Pelvic pain treatments 'outdated' anaesthetists told

Amelia Mardon says treatment guidelines for chronic pelvic pain are outdated.

Women with chronic pelvic pain are routinely told by doctors they should get pregnant or have a hysterectomy despite a lack of evidence either would help, a review of pelvic pain treatment guidelines has found.

The international review, by Western Sydney University post doctoral research fellow, Amelia Mardon, examined pelvic pain guidelines in 20 countries, including Australia.

Ms Mardon told the Australian and New Zealand College of Anaesthetists Annual Scientific Meeting in Brisbane on Sunday the guidelines were so “archaic and outdated” non-surgical treatments for diseases like endometriosis were not even considered.

She said her findings reflected the prevailing attitudes towards pelvic pain as a “disgusting, taboo” subject.

At the same time medical practitioners were offered little, if any training, about the range of treatment options available.

“Many doctors are telling patients they are hypochondriacs, there’s nothing wrong with you, its part of being a woman, its all in your head, you’re just stressed,’ she said.

“I’ve heard of stories of teens being told if they have endometriosis they should have a baby early, because of the infertility issues.”

Ms Mardon said the review identified there was still too much emphasis on surgical and medical interventions.

“We found that unlike other pain conditions, guidelines for pelvic pain do not recognise the benefits of pain science education for those living with the condition so there is a big research gap there.”

Half the guidelines advised hysterectomies as the gold standard treatment for pelvic pain, despite the fact it only worked for some women.

“We used to think remove the uterus and you will remove the pain, but pain is more complex than that, it’s a very dramatic, invasive procedure with no certainty it will work,’ Ms Mardon said.

“For endometriosis sufferers lesions can still be present and grow even after someone has a hysterectomy”.

Ms Mardon said her recent interview study for the University of South Australia, tracked the experience of 20 women with pelvic pain.

The study found the patient’s pain levels became much more manageable once they had a better understanding about biological mechanisms underlying their condition, and its impact on their brain and nervous system.

“Its infuriating that people aren’t adequately educated on their pelvis,” Ms Mardon said.

“One in every five women will suffer from pelvic pain in their lives, yet every day their pain is being dismissed by medical professionals as “imaginary or exaggerated”.

Ms Mardon, who also suffers from endometriosis, said severe pelvic pain and endometriosis costs Australia an estimated $A9.5 billion per year, most of it in lost productivity.

She said pelvic pain has a devastating impact on every aspect of a patient’s life.

Many were overlooked for promotions at work or lost their jobs as a direct result of time off due to their condition.

They also suffered high levels of anxiety and depression, which was only exacerbated by health practitioners dismissing their pain as psychosomatic.

Personal relationships could also be challenging.

“Some patients feel like they can’t be in a relationship because they feel like they are not a good partner, especially when it comes to painful sex,’ Ms Mardon said.

“Its such an unpredictable condition, they are often forced to pull out of important social events, or struggle with daily activities like exercise.”

* The Australian and New Zealand College of Anaesthetists has facilitated coverage of the 2024 meeting.