OMT Efficacy for Chronic Pelvic Pain Secondary to a Delayed Diagnosis of Endometriosis




Settlemyre, Destinie
Nelsen, Meaghan


0000-0003-1159-0643 (Settlemyre, Destinie)

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Background: Endometriosis is a gynecological disease characterized by ectopic growth of endometrial tissue. Common symptoms include dysmenorrhea, dyspareunia, chronic pelvic pain, and infertility. Additionally, current research is showing an increased incidence of systemic inflammatory illnesses in those with endometriosis. Due the variability in the presentation of symptoms and location of endometrial lesions, patients are often told their symptoms are consistent with normal menstruation and their true diagnosis is significantly delayed. Recent research suggests most patient experience a 7–9-year delay in diagnosis. Furthermore, after years of these troubling symptoms, treatment is not always effective at achieving pain relief. It has been found that up to 59% of patients continue to have pain after treatment. OMT has been poorly researched in this area, but currently available research has shown success in achieving pain relief for these patients. Case Presentation: A 39-year-old female presented to the UNTHSC OMM clinic for evaluation of pelvic pain secondary to endometriosis. Though she experienced symptoms of severe dysmenorrhea and pelvic pain since menarche and dyspareunia, infertility, and other systemic inflammatory illnesses since early in her reproductive years, she was not given the diagnosis of endometriosis until she was 27, after a disproportionately painful pelvic exam prompted an ultrasound. This ultrasound revealed two endometriomas, measuring 5.7x3.6cm and 4.5x3.4cm. Six months later, after a failed trial of progesterone and continued growth of the lesions, she underwent laparoscopic removal of the cysts which confirmed the composition of these endometriomas. She was then placed on oral contraceptive pills for management of her disease. Initially these were taken to allow for monthly menstruation, and she found enough relief to make her symptoms bearable for the next six years. However, at age 34, she was advanced to continuous use due to catamenial migraines. This regimen allowed her to return to roughly 50% of her normal daily activities, though she was still limited due to chronic pelvic pain and stress-induced flare-ups. Finally in 2020, at age 39, she found the UNTHSC OMM clinic and began bi-monthly treatments for her pelvic pain. She reported that after being treated here she experienced immediate relief of her pain. This relief initially would last for roughly 1 week and then her pain would slowly return. After several months of regular visits, she was able to gradually space out her visits to as far as six months apart without breakthrough pain. Conclusion: Endometriosis is a complex disease that leads to significant pain and diminished quality of life. Not only do these patients struggle with various gynecologic symptoms and systemic inflammatory flares, but they are also left to suffer for years without a diagnosis due to their pain being attributed to normal menstruation. After finally getting their diagnosis, many patients still do not get pain relief due to the reliance on medicinal treatments. This case is a clear example of the need for more intensive education for medical professionals in both the diagnosis of endometriosis and the addition of OMT to the treatment regimen.