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Understanding and Mitigating the Multidimensional Impact of Chronic Pelvic Pain on Women and Workplaces: A Comprehensive Analysis 

This white paper aims to highlight the significant impact that pelvic pain and period problems have on women’s lives, especially in the workplace. We want to show how these conditions can have wide-ranging consequences, and how our product can help alleviate the physical, emotional, and financial burdens that women face due to these issues.  

The Comprehensive Nature of Women’s Health Issues 

P Pelvic pain and problems with menstrual periods are significant health concerns that affect a large number of women, regardless of their age, background, or location. These issues are not isolated events but rather recurring challenges that can greatly impact women’s daily lives. 

Prevalence 

Period pain, also known as dysmenorrhea, is extremely common. According to the World Health Organization (WHO), around 80% of women experience some form of period pain during their reproductive years. For about 14% of these women, the pain is severe enough to disrupt their daily activities. 

Period pain is not just a minor inconvenience. It can be excruciating and debilitating, causing women to miss work, school, or social events. The pain can manifest as cramping, lower back discomfort, and general physical unease, making it difficult for women to carry out their daily routines. 

Pelvic pain is also very common, affecting around 15-20% of women at some point in their lives. It can happen to women of any age or background. Like period problems, pelvic pain is not a one-time issue but a recurring challenge that impacts the daily lives of women from all walks of life. 

Significance 

The significance of pelvic pain and period problems goes beyond just physical discomfort. Women dealing with these issues often experience emotional distress and a lower quality of life. 

The discomfort and unpredictability of period problems can lead to persistent anxiety, stress, and decreased productivity. It can be challenging for women to predict when symptoms will occur, making it difficult to plan activities and work commitments. The fear of disruptive symptoms can also take a psychological toll, affecting overall well-being and mental health. 

Chronic pelvic pain is another aspect of this issue that can profoundly interfere with daily activities, relationships, and overall quality of life. Women suffering from chronic pelvic pain may experience pain during intercourse, difficulty engaging in physical activities, and a constant sensation of discomfort. 

These physical and emotional strains not only affect individual women but can also have a ripple effect on their families, workplaces, and communities. The impact extends beyond the individual, affecting various aspects of a woman’s life. 

Economic Impact 

Pelvic pain and period problems also have a substantial economic impact. Women affected by these conditions often face high medical costs, including expenses for doctor visits, specialist consultations, medications, and sometimes even surgical procedures. Over time, the cumulative financial burden of these treatments can be significant for both the individuals and the healthcare system. 

However, the economic consequences go beyond just direct medical costs. There are also indirect costs, such as missed workdays, reduced productivity on the job, and absenteeism. Women may need to take time off from work to manage their symptoms or seek medical care, resulting in productivity losses for employers. Reduced efficiency and increased absenteeism can translate into higher costs for companies, lower job satisfaction for affected employees, and decreased overall workplace morale. 

In summary, pelvic pain and period problems impact women in multiple ways, including physical, emotional, and financial aspects. Addressing these issues not only improves women’s health and well-being but also has the potential to positively impact the workplace. Employees experiencing improved health and reduced disruptions due to these conditions can lead to increased productivity and morale. 

The Direct Financial Costs Incurred by Women: A Comprehensive Examination 

Chronic Pelvic Pain (CPP) is a challenging and often underrecognized health concern that transcends the realms of physical suffering and emotional distress. Equally important is the financial burden it imposes on women who grapple with CPP as they navigate the complex landscape of diagnosis and treatment. This section embarks on a comprehensive exploration of the direct financial costs that women shoulder in their journey through CPP, shedding light on the intricate details of the specific expenses involved. 

Pelvic Floor Physical Therapy: Pelvic floor physical therapy is often the first non-medication treatment tried for chronic pelvic pain (CPP). It involves a variety of techniques like: 

  • Internal and external massage of the pelvic muscles 
  • Mobilizing the organs in the pelvic area 
  • Nerve gliding exercises 
  • Balance and movement retraining 

These therapies are widely considered the first line of treatment for CPP. Our research confirms this, as physical therapy is the most commonly sought treatment by our patients with CPP. 

A notable 46% of patients start their journey to relief by doing at least one pelvic floor physical therapy session. On average, each patient completes 24 physical therapy sessions before seeking further medical help. 

Remarkably, one patient stands out by undergoing an astonishing 500 physical therapy sessions while still experiencing persistent pelvic pain and discomfort from CPP. This highlights how chronic and debilitating this condition can be for some individuals, even with extensive physical therapy. 

Diagnostic Procedures: Accurate diagnosis and developing individualized treatment plans for chronic pelvic pain (CPP) often require diagnostic procedures. Our study highlights the importance of these diagnostics, with a remarkable 77% of our patients having undergone at least one diagnostic procedure before arriving at our clinic. 

The most commonly performed diagnostic tests include: 

  • Pelvic Ultrasound (57% of patients) 
  • Pelvic MRI (40% of patients) 
  • Exploratory surgery (13% of patients) 

These diagnostic procedures are essential for unraveling the complex nature of CPP and serve as the foundation for making informed treatment decisions. 

The extensive nature of these procedures is further underscored by individual cases where patients have undergone an exceptionally high number of diagnostics, highlighting their persistent quest for clarity and relief. Some patients have experienced up to: 

  • 25 colonoscopies 
  • 30 esophagogastroduodenoscopies (EGDs) 
  • 40 cystoscopies 

before seeking the specialized care of our practice. This emphasizes the challenges in diagnosing and managing CPP, often requiring multiple invasive tests over an extended period. 

Surgical Interventions: Surgical procedures play an important role in treating chronic pelvic pain (CPP), especially when other conditions are present. In our study of patients, we found: 

For the 450 female patients: 

  • 30% had at least one female-specific surgery 
  • Of those surgeries, 58% were related to endometriosis (ablation or excision) 
  • 40% had a hysterectomy (removal of the uterus), the second most common surgery 

For the 157 male patients: 

  • 4 patients had male-specific surgeries 

Additionally, 89 patients (both male and female) reported having gender-neutral surgeries in the past, such as: 

  • 25% had inguinal hernia repair 
  • 20% had hemorrhoid surgery 

These numbers highlight the complex nature of CPP and the diverse range of surgical treatments that may be needed, depending on the underlying causes and complicating factors for each patient. An individualized, multifaceted approach is often required to effectively manage this condition. 

Fig1:  This diagram shows the different types of treatments used for chronic pelvic pain (CPP) and how common each treatment is among patients. The pie chart showcases the proportion of patients undergoing physical therapy, diagnostic procedures, and surgical interventions. The bar charts give more details on the specific diagnostic tests and surgeries that are frequently used, along with the percentage of patients who had each one. This visual representation underscores the multifaceted approach required in managing CPP, from non-pharmacological treatments like physical therapy to more invasive diagnostic and surgical interventions. 

Direct Financial Costs Associated with Procedures 

The various procedures used to manage chronic pelvic pain (CPP), including treatments, diagnostic tests, and surgeries, all come with direct financial costs. Looking at the costs in these three main categories can help shed light on the significant economic impact of dealing with CPP. 

Costs of Treatment 

Our analysis found that pelvic floor physical therapy costs an average of $8,937 per patient when receiving in-network treatment. 

This total cost takes into account: 

  • The average number of physical therapy sessions each patient attends 
  • The standard cost for each session based on medical billing codes 
  • The total number of patients receiving this treatment 

So for a typical course of pelvic floor physical therapy involving multiple sessions and billed at standard in-network rates, the overall cost per patient comes out to nearly $9,000. This highlights the significant financial burden this common treatment places on patients dealing with chronic pelvic pain. 

Costs of Diagnostics 

For the 466 chronic pelvic pain patients who required diagnostic testing, the average cost per patient for these procedures was $5,264.22. 

This total diagnostic cost takes into account: 

  • The number of patients who had each type of test (like ultrasound, MRI, etc.) 
  • The standard medical billing cost for each diagnostic procedure 
  • Cases where patients needed to repeat the same test multiple times 

When diagnostic tests are repeated frequently, which is common for this condition, the costs really add up. The more patients who need a test, and the more times it needs to be repeated, the higher the overall diagnostic costs become. 

So with a variety of complex diagnostic imaging and procedures often needed to evaluate chronic pelvic pain, the average $5,264 per patient price tag for this testing represents a significant financial burden. Obtaining an accurate diagnosis requires these costly tests for many patients. 

Costs of Surgeries 

Surgical procedures for managing chronic pelvic pain (CPP) also come with significant financial costs: 

  • For surgeries specific to female reproductive conditions like hysterectomies or endometriosis procedures, the average cost per patient was $16,800 when receiving in-network care. 
  • For male-specific surgeries related to CPP, the average cost per patient was $11,977 for in-network services. 
  • For all other non-gender-specific surgeries, the average cost per patient was $13,443 when performed in-network. 

Overall, when combining the costs of female-specific, male-specific, and gender-neutral surgical interventions, the total average cost burden per CPP patient for surgical treatment was $15,750 when utilizing in-network services. 

This surgical cost was part of the total comprehensive cost of $29,951 per patient for managing CPP through in-network services. This total included costs for non-surgical treatments like physical therapy as well as diagnostic procedures in addition to surgeries. 

Fig2: The diagram illustrates the financial burden of Chronic Pelvic Pain (CPP) management, broken down into three primary categories: Treatment, Diagnostics, and Surgeries. 

Variability in Costs 

There is significant variability in the financial burden experienced by patients with chronic pelvic pain (CPP). The costs can range widely from patient to patient. For example: 

  • At the lower end, two patients reported total costs of only $202 each. 
  • On the higher end, one patient faced exceptionally high costs exceeding $305,000, likely due to a very complex medical history. 

This large variability highlights how costs can differ drastically based on factors like the severity of the condition, other health issues, and the specific treatments required for each individual patient. 

Another Example: Understanding the Financial Impact of Heavy Menstrual Bleeding (HMB) 

As we look at major women’s health issues, heavy menstrual bleeding (HMB) stands out as a condition with significant financial impacts. HMB can negatively affect a woman’s overall well-being and also lead to: 

  • Increased use of healthcare services 
  • Lost productivity and missed work 
  • Higher healthcare costs 

This section explores the wide-ranging economic effects of HMB by examining the findings from a large-scale study. This study utilized data from a large employer database to comprehensively analyze the economic burden associated with HMB. 

This investigation, spanning from 1998 to 2009 and utilizing data from 55 self-insured U.S. companies, was dedicated to exploring the complexities associated with idiopathic heavy menstrual bleeding (HMB). Focusing on women between the ages of 18 and 52 who had at least two HMB claims, the research meticulously excluded individuals with known causes of HMB. It comprehensively examined aspects such as healthcare utilization, work productivity loss, costs, and treatment patterns that are intricately linked to HMB. 

The study found that women with heavy menstrual bleeding (HMB) used significantly more healthcare resources compared to women without HMB. Specifically: 

  • They had higher rates of hospitalization 
  • They visited the emergency room more often 
  • They had more outpatient appointments 

From a cost perspective, HMB led to much higher healthcare expenses for these women. On average, a woman with HMB incurred an additional $2,607 in annual costs compared to women without HMB. About half of these extra costs – around $1,313 – were directly related to medical expenses for treating and managing the HMB itself.  

The study also looked at how HMB was treated. It found a notable trend towards surgical treatment as the first approach for managing HMB. Specifically, 63.2% of women with HMB underwent surgery as their initial treatment. This high rate of surgical interventions highlights that more invasive methods are commonly used to treat heavy menstrual bleeding, rather than trying non-surgical options first.  

Overall, this investigation provides a thorough understanding of the financial and healthcare burdens associated with HMB, underlining the increased healthcare costs and the preference for surgical treatments. The findings emphasize the need for targeted strategies to improve life quality for HMB sufferers and optimize healthcare resource utilization. 

Healthcare Utilization and Costs 

Employees suffering from pelvic floor disorders often require frequent medical care. This can include seeing multiple specialists, undergoing physical therapy, and sometimes needing surgery. Studies show that the additional healthcare costs for someone with a pelvic floor disorder are much higher compared to someone without such a condition: 

  • For in-network health coverage: Around $28,984 more per year 
  • For out-of-network coverage: Around $73,768 more per year 
  • For Medicare coverage: Around $4,920 more per year 

These elevated costs don’t just cover direct medical expenses. They also account for the increased utilization of healthcare services that pelvic floor disorder patients require, such as more frequent doctor visits, extended treatment plans over longer periods and higher overall consumption of healthcare resources. 

Financial Implications of Chronic Pelvic Pain (CPP) for Employers 

Chronic pelvic pain (CPP) takes a major toll on employees suffering from this debilitating condition. But the impacts extend far beyond just the individual – CPP also creates significant financial challenges for employers. 

The costs to employers are not limited to just the direct medical expenses for treating CPP. There are also substantial indirect costs related to: 

  • Lost productivity and reduced work output from CPP-affected employees 
  • Increased absenteeism and missed workdays due to CPP symptoms and treatments 

Fig3: Financial Burden of Chronic Pelvic Pain (CPP) on Employers: This diagram depicts the range of costs associated with CPP, highlighting both the direct and indirect financial implications for employers. It presents a comparative view of the minimum and maximum estimated annual costs across three critical categories: Healthcare Costs, Prescription Costs, and Indirect Costs due to lost productivity. The dual-bar representation for each category underscores the significant variability in the financial impact of CPP, from healthcare expenses to productivity losses, emphasizing the considerable economic challenge it poses to employers. 

Healthcare Costs Incurred by Employers 

Employers need to be aware of the extensive healthcare costs associated with CPP. Our analysis shows that estimated healthcare costs for women with CPP can range from $1,367 to $7,043 per woman per year. Additionally, prescription costs can range from $193 to $2,457 per woman per year. These figures highlight the financial burden that CPP can place on employer-sponsored health insurance plans. 

Indirect Costs from Lost Productivity 

In addition to direct healthcare expenses, chronic pelvic pain also results in substantial indirect costs to employers from lost productivity among affected employees. These indirect costs can range from $4,216 to $12,789 per employee with CPP each year. 

This lost productivity includes: 

  • Time missed from work due to CPP symptoms or treatments 
  • Reduced output and productivity while at work suffering from CPP 

In the patient group analyzed, a significant portion faced these productivity challenges: 

  • 76% were employed 
  • Of those, 30.5% reported missing work time because of their CPP 
  • 62.1% reported reduced productivity at work due to CPP 

When employees are frequently absent or underperforming due to a chronic condition like pelvic pain, it directly impacts the company’s operations and profitability. The losses in productivity can lead to major financial costs for employers over time. 

Challenges in Timely Diagnosis and Effective Treatment 

Chronic pelvic pain (CPP) is a complex condition that can stem from many different underlying causes and overlapping pain conditions. This makes it extremely challenging to diagnose CPP in a timely manner. 

The diagnostic process is often long and arduous, involving: 

  • Multiple surgeries and diagnostic procedures 
  • Consultations with various medical specialists 
  • A prolonged period of uncertainty before an accurate diagnosis 

Not only do these diagnostic difficulties drive up healthcare costs, but they also contribute to other major impacts on patients and employers: 

  • Extended periods of work absence for the patient 
  • Reduced productivity and work output during the diagnostic phase 

Emergency Room Visits and Opioid Prescriptions 

The data shows that 14% of patients with chronic pelvic pain (CPP) seek treatment through emergency room visits. However, this route often fails to properly address their condition: 

  • Most CPP patients who go to the ER are simply prescribed opioid painkillers 
  • They are then referred to see their OB/GYN, rather than receiving specialized CPP care 

This pattern of prescribing opioids without appropriate follow-up treatment can worsen CPP symptoms over time. 

Additionally, the inappropriate use of opioids for CPP leads to further health complications down the line. 

Mental Health and Quality of Life 

For a significant portion of chronic pelvic pain (CPP) patients – between 66-71% – they also suffer from co-existing mental health conditions like anxiety and depression. 

The presence of these comorbid mental health issues creates additional challenges: 

  • It negatively impacts the overall quality of life for CPP patients, reducing their general well-being. 
  • It can further diminish productivity and work performance among employed CPP patients. 

Compounding the problem, opioid painkillers are sometimes inappropriately prescribed as a treatment for CPP. However, repetitive opioid use is not recommended for managing this condition. The misuse of opioids for CPP can lead to additional health complications down the line. This contributes to an overall decline in the physical and mental well-being of employees suffering from chronic pelvic pain. 

Recommendations 

Implementing Telehealth Systems to Manage Chronic Pelvic Pain (CPP) 

One recommended solution to address the financial and health impacts of chronic pelvic pain (CPP) in the workplace is to implement telehealth systems. 

Telehealth involves using technology to virtually deliver healthcare services remotely. For CPP, it can provide: 

  • More accessible care options for employees 
  • More efficient treatment approaches 
  • A more cost-effective way to manage this condition 

By integrating telehealth, employers and employees could potentially reduce their overall CPP-related costs by around 25%. 

Benefits of Telehealth in Managing CPP 

Cost Reduction 

One major benefit of utilizing telehealth for CPP is the potential to significantly reduce costs compared to traditional in-person healthcare visits. Telehealth can lower costs in a few key ways: 

  • Minimizing the need for patients to travel for appointments 
  • Reducing missed time from work for doctor visits 
  • Cutting down on expenses related to in-office consultations 

By making care more accessible remotely, telehealth eliminates many of the indirect costs associated with CPP treatment that burden both employees and employers. 

Convenient Follow-Up Care 

Telehealth also facilitates more consistent, convenient follow-up care for CPP patients by providing: 

  • Easier, virtual follow-up appointment options 
  • More frequent monitoring of the patient’s condition remotely 
  • Ability to quickly adjust treatment plans as needed 

This ongoing monitoring and care management is extremely important for a complex chronic condition like pelvic pain. Telehealth improves access to the follow-up care that is crucial for successfully treating CPP over the long-term. 

Focus on Mental Health 

An important aspect of telehealth services for chronic pelvic pain (CPP) is providing mental health support. Telehealth allows for an integrated, holistic approach that addresses both the physical chronic pain and the mental health challenges many CPP patients face. By utilizing telehealth to manage the psychological impacts alongside the physical symptoms, patients can experience improvements in their overall well-being. This mind-body approach facilitated by virtual care has the potential to enhance daily functioning and productivity at work for CPP sufferers. 

Reduced Frequency of Doctor Visits 

Telehealth allows for remote monitoring and virtual consultations with healthcare providers. This reduces the need for frequent physical office visits, which is especially helpful for a condition like chronic pelvic pain (CPP). By making care more accessible remotely, telehealth minimizes the frequency of office visits required while still ensuring CPP patients receive consistent, quality care. This improves treatment adherence and management of the chronic condition. 

Personalized Medical Recommendations 

With telehealth, providers can deliver more personalized care and medical recommendations tailored to each chronic pelvic pain (CPP) patient’s specific needs and circumstances. 

Some key ways telehealth enables personalized CPP treatment include: 

  • Virtual visits allow more time for in-depth discussions of the patient’s condition and concerns 
  • Providers can better account for individual factors like lifestyle, living situation, etc. 
  • Treatment plans can be customized based on the patient’s unique symptoms and response 
  • Recommendations are tailored, not one-size-fits-all 

This personalized approach through telehealth helps ensure CPP patients receive the most appropriate and effective care for managing their chronic pain. 

Faster Disease Diagnosis 

T Utilizing telehealth services can help speed up the process of getting an accurate diagnosis for chronic pelvic pain (CPP) and other conditions. This is because: 

  • Telehealth provides easy, convenient access to healthcare providers virtually 
  • Patients can report new or worsening symptoms in real-time via virtual visits 
  • Providers can then assess those symptoms more quickly 
  • This accelerates the diagnostic workup and evaluation process 

Rather than waiting for an open appointment slot or delaying reporting symptoms, telehealth allows for rapid communication of health issues as they arise. 

Effective in Education and Awareness 

Telehealth technology provides an effective way to educate patients about chronic pelvic pain (CPP) and how to properly manage the condition. Through virtual platforms, providers can: 

  • Teach patients about CPP – what it is, causes, symptoms, etc. 
  • Explain different treatment options and management approaches 
  • Recommend helpful lifestyle changes to improve symptoms 
  • Provide resources and materials to reinforce the education 

This educational component of telehealth is extremely valuable. It empowers patients by giving them a better understanding of their condition and what they can do about it. 

When patients have more knowledge about CPP, they can take a more active role in their own care. They become partners working alongside providers, rather than just passive recipients of treatment. 

Facilitates Remote Monitoring 

Telehealth allows healthcare providers to remotely monitor their patients’ chronic pelvic pain (CPP) symptoms and treatment progress virtually. 

Some key benefits of this remote monitoring capability include: 

  • Providers can check in on how patients are responding to treatments from afar 
  • They can identify any issues or need for adjustments earlier 
  • Treatment plans can be modified as needed without an in-person visit 
  • Patients can report symptom changes or concerns in real-time 

This continuous remote monitoring facilitated by telehealth ensures patients are receiving the most appropriate and effective care at any given time for managing their CPP. 

Conclusion 

Chronic pelvic pain (CPP) and heavy menstrual bleeding (HMB) are debilitating conditions with wide-ranging consequences, imposing significant financial burdens on patients and employers. Studies show CPP can cost individuals thousands to over $70,000 annually, while HMB results in an average of $2,607 in extra expenses per affected woman. These conditions also lead to substantial productivity losses for employers, estimated at $1,367 to over $19,000 per affected employee yearly. 

Beyond financial strain, CPP and HMB greatly diminish quality of life, causing emotional distress and disrupting daily activities. The diagnostic process is often lengthy and exhausting, involving multiple procedures over several years before effective treatment. 

Telehealth offers a promising solution by: 

  • Cutting costs through remote virtual visits 
  • Providing convenient follow-up care and monitoring 
  • Integrating mental health support 
  • Speeding up diagnosis and tailoring treatment plans 
  • Offering patient education for self-management 

By leveraging technology for comprehensive care, telehealth can ease the physical, emotional, and economic burdens of chronic pelvic conditions on women, their families, and the healthcare system. Implementing telehealth initiatives enables proactive, holistic management of these complex issues in a cost-effective virtual care model, improving outcomes and alleviating personal and financial impacts associated with CPP, HMB, and other pelvic pain disorders. 

Reference 

  1. Hutton, D., Mustafa, A., Patil, S., Rathod, S., Shrikhande, G., Advincula, A., Drummond, J., Gregersen, P., Hall, J., Metz, C., Milspaw, A., Orbuch, I. K., Stahl, P., Stein, A., & Shrikhande, A. (2023). The burden of Chronic Pelvic Pain (CPP): Costs and quality of life of women and men with CPP treated in outpatient referral centers. PloS one, 18(2), e0269828. https://doi.org/10.1371/journal.pone.0269828 

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