Surgery for dysmenorrhoea

Clinical bottom line

There is no clear evidence that surgery is helpful for dysmenorrhoea.

Background

Surgery has been suggested for dysmenorrhoea, and observational series have been reported.

Reference

ML Proctor et al. Surgical interruption of pelvic nerve pathways for primary and secondary dysmenorrhoea. Cochrane Database of Systematic Reviews 2005, issue 4.

Systematic review

The review had a thorough search strategy. It sought randomised comparisons of surgical interruption of pelvic nerve pathways (any type of procedure).

Results

Nine trials were found, with three different techniques. Some were small, with fewer than 50 women. Few had measured pain relief beyond 6-12 months.

For pain relief up to 12 months, there was no statistical benefit from surgery, except for two trials of PSN in 197 women, where one trial had more pain relief, and where there was more pain relief overall (85% for surgery vs 64% for control). The control was conservative surgery for endometriosis, and women had to have endometriosis for inclusion. Even here, the statistical significance depended upon the statistical model used for analysis.

Comment

This is difficult to interpret. However, surgery is unlikely to ever be an early choice of treatment, and even then only when other conditions like endometriosis are present.