Pelvic pain and psycho­emotional status in women with ovarian endometrioma combined with pelvic inflammatory diseases: treatment options choice

The connection between chronic pelvic pain and the presence in the body of a pathological source of structural and morphological changes in tissue, e.g. in connection with uterine fibroids, endometriosis, chronic inflammatory processes of the pelvic organs remains a traditional opinion. Endometriosis, which is characterized by a chronic pelvic pain, affects about 10% of women of reproductive age, and the problem of studying of endometrioid cysts demonstrates its relevance by dominating in the structure of genital endometriosis up to 59%. Chronic pelvic pain causes inappropriate courses of antibacterial therapy and, as a consequence, dysbiosis, the development of ovarian insufficiency syndrome, and the surgical approach does not always show the desired results, often worsening the clinical picture and psycho-emotional status of the patient. The objective: of this study was to assess the severity of the pain syndrome and psychological status in patients with pelvic pain associated with ovarian endometrioma and to seek effective therapeutic options. Materials and methods. The study included 40 patients with ovarian endometriosis combined with pelvic inflammatory disease (main group) and 40 patients with isolated endometrioma (comparison group). The control group consisted of 30 patients without manifestations of genital endometriosis. Analysis of somatic and gynecological anamnesis was used, as well as the objective and gynecological examination, data from adapted Beck’s Depression Inventory and State-Trait Anxiety Inventory, pain assessment according to the visual-analog scale (VAS), sonographic examination of the pelvic organs, evaluation of magnetic resonance imaging, endoscopic and histological methods of examination. Results. Dyspareunia was noted in one third of patients of the main group; dysuric manifestations, intestinal disorders in one in four women, a combination with manifestations of asthenic-neurotic syndrome in a third of women, the intensity of pain was presented in a third as severe and unbearable. It should be noted that the percentage of secondary infertility increased by 2.6 times, in two thirds of cases there were menstrual disorders, which were dominated by manifestations of algodysmenorrhea and abnormal uterine bleeding. The analysis of psychological questionnaires noted equal percentage of moderate and mild depressive symptoms in the main group, as well as, along with a decrease in psychological and emotional adaptation, high rates of situational and personal anxiety. Proposed therapeutic options included the use of dienogest primarily in women with mild to moderate pain syndrome, the possibility of long-term use at risk of recurrence and taking into account the smaller percentage of probable side effects. Conclusions. The analysis of the obtained data allowed to indicate to more intense pain syndrome, high frequency of menstrual disorders, secondary infertility and manifestations of nonspecific clinical symptoms in patients with endometriomas combined with the pelvic inflammatory processes. The psycho-emotional state of women is characterized by high levels of depressive and anxiety disorders, as well as a pronounced intensity of pain syndrome in one third of cases. At weak and moderate degree of pelvic pain the drug of choice of the therapeutic program is dienogest, the use of which is expedient in the long run, in case of the expressed intensity of a pain syndrome it is expedient to give a preference to the gonadotropin-releasing hormone agonist.