Chronic pelvic pain

Question 1

Definition of CPP

Answer 1

• Lower abdo/pelvic pain >6months
• Not related exclu to periods/intercourse

Question 2

Burden on the system

Answer 2

• 10% of gynae referrals
• 40% of dx laps
• 12% of hysterectomies

Question 3

Diagnosis

Answer 3

• CPP is a symptom
• Rule out causes
• Good hx- Listen to the pt, they might have an idea of what it is
• Pattern of the pain, relation to bowels/periods etc.
• Examine

Question 4

Investigation

Answer 4

• Pain dairy over 2-3 cycles
• Rule out red flag symptoms
• Screen for infection
• TVS ?endo
• MRI if needed
• Dx lap if normal TVS but suspicion of endo

Question 5

Types of pain

Answer 5

• Neuropathic- nerve pain
• Peripheral nerve pain- leads to altered sensation in an area

Question 6

Pain related to hormones/period cycle

Answer 6

• Possible endometriosis
• Findings at Dx lap can be a poor predictor of symptoms

Question 7

Other causes

Answer 7

• Pelvic congestion- Difficult to dx, treat with GnRH or progestins
• IBS- can vary with cycle
• Adhesions- removal doesnt improve pain
• MSK pain
• Psych- sleep disorders, depression, hx of physical abuse.

Question 8

Mx of CPP

Answer 8

• Refer to relevant team- gastro etc if needed
• Trial of hormonal rx for 3-6months - before considering dx lap
• Analgesia
• Dietary changes
• Pain team