Use of pre-operative GnRH-analogue to predict pain outcome following hysterectomy with or without oophorectomies for chronic pelvic pain

Abstract

Introduction:

Chronic pelvic pain (CPP) is a common and variable condition often without standardised or effective treatment. A hysterectomy and/or oophorectomies alleviates CPP long term in some patients. Gonadotrophin releasing hormone analogues (GnRHa) induce a pseudo-menopausal state, mimicking some outcomes of these surgical procedures. This study aims to examine whether the use of pre-operative GnRHa can predict the pain outcome of patients undergoing hysterectomy and/or oophorectomies for CPP.

Methods:

This is a retrospective cohort study at a tertiary university-affiliated hospital between 2010 and 2019 inclusive. Of 647 patients screened, 56 met the inclusion criteria of (i) pre-operative GnRHa prescription for pain management and (ii) proceeding to hysterectomy and/or oophorectomies. A positive pain response was considered either partial or complete pain relief.

Results:

All patients (N = 16) who had complete pain relief with GnRHa had complete pain resolution after surgery. Of the 25 patients who had partial resolution of pain with GnRHa, 22 (88.0%) had a positive pain response post-surgery. One patient reported no pain relief with either intervention. Pre-operative GnRHa had a sensitivity of 90.5% and specificity of 100% in predicting pain outcomes post hysterectomy and/or oophorectomies in this study.

Conclusion:

Pre-operative GnRHa may be useful in patients with CPP to predict pain outcome after hysterectomy and/or oophorectomies.