Chronic pelvic pain Flashcards
female pt comes in with dysmenorrhoea b4 onset period. sometimes dyspareunia. been trying for baby but no luck. dx?
?Endometriosis
SS Endometriosis:
dyspareunia, cyclical dysmenorrhea, dyschezia, dysuria, haematuria or rectal or umbilicus, rupture cyst, sub fertility
On examination pt uterus is tender and thickened at the back. what other signs could indicate endometriosis
Endometriosis ex: tender, thickening, retroverted or immobile/frozen pelvis if severe, can be normal if mild
diagnostic investigation for endometriosis
laparoscopy +- biopsy (others are TVUSS, MRI and IVP)
Ddx endometriosis
Adenomyosis, Chronic pelvic pain or PID, IBS, Pelvic mass causes eg ca
Pt wants med mx of endometriosis. options are (4)
- COCP back to back to reduce withdrawal pain/bleed)
- Progestogens
- GnRH analogues (only for 6m with add back HRT)
- IUS
which mx best for women with endometriosis who want to conceive
surgery - laser, scissors or bipolar diathermy
all surgery options for endometriosis
- laser, scissors, diathermy
- dissection
- removal endometriomas
- hysterectomy with BSO
which HRT used after hysterectomy due to endometriosis?
oestrogen and progesterone (as ectopic tissue)
why would you do MRI for endometriosis
if affect structures, infiltrating. plus IVP and barium studies
does med tx affect fertility? and is there an exception?
no unless tubes affected
prognosis with med tx endometriosis
recurrence likely
analgesic options for chronic pelvic pain
NSAIDS, paracetamol, amitriptyline, gabapentin
define chronic pelvic pain
> 6m, intermittent or constant, not just during sex or menstruation
causes chronic pelvic pain
- endometriosis, adenomyosis
- IBS
- interstitial cystitis
- adhesions
- psychological factors
