Pelvic pain

Question 1

What are cyclical (gynaecological) causes of pelvic pain?

Answer 1

Endometriosis
Adenomyosis
PID
Primary dysmenorrhoea

Question 2

What are non-cyclical causes of pelvic pain?

Answer 2

Gynaecological - PID, Adhesions, Hydrosalpinges, Tumours
Gastrointestinal - IBS
Urological - Recurrent UTIs, Interstitial Cystitis
Neurological - Nerve injury/entrapment
Musculoskeletal - Myofascial pain

Question 3

What are investigations for pelvic pain?

Answer 3

Triple swabs
MSU
Pelvic USS

Question 4

What are symptoms associated with pelvic pain?

Answer 4

Chronicity
Dysmenorrhoea
Dysparaeunia / Dyschesia
Affected by micturition
Associated with bloating, diarrhoea, constipation, nausea
Recent weight change / appetite change

Question 5

What is endometriosis?

Answer 5

The presence of endometrial-like tissue outside the uterus which induces a chronic, inflammatory reaction

Question 6

What are common sites of endometriosis?

Answer 6

Ovaries
Utero-sacral ligaments
Pouch of Douglas
Broad ligament

Question 7

How does endometriosis present?

Answer 7

Pain
- Cyclical (pain and GIT symptoms)
- Dysmenorrhoea
- Dyspareunia
- Chronic pelvic pain
- Dyschesia
Infertility

Question 8

How is endometriosis diagnosed?

Answer 8

Laparoscopy and histological verification is the gold standard

USS - ground-glass appearance = endometriosis

Question 9

What is treatment of endometriosis?

Answer 9

-Non-hormonal
- Simple analgesia

Hormonal
- Progestogens
- COCP
- Mirena
- Gonadotrophin releasing hormone agonists +/- add back HRT

Question 10

What surgeries can be done for endometriosis?

Answer 10

Destruction of visible endometriosis:
- Diathermy
- Excision
- Laser

Radical – remove uterus, ovaries and nodules