Biopsychosocial approach in a woman with chronic pelvic pain, abnormal uterine bleeding, and primary subfertility due to endometriosis

The presence of normal endometrial mucosa outside of the uterine cavity is known as endometriosis. Endometriosis patients complain of several symptoms, including chronic pelvic pain in 50% of patients, subfertility in 30% - 50%, and dysmenorrhea in 12% - 32% [1, 2]. Chronic pain and subfertility can affect the psychological status of endometriosis patients. Adequate counseling can improve the patients’ and their spouses’ acceptance of the condition and improve treatment compliance. A 31-yearold woman presented with chief complaints of dysmenorrhea with a Visual Analog Scale (VAS) score of 6, anemia due to abnormal uterine bleeding, and primary infertility for 6 years. The patient had suffered from pelvic pain for 10 years. She used to work but resigned because of her condition. She also admitted that the symptoms affect her daily activity and social life. The subfertility causes her to avoid meeting friends and family. The physical examination and ultrasound identified adenomyosis and a right endometriosis cyst. The patient was hospitalized for transfusion and given an analgetic and dienogest. Dysmenorrhea had affected the patient’s daily activities for approximately 10 years and had worsened in the past 2 years. She received medical treatment, and the pain decreased. However, she had not been regularly taking her medication recently, and she returned to the hospital because of abnormal uterine bleeding and pain. The management for endometriosis is to relieve the symptoms and increase the chance for fertility. Psychologically, the pain and the frequent admissions to the hospital affected her life, causing depression and eliminating her social life. Adequate counseling provided to the patient and her husband regarding her condition and understanding the possibility of treatment for pain and infertility may decrease the psychological problem.