Analysis of Risk Factors Associated With Persistent Noncyclic Pelvic Pain Despite Hormonal Treatment in Patients With Endometriosis

Purpose To identify risk factors that predict the persistence of noncyclical pelvic pain in patients with endometriosis despite receiving hormone therapy. Methods This retrospective study examined 164 patients with histopathologically confirmed deep infiltrating endometriosis (DE) and/or ovarian endometrioma (OV). Clinical data obtained through preoperative face‐to‐face interviews were analyzed to identify risk factors for persistent pain despite receiving hormonal treatment (defined as visual analog‐scale score [VAS] score > 30). All patients received preoperative hormonal treatment with progestins, combined oral contraceptives, or gonadotropin‐releasing hormone agonists for at least three months prior to surgery. Results Multivariable analysis identified several risk factors: OV (odds ratio [OR]: 4.11, 95% confidence interval [CI]: 1.67–10.1, p = 0.002) versus no OV, noncyclical chronic pelvic pain (VAS score ≤ 60: OR: 12.0, 95% CI: 4.17–34.6; VAS score > 60: OR: 7.03, 95% CI: 2.25–21.9, p < 0.001) versus no pain, severe dyspareunia (VAS score > 60) (OR: 6.73, 95% CI: 4.17–34.6, p = 0.002) versus no dyspareunia, and a previous cesarean section (OR: 9.53, 95% CI: 1.54–59.0, p = 0.02) versus no previous cesarean section. Conclusions Patients with ovarian endometrioma, noncyclical chronic pelvic pain, severe dyspareunia, and a history of cesarean section are at an increased risk for persistent pain despite hormonal treatment.