Hysterectomy for Chronic Pelvic Pain

  • Richard Cockrum
    Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Walgreen's Bldg 1507, 2650 Ridge Avenue, Evanston, IL 60201, USA

    Department of Obstetrics and Gynecology, University of Chicago, Pritzker School of Medicine, Chicago, IL, USA
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  • Frank Tu
    Corresponding author.
    Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Walgreen's Bldg 1507, 2650 Ridge Avenue, Evanston, IL 60201, USA

    Department of Obstetrics and Gynecology, University of Chicago, Pritzker School of Medicine, Chicago, IL, USA
    Search for articles by this author


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        • Mathias S.D.
        • Kuppermann M.
        • Liberman R.F.
        • et al.
        Chronic pelvic pain: prevalence, health-related quality of life, and economic correlates.
        Obstet Gynecol. 1996; 87: 321-327
        • Merrill R.M.
        Hysterectomy surveillance in the United States, 1997 through 2005.
        Med Sci Monit Int Med J Exp Clin Res. 2008; 14: CR24-CR31
        • Brandsborg B.
        • Nikolajsen L.
        • Hansen C.T.
        • et al.
        Risk Factors for Chronic Pain after Hysterectomy: A Nationwide Questionnaire and Database Study.
        Anesthesiology. 2007; 106: 1003-1012
        • Nicholas M.
        • Vlaeyen J.W.S.
        • Rief W.
        • et al.
        The IASP classification of chronic pain for ICD-11: chronic primary pain.
        PAIN. 2019; 160: 28-37
        • Ghai V.
        • Subramanian V.
        • Jan H.
        • et al.
        Evaluation of clinical practice guidelines (CPG) on the management of female chronic pelvic pain (CPP) using the AGREE II instrument.
        Int Urogynecol J. 2021; 32: 2899-2912
        • American College of Obstetricians and Gynecologists
        Chronic Pelvic Pain: Practice Bulletin 218.
        Obstet Gynecol. 2020; 135: e98-e109
        • Tu F.
        • As-Sanie S.
        A modest proposal to investigate chronic uterine pain.
        BJOG Int J Obstet Gynaecol. 2017; 124: 182-184
        • Janda A.M.
        • As-Sanie S.
        • Rajala B.
        • et al.
        Fibromyalgia Survey Criteria Are Associated with Increased Postoperative Opioid Consumption in Women Undergoing Hysterectomy.
        Anesthesiology. 2015; 122: 1103-1111
        • Brummett C.M.
        • Urquhart A.G.
        • Hassett A.L.
        • et al.
        Characteristics of fibromyalgia independently predict poorer long-term analgesic outcomes following total knee and hip arthroplasty.
        Arthritis Rheumatol Hoboken NJ. 2015; 67: 1386-1394
        • Diatchenko L.
        • Nackley A.G.
        • Slade G.D.
        • et al.
        Idiopathic pain disorders--pathways of vulnerability.
        Pain. 2006; 123: 226-230
        • Ghai V.
        • Subramanian V.
        • Jan H.
        • et al.
        A systematic review on reported outcomes and outcome measures in female idiopathic chronic pelvic pain for the development of a core outcome set.
        BJOG Int J Obstet Gynaecol. 2021; 128: 628-634
        • Stovall T.G.
        • Ling F.W.
        • Crawford D.A.
        Hysterectomy for Chronic Pelvic Pain of Presumed Uterine Etiology.
        Obstet Gynecol. 1990; 75: 676-679
        • Hillis S.D.
        • Marchbanks P.A.
        • Peterson H.B.
        The Effectiveness of Hysterectomy for Chronic Pelvic Pain.
        Obstet Gynecol. 1995; 86: 941-945
        • Carlson K.J.
        • Miller B.A.
        • Fowler F.J.J.
        The Maine Women’s Health Study: I. Outcomes of Hysterectomy.
        Obstet Gynecol. 1994; 83: 556-565
        • Tay S.K.
        • Bromwich N.
        Outcome of Hysterectomy for Pelvic Pain in Premenopausal Women.
        Aust N Z J Obstet Gynaecol. 1998; 38: 72-76
        • Hartmann K.E.
        • Ma C.
        • Lamvu G.M.
        • et al.
        Quality of Life and Sexual Function After Hysterectomy in Women With Preoperative Pain and Depression.
        Obstet Gynecol. 2004; 104: 701-709
        • As-Sanie S.
        • Till S.R.
        • Schrepf A.D.
        • et al.
        Incidence and predictors of persistent pelvic pain following hysterectomy in women with chronic pelvic pain.
        Am J Obstet Gynecol. 2021; 225: 568.e1-568.e11
        • Meltzer-Brody S.
        • Leserman J.
        • Zolnoun D.
        • et al.
        Trauma and posttraumatic stress disorder in women with chronic pelvic pain.
        Obstet Gynecol. 2007; 109: 902-908
        • Abu-Alnadi N.
        • Frame B.
        • Moore K.J.
        • et al.
        Myofascial Pain in Hysterectomy Patients.
        J Minim Invasive Gynecol. 2021; 28: 2067-2072
        • Chung M.H.
        • Huh C.Y.
        Comparison of treatments for pelvic congestion syndrome.
        Tohoku J Exp Med. 2003; 201: 131-138
        • Shakiba K.
        • Bena J.F.
        • McGill K.M.
        • et al.
        Surgical treatment of endometriosis: a 7-year follow-up on the requirement for further surgery.
        Obstet Gynecol. 2008; 111: 1285-1292
        • Chung M.K.
        Interstitial Cystitis in Persistent Posthysterectomy Chronic Pelvic Pain.
        JSLS. 2004; 8: 329-333
        • Lamvu G.
        • Robinson B.
        • Zolnoun D.
        • et al.
        Vaginal Apex Resection: A Treatment Option for Vaginal Apex Pain.
        Obstet Gynecol. 2004; 104: 1340-1346
        • Brandsborg B.
        • Dueholm M.
        • Nikolajsen L.
        • et al.
        A Prospective Study of Risk Factors for Pain Persisting 4 Months After Hysterectomy.
        Clin J Pain. 2009; 25: 263-268
        • Benlolo S.
        • Hanlon J.G.
        • Shirreff L.
        • et al.
        Predictors of Persistent Postsurgical Pain After Hysterectomy—A Prospective Cohort Study.
        J Minim Invasive Gynecol. 2021; 28: 2036-2046.e1
        • Sangha R.
        • Bossick A.
        • Su W.T.K.
        • et al.
        A Prospective Study of Patterns of Regret in the Year After Hysterectomy.
        J Patient-centered Res Rev. 2020; 7: 329-336
        • Parker W.H.
        • Feskanich D.
        • Broder M.S.
        • et al.
        Long-term Mortality Associated with Oophorectomy versus Ovarian Conservation in the Nurses’ Health Study.
        Obstet Gynecol. 2013; 121: 709-716
        • Richards L.
        • Healey M.
        • Cheng C.
        • et al.
        Laparoscopic Oophorectomy to Treat Pelvic Pain Following Ovary-Sparing Hysterectomy: Factors Associated with Surgical Complications and Pain Persistence.
        J Minim Invasive Gynecol. 2019; 26: 1044-1049
        • Behera M.
        • Vilos G.A.
        • Hollett-Caines J.
        • et al.
        Laparoscopic findings, histopathologic evaluation, and clinical outcomes in women with chronic pelvic pain after hysterectomy and bilateral salpingo-oophorectomy.
        J Minim Invasive Gynecol. 2006; 13: 431-435
        • Stone R.
        • Carey E.
        • Fader A.N.
        • et al.
        Enhanced Recovery and Surgical Optimization Protocol for Minimally Invasive Gynecologic Surgery: An AAGL White Paper.
        J Minim Invasive Gynecol. 2021; 28: 179-203
        • Keil D.S.
        • Schiff L.D.
        • Carey E.T.
        • et al.
        Predictors of Admission After the Implementation of an Enhanced Recovery After Surgery Pathway for Minimally Invasive Gynecologic Surgery.
        Anesth Analg. 2019; 129: 776-783
        • U.S. Department of Health and Human Services
        Pain Management Best Practices Inter-Agency Task Force Rep Updates, Gaps, Inconsistencies, Recommendations.
        (Available at:) (Accessed October 23, 2021)
        • As-Sanie S.
        • Till S.R.
        • Mowers E.L.
        • et al.
        Opioid Prescribing Patterns, Patient Use, and Postoperative Pain After Benign Hysterectomy.
        Obstet Gynecol. 2017; 130: 1261-1268
        • Till S.R.
        • Wahl H.N.
        • As-Sanie S.
        The role of nonpharmacologic therapies in management of chronic pelvic pain: what to do when surgery fails.
        Curr Opin Obstet Gynecol. 2017; 29: 231-239
        • Vandyken C.
        • Hilton S.
        Physical Therapy in the Treatment of Central Pain Mechanisms for Female Sexual Pain.
        Sex Med Rev. 2017; 5: 20-30
        • Weinrib A.Z.
        • Azam M.A.
        • Birnie K.A.
        • et al.
        The psychology of chronic post-surgical pain: new frontiers in risk factor identification, prevention and management.
        Br J Pain. 2017; 11: 169-177
        • Wong M.
        • Vogell A.
        • Wright K.
        • et al.
        Opioid use after laparoscopic hysterectomy: prescriptions, patient use, and a predictive calculator.
        Am J Obstet Gynecol. 2019; 220: 259.e1-259.e11
        • Vilkins A.L.
        • Sahara M.
        • Till S.
        • et al.
        Effects of Shared Decision Making on Opioid Prescribing After Hysterectomy.
        Obstet Gynecol. 2019; 134: 823-833