeply infiltrating endometriosis. Obstet Gynecol 2014;124:709–717.
Laganà AS, Vitale SG, Trovato MA, et al. Full-thickness excision versus shaving by laparoscopy for intestinal deep infiltrating endometriosis: Rationale and potential treatment options. Biomed Res Int 2016;2016:3617179.
Ladfors MB, Löfgren MEO, Gabriel B, Olsson J-HA. Patient accept questionnaires integrated in clinical routine: A study by the Swedish National Register for Gynecological Surgery. Acta Obstet Gynecol Scand 2002;81:437–442.
Pakbaz M, Mogren I, Löfgren M. Outcomes of vaginal hysterectomy for uterovaginal prolapse: A population-based, retrospective, cross-sectional study of patient perceptions of results including sexual activity, urinary symptoms, and provided care. BMC Womens Health 2009;9:9.
Nilsson M, Lalos O, Lindkvist H, Löfgren M, Lalos A. Female urinary incontinence: Patient-reported outcomes 1 year after midurethral sling operations. Int Urogynecol J 2012;23:1353–1359.
Nüssler E, Kesmodel US, Löfgren M, Nüssler EK. Operation for primary cystocele with anterior colporrhaphy or non-absorbable mesh: Patient-reported outcomes. Int Urogynecol J 2015;26:359–366.
Greene AD, Lang SA, Kendziorski JA, Sroga-Rios JM, Herzog TJ, Burns KA. Endometriosis: Where are we and where are we going? Reproduction 2016;152:R63–R78.
Petraglia F, Hornung D, Seitz C, et al. Reduced pelvic pain in women with endometriosis: Efficacy of long-term dienogest treatment. Arch Gynecol Obstet 2012;285:167–173.

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Published In

cover image Journal of Women's Health
Journal of Women's Health
Volume 27Issue Number 5May 2018
Pages: 691 - 698
PubMed: 29148910


Published in print: May 2018
Published online: 1 May 2018
Published ahead of print: 17 November 2017


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Hanna Grundström, RNM
Department of Obstetrics and Gynecology, Vrinnevi Hospital, Norrköping, Sweden.
Department of Medical and Health Sciences, Faculty of Medicine and Health Science, Linköping University, Linköping, Sweden.
Siw Alehagen, RNM, PhD
Department of Medical and Health Sciences, Faculty of Medicine and Health Science, Linköping University, Linköping, Sweden.
Carina Berterö, RNT, BSc, MScN, PhD
Department of Medical and Health Sciences, Faculty of Medicine and Health Science, Linköping University, Linköping, Sweden.
Preben Kjølhede, MD, PhD
Department of Obstetrics and Gynecology, Faculty of Medicine and Health Science, Linköping University, Linköping, Sweden.
Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Science, Linköping University, Linköping, Sweden.


Address correspondence to:Hanna Grundström, RNMDepartment of Obstetrics and GynecologyVrinnevi HospitalNorrköping SE-601 82Sweden
E-mail: [email protected]

Author Disclosure Statement

No competing financial interests exist.

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