9 - Gynae - Endometriosis + Chronic Pelvic Pain - CPP

Question 1

defined as ?/? pain in ? abdo/? of >?m, not occurring exclusively with ? or ?. Present in 1’ care as often as ? or ?? pain. Effects ?% of adult women. Carries heavy ? + ? price

Answer 1

intermittent/constant
lower, pelvis
6
menstruation or intercourse
migraine 
lower back 
15%
social and economic

Question 2

Assessment and Ix

• discuss womens ? ? on cause
• frequently >1 ? of pain
• what does a full Hx prevent?
• may need ? evaluation
• poss Ix include ?, ? or ?

Answer 2

own ideas
component
missing non-gynae diagnosis
psych
TVUSS, Laparoscopy, MRI

Question 3

Possible causes

• what suggests gynae conditions like endometriosis/adenomyosis?
• ? activity appears to be important - why? 2 reasons (one re postmenopause and one re suppression of ov activity)
• may be gynae or pelvic ? but these may be ?
• ovarian tissue can become trapped in ? -> ? pain trtd by ? or adhesiolysis

Answer 3

pelvic pain varying considerably over menstrual cycle (due to hormonal driven gynae conditions)

oestrogen
postmeno pain is rare and more likely to be malignant
ovarian suppression cures 2/3 cases

adhesions
incidental
adhesions
cyclical
oopherectomy

Question 4

Sx suggestive of ? or ?? often present in women with CPP

? factors are important. Depression and ? disorders common. Many give Hx of ?/ongoing ? or physical abuse.

Other poss theories include

• pelvic congestion syndrome..??
• myofascial syndrome ..??

Answer 4

IBS / interstitial cystitis

psych
sleep
childhood
sexual

venous congestion in pelvis > pain

pain from muscle trigger points/trapped nerves

Question 5

MGMT

• if Sx suggest IBS -> ? change and trial of ? 1st line
• appropriate ?
• women with cyclical pain offered trial w ? or GnRH analogue with ??? for 3-6m before ?? if pain unresolved
• Progestogen ? also considered

Answer 5

dietary
antispasmodics
analgesia
COCP
add-back HRT
diagnostic laparoscopy
IUS