This document discusses chronic pelvic pain, its causes, treatments, and management. It provides statistics on the most common causes of chronic pelvic pain, which are endometriosis (31% of cases), adhesions (23% of cases), and conditions without a gynecological cause (40% of cases). It outlines investigation methods and various treatment options for different conditions that may be causing pelvic pain, including endometriosis, adhesions, ovarian cysts, fibroids, and chronic pelvic inflammatory disease. The success rates of different treatment methods are provided, such as excision surgery for endometriosis having a 70-90% success rate. Specialized pain clinics are recommended for
This document discusses chronic pelvic pain, its causes, treatments, and management. It provides statistics on the most common causes of chronic pelvic pain, which are endometriosis (31% of cases), adhesions (23% of cases), and conditions without a gynecological cause (40% of cases). It outlines investigation methods and various treatment options for different conditions that may be causing pelvic pain, including endometriosis, adhesions, ovarian cysts, fibroids, and chronic pelvic inflammatory disease. The success rates of different treatment methods are provided, such as excision surgery for endometriosis having a 70-90% success rate. Specialized pain clinics are recommended for
This document discusses chronic pelvic pain, its causes, treatments, and management. It provides statistics on the most common causes of chronic pelvic pain, which are endometriosis (31% of cases), adhesions (23% of cases), and conditions without a gynecological cause (40% of cases). It outlines investigation methods and various treatment options for different conditions that may be causing pelvic pain, including endometriosis, adhesions, ovarian cysts, fibroids, and chronic pelvic inflammatory disease. The success rates of different treatment methods are provided, such as excision surgery for endometriosis having a 70-90% success rate. Specialized pain clinics are recommended for
This document discusses chronic pelvic pain, its causes, treatments, and management. It provides statistics on the most common causes of chronic pelvic pain, which are endometriosis (31% of cases), adhesions (23% of cases), and conditions without a gynecological cause (40% of cases). It outlines investigation methods and various treatment options for different conditions that may be causing pelvic pain, including endometriosis, adhesions, ovarian cysts, fibroids, and chronic pelvic inflammatory disease. The success rates of different treatment methods are provided, such as excision surgery for endometriosis having a 70-90% success rate. Specialized pain clinics are recommended for
Colchester University Hospital Essex Pelvic pain - Is it a Gynaecological problem? What is chronic pelvic pain ? Pain confined to pelvis > 6 months duration
Not exclusively with menstruation/intercourse
Not associated with pregnancy
Incidence up to 1 in 5 women
Clues in the history Cyclical variation in pain midcycle / dyschezia / sec dysmen Irregular pv bleeding anovulation / exclude pregnancy / Ca PV discharge / fever Infection Swelling / abdo mass. cyst / pregnancy / fibroid Examination clues Cervical excitation
50% - Irritable bowel Improvement 36% No Gynae cause for CPP 40% CASES Endometriosis History secondary dysmen, dyschezia ca125 (25-50% sensitivity) Scans Pelvic pain mapping during menses (if normal 80% chance lap normal) Adenomyosis seen more effectively with power doppler Endometriosis 30% placebo NO BETTER THAN EXCISION 80% 70% mild 90% sev 70% mild 80% mild 60% sev Success rate 1 year Diagnostic laparoscopy LUNA Presacral neurectomy Laparoscopic excision Laparoscopic ablation 65% mild 25% sev OCP/PROVERA/GnRH Success rate 5years Treatment Endometriosis - new drug therapies Aromatase inhibitors (letrozole/arimidex) 95% success when routine medical therapy failed Alpha E2 Antagonists Selective Prog receptor modulators (due licence 2007) Mifegyne new contraceptive / stops periods Adhesions Only dense vascular adhesions really relevant Good data on success rates lacking (20-80%) ? Anti-adhesion forming agents useful Chronic PID Especially < 25 yrs Stat azithromycin maybe beneficial if non compliant Ovarian cyst Pain usually persistent Conservative follow-up if < 5cm + simple
Residual ovary / Trapped ovary / trapped nerve post Pfannenstiel GnRH relieves pain , then oophorectomy Pain blocks for ilioinguinal nerve
Deep dyspareunia (positional) with retroverted uterus Advise change in position Can perform laparoscopic ventrosuspension (90% success, but in those finished family ideally) Fibroid When large and degenerating constant pain ? SPRMs 30% size reduction Lap myomectomy with embolisation Lap myolysis Or hysterectomy
Pelvic varicosities Aching pain after standing / bending forward Aching pain for next day after intercourse Periovarian vessels > 5mm size Provera 30-50mg for 6/12, has 50% success Embolisation for resistant cases 65% success Hysterectomy last resort
Conventional treatment failures Pentoxiphylline Mirena Letrozole / micronor Diet modification Psych / sex / nonpenetration Avoid multiple laparoscopies Specialised Pain clinics Summary Treatment success Incidence Cause of pelvic pain 1% 1% 1-3% 4% 7% 23% 31% 40% 50-100% Trapped nerve/ residual ovary / ventrosuspension 50-65% Pelvic varicosities 50-90% Fibroid 90% Ovarian cyst 80% Chronic PID ? 30-80% Adhesions 30-90% Endometriosis 25-50% No gynae cause What to do when all else fails ?