The Utility and Impact of the Painful Periods Screening Tool (PPST) to Improve Healthcare Delivery for People with Symptoms of Pelvic Pain

The objective of this study was to evaluate the utility and impact of the Painful Periods Screening Tool (PPST) to improve healthcare delivery for people with symptoms of pelvic pain. The design of this study was a survey study. After IRB approval, patients aged 18–55 years with self-reported pelvic, abdominal, or lower back pain before, during, or after menstrual periods were invited to participate in the study from September 2020 to June 2021. Participants filled out the PPST questionnaire on the day of their Johns Hopkins clinic visit and the follow-up questionnaire 1–14 days after the clinic visit. Demographics and duration of pain were assessed, and participants who completed the PPST questionnaire were sent a follow-up questionnaire to assess utility and impact of PPST. Of the 1352 patients who met study eligibility, 1000 participants responded to both questionnaires. Most subjects (82.9%; 95% CI: 80.4–85.2%) reported having severe pelvic/abdominal or lower back pain during menses. Nine hundred fifteen participants (91.5%; 95% CI: 89.6–93.2%) reported that if given regularly, the PPST would help women discuss their pain symptoms with their healthcare provider. Six hundred seventy-eight participants (67.8%; 95% CI: 64.8–70.7%) reported that the PPST helped them initiate a conversation about their symptoms. Seven hundred seven participants (70.7%; 95% CI: 67.8–73.5%) were more comfortable discussing symptoms of pelvic pain with their provider after filling out the PPST. These findings support the utility of PPST as an endometriosis screening tool and suggest that this tool facilitated communication between patients and providers about pain symptoms. Similar content being viewed by others Data Availability All data collected as part of the study has been presented in the manuscript.

Giudice LC, Kao LC. Endometriosis. Lancet Lond Engl. 2004;364(9447):1789–99. https://doi.org/10.1016/S0140-6736(04)17403-5. Mathieu S-V, Kobe A, Pfammatter T, Hötker A. Endometriosis. Ther Umsch Rev Ther. 2020;77(2):57–61. https://doi.org/10.1024/0040-5930/a001153. Chapron C, Marcellin L, Borghese B, Santulli P. Rethinking mechanisms, diagnosis and management of endometriosis. Nat Rev Endocrinol. 2019;15(11):666–82. https://doi.org/10.1038/s41574-019-0245-z. Johnson NP, Hummelshoj L, Adamson GD, Keckstein J, Taylor HS, Abrao MS, Bush D, Kiesel L, Tamimi R, Sharpe-Timms KL, Rombauts L, Giudice LC. World Endometriosis Society consensus on the classification of endometriosis. Hum Reprod. 2017;32(2):315–24. https://doi.org/10.1093/humrep/dew293. Christ JP, Yu O, Schulze-Rath R, Grafton J, Hansen K, Reed SD. Incidence, prevalence, and trends in endometriosis diagnosis: a United States population-based study from 2006 to 2015. Am J Obstet Gynecol. 2021;225(5): 500.e1–500.e9. https://doi.org/10.1016/j.ajog.2021.06.067. Giudice LC. Clinical practice. N Engl J Med. 2010;362(25):2389–98. https://doi.org/10.1056/NEJMcp1000274. Lamvu G, Antunez-Flores O, Orady M, Schneider B. Path to diagnosis and women’s perspectives on the impact of endometriosis pain. J Endometr Pelvic Pain Disord. 2020;12(1):16–25. https://doi.org/10.1177/2284026520903214. Surrey E, Soliman AM, Trenz H, Blauer-Peterson C, Sluis A. Impact of endometriosis diagnostic delays on healthcare resource utilization and costs. Adv Ther. 2020;37(3):1087–99. https://doi.org/10.1007/s12325-019-01215-x. Soliman AM, Fuldeore M, Snabes MC. Factors associated with time to endometriosis diagnosis in the United States. J Womens Health. 2017;26(7):788–97. https://doi.org/10.1089/jwh.2016.6003. Practice Bulletin No. 114: Management of endometriosis, obstetrics & gynecology. 2010;116(1): 223–236. https://doi.org/10.1097/AOG.0b013e3181e8b073. Becker CM, Bokor A, Heikinheimo O, Horne A, Jansen F, Kiesel L et al. ESHRE Endometriosis Guideline Group, ESHRE guideline: endometriosis. Hum Reprod Open. 2022;2022(2): hoac009. https://doi.org/10.1093/hropen/hoac009. Greene R, Stratton P, Cleary SD, Ballweg ML, Sinaii N. Diagnostic experience among 4,334 women reporting surgically diagnosed endometriosis. Fertil Steril. 2009;91(1):32–9. https://doi.org/10.1016/j.fertnstert.2007.11.020. Kennedy S, Bergqvist A, Chapron C, et al. ESHRE guideline for the diagnosis and treatment of endometriosis. Hum Reprod. 2005;20(10):2698–704. https://doi.org/10.1093/humrep/dei135. Chilton N, van Oudtshoorn S, Pontré J, Karthigasu K, McElhinney B. ‘My devil womb’: patients’ perspectives on, and understanding of, endometriosis: an observational cross-sectional study. J Endometr Pelvic Pain Disord. 2021;13(4):223-228. https://doi.org/10.1177/22840265211034092. Bullo S. “I feel like I’m being stabbed by a thousand tiny men”: the challenges of communicating endometriosis pain. Health (N Y). 2020;24(5):476–92. https://doi.org/10.1177/1363459318817943. About the Campaign | CDC. Published September 14, 2021. https://www.cdc.gov/hearher/about-the-campaign/index.html. Accessed September 19, 2021. InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Benefits and risks of screening tests. 2013 Nov 7 [Updated 2019 Dec 17]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279418/. Parker MA, Kent AL, Sneddon A, Wang J, Shadbolt B. The menstrual disorder of teenagers (MDOT) study no. 2: Period ImPact and Pain Assessment (PIPPA) tool validation in a large population-based cross-sectional study of Australian teenagers. J Pediatr Adolesc Gynecol. 2022;35(1):30–8. https://doi.org/10.1016/j.jpag.2021.06.003. Raising awareness tool for endometriosis (RATE) [Internet]. RANZCOG. 2022 [cited 2022 Sep 15]. Available from: https://ranzcog.edu.au/resources/raising-awareness-tool-for-endometriosis-rate/. Matsuzaki S, Canis M, Pouly J-L, Rabischong B, Botchorishvili R, Mage G. Relationship between delay of surgical diagnosis and severity of disease in patients with symptomatic deep infiltrating endometriosis. Fertil Steril. 2006;86(5):1314–6. https://doi.org/10.1016/j.fertnstert.2006.03.048. Fauconnier A, Staraci S, Huchon C, Roman H, Panel P, Descamps P. Comparison of patient- and physician-based descriptions of symptoms of endometriosis: a qualitative study. Hum Reprod Oxf Engl. 2013;28(10):2686-2694. https://doi.org/10.1093/humrep/det310. DiBenedetti DB, Soliman AM, Ervin C, et al. Development of the painful periods screening tool for endometriosis. Postgrad Med. 2018;130(8):694–702. https://doi.org/10.1080/00325481.2018.1526623. Culley L, Law C, Hudson N, et al. The social and psychological impact of endometriosis on women’s lives: a critical narrative review. Hum Reprod Update. 2013;19(6):625–39. https://doi.org/10.1093/humupd/dmt027. Wilbur MA, Shih I-M, Segars JH, Fader AN. Cancer implications for patients with endometriosis. Semin Reprod Med. 2017;35(1):110–6. https://doi.org/10.1055/s-0036-1597120. Surrey E, Carter CM, Soliman AM, Khan S, DiBenedetti DB, Snabes MC. Patient-completed or symptom-based screening tools for endometriosis: a scoping review. Arch Gynecol Obstet. 2017;296(2):153–65. https://doi.org/10.1007/s00404-017-4406-9. Attestation Statements • Data regarding any of the subjects in the study has not been previously published unless specified. • Data will be made available to the editors of the journal for review or query upon request. Funding The study was funded by AbbVie. Author information Authors and Affiliations Contributions BS, YX, AS, CT, and JS developed the study protocol and conducted the study. BS, YX, JB, AS MV, CT, and JS compiled the manuscript and edited it. Corresponding author Ethics declarations Conflict of Interest Yanqing Xu and Ahmed M Soliman are AbbVie employees and hold AbbVie stock or stock options and patents. Dr. Segars has served as consultant or had research funding from Bayer, AbbVie, Myovant, Organon, Allergan, or Obseva. Other authors have no relevant disclosures. Capsule The use of a screening questionnaire, the PPST, has clinical utility and facilitated communication between patients and providers about pain symptoms. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Supplementary Information Below is the link to the electronic supplementary material. Rights and permissions Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. About this article Cite this article Singh, B., Berry, J., Volovsky, M. et al. The Utility and Impact of the Painful Periods Screening Tool (PPST) to Improve Healthcare Delivery for People with Symptoms of Pelvic Pain. Reprod. Sci. 30, 1676–1683 (2023). https://doi.org/10.1007/s43032-022-01119-2 Received: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s43032-022-01119-2