Hip pain level variation in female femoroacetabular impingement syndrome patients in menstrual cycle.

backgroundIn clinical practice, we noticed that a large group of young female patients diagnosed with femoroacetabular impingement syndrome (FAIS) suffer from hip/groin pain in daily lives and particularly during menstruation. However, it is unknown if female patients have higher burden of pain during menstruation compared to other stages in the menstrual cycle. PURPOSE: Our study was to preliminarily identify the hip “pain-peak” in a menstruation cycle in female FAIS patients and explore possible explanations for the correlation.

methodsFemale outpatients diagnosed with FAIS with hip/groin pain were assessed between May 2023 and January 2024. All participants underwent hip radiographs and magnetic resonance imaging (MRI). The diagnosis of FAIS and differential diagnosis was made based on medical history, physical examinations, and radiographs. A standard questionnaire was used to collect participant information and data at outpatient clinic and during follow-up. Visual analogue scale (VAS) pain level, Hip Outcome Score -Activities of Daily Living (HOS-ADL) and Sports-Specific (HOS-SS) scores were collected at different stages in one menstruation cycle.

resultsFifty female patients diagnosed as FAIS with labral tear were recruited for the study. Twenty-seven (54%) patients reported ten types of gynecological history. Six (12%) patients had a history of thyroid disease, with subclinical or clinical hypothyroidism being the main type. The average VAS pain during menstruation of all patients was 4.8 ± 1.9, while the mean VAS pain was 4.0 ± 1.9 during non-menstrual phase pain (p < 0.05). Pain level reached the peak during menstruation phase in 22 patients (43%). Accordingly, 39% (27 patients) and 35% (24 patients) of the patients reached their lowest point of HOS-ADL and HOS-SS score during menstruation. The overall average HOS-ADL and HOS-SS score during menstruation was 76.5 ± 15.0 and 62.4 ± 20.1 respectively. In the binary logistic regression analysis, none of the following factors showed a significant association with whether the pain level reached its peak during menstruation: the presence of dysmenorrhea, the severity of dysmenorrhea, history of pregnancy and childbirth, age, body mass index (BMI), duration of symptoms or the type of FAI deformity.

conclusionsIn conclusion, within the studied cohort, a notable portion of FAIS patients reported more severe hip pain during the menstruation stage than at other points in their cycle. The physiological changes of menstruation could be one factor contributing to this cyclical variation in symptoms. LEVEL OF EVIDENCE: Level 4.