Pelvic pain Flashcards
Define chronic pelvic pain
intermittent or constant pain in the lower abdomen or pelvis of a women of at least 6 months in duration, not occurring exclusively with menstruation or intercourse and not associated with pregnancy
Pathologies associated with chronic pelvic pain
adhesions
pelvic inflammatory disease
ovarian cysts
endometriosis
adenomyosis
pelvic congestion syndrome
nerve entrapment/MSK
interstitial cystitis
IBS
no obvious underlying pathology
What is endometriosis?
common, benign, oestrogen-dependent chronic gynaecological disorder
presence of endometrial tissue outside normal location
Common endometriosis locations
pelvic peritoneum
ovaries
recto-vaginal septum
other - pericardium, pleura, brain (rare)
Endometriosis symptoms
painful periods
chronic pelvic pain
dyspareunia
bowel dyschezia (painful bowel movements)
dysuria
fatigue
depression and/or anxiety
abdominal bloating
infertility
How is endometriosis diagnosed?
imaging
diagnostic laparoscopy (gold-standard)
Endometriosis management
analgesia:
- NSAIDs
- paracetamol
- codeine/opiates
cycle control:
- COCP/tricycling
progesterone:
- POP
- LNG-IUS/Depo MPA
HPO axis suppression:
- GnRH +/- add-back HRT
excisional surgery
ablative treatment
What is add back therapy with GnRH agonists for endometriosis?
hormonal add back therapy to coincide with start of GnRH agonist therapy
prevents bone loss and hypoestrogenic symptoms
What is DIE?
deeply invasive endometriosis
How can endometriosis cause subfertility?
reduced coital frequency
adhesions - distorted pelvic anatomy
endometriomas - impaired ovarian function
What is CPPS?
chronic pelvic pain syndrome
occurrence of chronic pelvic pain with no proven infection or obvious other local pathology that may account for the pain
diagnosis of exclusion
