Chronic Pelvic Pain Flashcards
What is adenomyosis?
the presence of ectopic glandular tissue found in the muscular wall of the uterus (myometria). I.E. when the endometrium dives down and ectopic transplants into the myometrium
How does adenomyosis present?
Chronic, persistent, pelvic pain that may tend to get worse with menses or menorrhagia that presents with a boggy, enlarged, tender uterus on exam
How is adenomyosis diagnosed?
Can only be made by pathology after hysterectomy
How is adenomyosis treated initially?
The first line is to prevent ovulation using OCPs and treat pain with NSAIDs
How is adenomyosis treated after failed medical treatment?
hysterectomy
What else might be on the DDx for persistent pelvic pain that gets worse with menses and sex?
Endometriosis
What else should be on the DDx if a woman comes in and says she is chronic (every day) experiencing some degree of pelvic pain?
- Endometriosis/Adenomyosis
- PID (infections)
- Adhesions (from surgeries msot commonly)
Irritable Bowel Syndrome
•Leiomyomata or Ovarian Cysts (should be low on the DDx- not likely to cause significant pain)
Again, leomyomatas should be low on the DDx for causing chronic pain. Why?
They are not responsive to hormones, and typically can only cause this type of pain mechanically be inpinging on local structures
Someone comes in a complaint of chronic pelvic pain. How do you begin?
With the history. Be systematic:
Go down the DDx starting with endometriosis/adenomyosis- since this classically presents with chronic pelvic in women in their 30s that is markedly worse during menses and sex, ask about dysmenorrhea and dyspareunia
What should you be suspecting if a pt. has a complaint of chronic pelvic pain and GI problems such as diarrhea or constipation?
Possibly irritable bowel
What would you ask for if you suspected Adhesions as the source of the chronic pelvic pain?
history of PID or pelvic surgeries, most commonly C-section and hysterectomy
So how should you begin with a pt. complaining of pelvic pain?
Always begin with a Hx and physical to elicit any signs/symptoms and then get a pelvic ultrasound
Remember that ovarian cysts and fibroids (leiomyomatas) dont typically cause pain and that a pelvic ultrasound wont show adhesions or PID!
Why would it be a good idea to ask women with chronic pelvic pain (or chronic HA) about a Hx of sexual abuse as a child?
There is a correlation between a Hx of sexual abuse and somatization manifesting a pelvic pain
What if after exhausting all non-invasive options, you still cant find a reason for the chronic pelvic pain?
Offer laparscopy to look into the pelvis- might see adhesions, etc.
Remember, studies have shown that women tend to get better even if told that the pelvis is clean!
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