Intensity of menstrual pain and estimated angle of uterine flexion

ObjectiveTo assess the impact of ultrasound-estimated uterus position on the intensity of pelvic pain. DesignDescriptive analytical study. SettingTertiary university gynecology unit. Population181 consecutive patients with pelvic pain. MethodsEach woman underwent physical examination, transvaginal sonography and filled self-administered questionnaires on pain using a 10-cm visual analog scale (VAS). Main outcome measuresVisual analog scale score of menstrual pain, intermenstrual pain and dyspareunia was related to uterine version (ante- or retroversion) and the angle of uterine flexion (actual angle between cervix and uterine body) evaluated by transvaginal sonography. ResultsEstimated uterine version was not associated with the intensity of any type of pain. The estimated angle of flexion was higher in retroverted than in anteverted uteri (182.3 degrees 50.3 degrees vs. 142.3 degrees +/- 24.2 degrees, p<0.0001). Intensity of menstrual pain was lowest with flexion between 150 degrees and 210 degrees (4.9 +/- 3.1) (p=0.002), intermediate with flexion <150 degrees (6.3 +/- 2.8) and highest with flexion 210 degrees (7.9 +/- 2.3). Severe menstrual pain was more prevalent with flexion 210 degrees (77.7%) than between 150 degrees and 210 degrees (31.4%; p=0.0008) or <150 degrees (45.2%; p=0.005). The intensity of intermenstrual pain and dyspareunia were not associated with the angle of flexion. In multiple regression analysis, the angle of flexion was independently related only to the intensity of menstrual pain (r=0.272; p=0.002). ConclusionsIn women with pelvic pain, ultrasound-estimated uterine flexion represents an independent risk for intense menstrual pain.