Chronic Pelvic Pain

Question 1

What is the definition of chronic pelvic pain?

Answer 1

Intermittent or constant pain in lower abdomen or pelvis, >6 months, not occurring exclusively with menstruation or intercourse.

Question 2

How is chronic pelvic pain investigated?

Answer 2

1. Full history, including psychiatric

2. TV USS, MRI, laparoscopy

Question 3

What should you ask in a history of chronic pelvic pain?

Answer 3

1. SOCRATES
2. Associated with periods or sex?
3. LMP, cycle length, HMB/IMB/PCB
4. Superficial or deep dyspareunia
5. How long have you been with current partner?
6. Discharge? Previous STI? Condom use?
7. Current contraception?
8. Obstetric history

Question 4

What are the causes of chronic pelvic pain?

Answer 4

1. Endometriosis - cyclical, non-heavy bleeding pain
2. Adenomyosis - cyclical pain, HMB
3. Fibroids - non-cyclical pain, HMB
4. IUD
5. PID
6. Ovarian cysts/mass
7. Cystitis
8. IBS/IBD/constipation
9. Depression, sleep disorders

Question 5

What is the management for chronic pelvic pain?

Answer 5

1. Cyclical - try COCP/GnRH
2. Exclude PID
3. IBS - anti-spasmodic
4. Pain management
5. Diet, exercise, relaxation techniques
6. Amitriptyline/gabapentin may be useful

Question 6

What is Mittelscherz?

Answer 6

Mid-cycle menstrual pain around time of ovulation