Chronic Pelvic Pain

Question 1

Define Chronic Pelvic Pain (CPP)

Answer 1

Intermittent or constant pain in the lower abdomen or pelvic of at least 6 months’ duration
Not occurring exclusively with menstruation or intercourse

Question 2

How may CPP present?

Answer 2

Intermittent or constant;
Lower abdo pain
Lower back pain
Often migraine

Question 3

What are possible causes of CPP?

Answer 3

Hormonally driven gynae conditions - pain varies with cycle: Endometriosis or adenomyosis.

Oestrogen important as postmenopausal pain is rare. Ovary suppression cures 2/3.

Adhesions - although evidence lacking.

IBS or interstitial cystitis - symptoms often present, may be a component.

Psychological factors important - depression, sleep disorders.

Question 4

Outline the ‘pelvic congestion syndrome’

Answer 4

Venous congestion in the pelvic is said to cause chronic pain

Question 5

Outline the ‘myofascial syndrome’

Answer 5

Pain originates in muscle trigger points or trapped nerves

Question 6

Outline the management of CPP

Answer 6

IBS symptoms - dietary change & trial of antispasmodics

Analgesia for pain

1) Trial of COContraceptive/ GnRH analogue with add-back HRT (3-6 months)
2) Progestogen IUS Mirena considered
3) Diagnostic laparoscopy - develops womans beliefs about pain
4) Relaxation techniques, sex therapy, diet and exercise