Pelvic Pain Flashcards
definition, symptoms, investigations and management of PRIMARY Dysmenorrhea
Definition: recurrent pelvic pain with menses
Epi: young, nulliparous Symptoms: crampy suprapubic pain, radiation to lower quads/lumbar/thighs, N/E, headache, dizziness, fatigue, syncope, fever Investigations: B-hCG, STI swabs, U/S
Management: regular exercise, TENS, NSAIDs, OCP, depo-provera, Mirena
investigations of adenomyosis
- P/E: normal or slightly bulky uterus
- Labs: B-HCG, CBC, iron, STI
- Imaging: US, MRI (rare)
definition of adenomyosis
Definition: endometrial glands and stroma are in the myometrium
epi/age of adenomyosis
late 30s to menopause, often multiparous
management of adenomyosis
Symptoms: severe dysmenorrhea, menorrhagia, deep dyspareunia
Investigations: P/E (normal or slightly bulky uterus), BHCG, CBC, Iron studies, STI, U/S, MRI, endometrial biopsy
Management: NSAIDs + Cox-2 inhibitors, OCP, depo, mirena, GnRH analogue, hysterectomy
management of fibroids and leiomyomas
Dysmenorrhea Management:
o Medical: tranexamic acid, NSAID, OCP, Mirena, GnRH agonist
o Radiologic: fibroid embolization
o Surgical: hysteroscopic myomectomy +/- endometrial ablation; myomectomy, hysterectomy
Pressure and Pain Management:
o Medical: GnRH agonist and antagonist
o Radiological: fibroid embolization
o Surgical: myomectomy (fertility preserving), hysterectomy
management of ovarian torsion
Management: surgery ASAP!!!! Detorsion with cystectomy or adnexectomy
management of ruptured ovarian cyst
Management:
• Hemodynamically stable: NSAIDs, OCP
• Hemodynamically unstable: ovarian cystectomy or salpingoophorectomy
Symptoms: often asymptomatic, sudden onset of acute unilateral pelvic pain (post-coitus or post-exercise) +/- vaginal bleeding
definition of mittelschmerz
Definition: pain with ovulation
Symptoms: cyclical midcycle pelvic pain, lasts hr-2d
Management: NSAIDs, OCP, depo-provera
note: read heidi’s notes on this system
