Pelvic pain

Notify the primary health care provider if bloating, stomach or pelvic pain, jaundice, blurred vision, hot flashes, breast discomfort, headache, nausea, or vomiting occurs. 

The device is removed for the following reasons pelvic infection, endometritis, genital actinomycosis (a non contagious bacterial infection), intradable pelvic pain, pregnancy, endometrial or cervical malignancy, increase in length of the threads extending from the cervix or any other indication of partial expulsion. 

Dysmenorrhea is commonly defined as crampy pelvic pain occurring with or just prior to menses. Primary dysmenorrhea implies pain in the setting of normal pelvic anatomy and physiology, whereas secondary dysmenorrhea is associated with underlying pelvic pathology.17... 

Complaints of crampy pelvic pain beginning shortly before or at the onset of menses. Symptoms typically last from 1 to 3 days. 

The medical management of dysmenorrhea should relieve the related pelvic pain. Effective management of dysmenorrhea also results in a reduction in lost school and work days. Table 46-2 identifies the agents used in the management of dysmenorrhea, their recommended doses, and their common side effects. Figure 46-5 is a treatment algorithm for the management of dysmenorrhea. 

The benefit of depo-medroxyprogesterone acetate in dysmenorrhea is related to its ability to render most patients amen-orrheic within 1 year of use.17 This is an expected side effect. Since the pelvic pain of dysmenorrhea is related to the prostaglandins released during menses, in the setting of amenorrhea, the underlying cause of dysmenorrhea is removed. 

Efficacy Reduction in/absence of pelvic pain related to menses reduction in time lost from work/school improved quality of life. 

UTI dyspareunia, sexual dysfunction, pelvic pain Dysuria, CVA tenderness, frequency... 

In women that experience uterine cramping, pelvic pain, or fever, administer acetaminophen to combat these symptoms. Additionally, make certain that the patient is well hydrated and has the opportunity to rest. 

Uterine leiomyomas are the most frequent benign disease of the female reproductive apparatus. At least 20-25% of women of fertile age and 50% of women studied in postmortem have uterine leiomyomas (Stewart 2001 Palomba et al. 2005a). In between 20 and 50% of cases, the uterine leiomyomas cause a clinically relevant symptomatology (such as menorrhagia, infertility, recurrent abortion, pelvic pain, and so on) and treatment is required (Stewart 2001 Palomba et al. 2006a). Thus, this disease is one of the main causes of health expense in the field of gynecology (Stewart 2001 Palomba et al. 2006a). In fact,... 

The main manifestations and symptoms of endometriosis are infertil-ity/subfertility and pelvic pain (Missmer et al. 2003 Olive et al. 2001). Retrospective data have, in fact, shown that women with subfertility are at a high risk of having endometriosis, and prospective studies have demonstrated that endometriosis is related to a low relative risk for pregnancy (D Hooghe et al. 2003 Akande et al. 2004). 

In addition, about 15% of cases of pelvic pain are due to endometriosis, and most primary care physicians consider pelvic pain to be a common clinical problem that accounts for as much as 25% of routine gynecologic office visits (Hurd 1998). Endometriosis is frequently associated with several types of pelvic pain such as dysmenorrhea, chronic pelvic pain, deep dyspareunia, and, occasionally, painful defecation (Hurd 1998). Specifically, endometriosis was... 

The severity of pelvic pain and the incidence of infertility are not related to the localization of the lesions or to the stage of the disease (Gruppo Ital-iano per lo Studio dell Endometriosi 2001), as categorized according to the revised American Fertility Society (r-AFS) guidelines (American Fertility Society 1985). In fact, the r-AFS classification system is inadequate to express the severity of the symptomatology because it does not reflect the disease in terms of cellular mass or activity. 

When pelvic pain is the characterizing symptom of the disease, medical treatment could have a significant role. Several medical treatments have been proposed to treat secondary chronic pelvic pain due to endometriosis (Stones et al. 2004). Moreover, few data are available regarding the effectiveness of the treatments for endometriosis on the quality of life of these patients that seems to be deeply impaired (Carter 1998). 

Like the medical treatment of uterine leiomyomas, danazol, gestrinone, mifepristone, and GnRH-a, with or without add-back therapy, have been proposed for the treatment of endometriosis as well (Olive et al. 2001 Stones et al. 2004), but unlike leiomyomas, oral contraceptive pills, in cyclic or continuous administration, and medroxyprogesterone acetate also seem to be effective (Olive et al. 2001 Stones et al. 2004). A significant benefit in terms of pelvic pain relief also is obtained with the use of nonsteroidal anti-inflammatory drugs (Olive et al. 2001 Stones et al. 2004). 

Furthermore, about 20% of women with chronic pelvic pain due to endometriosis are not responsive to medical treatment, and in these cases surgery represents the final diagnostic and therapeutic option (Olive et al. 2001 Stones et al. 2004). Several procedures have been described to treat medically unbeatable pelvic pain (Carter 1998). Nonconservative procedures, such as hysterectomy (Rannestad et al. 2001 Lefebvre et al. 2002), are effective in terms of pain relief, but they can be associated to the decrease in the quality of life (MacDonald et al. 1999), and considered unacceptable to women who wish to preserve intact their reproductive apparatus. 

Carter JE (1998) Surgical treatment for chronic pelvic pain. J Soc Laparoendoscop Surgeons 2 129-133... 

Hurd WW (1998) Criteria that indicate endometriosis is the cause of chronic pelvic pain. Obstet Gynecol 92 1029-1032... 

Porpora MG, Gomel V (1997) The role of laparoscopy in the management of pelvic pain in women of reproductive age. Fertil Steril 68 765-769... 

Stones RW, Mountfield J (2004) Interventions for treating chronic pelvic pain in women. Cochrane Library, Issue 2. Update Software, Oxford... 

Sutton CJ, Ewen SP, Whitelaw N (1994) Prospective, randomized double-blind controlled trial of laser laparoscopy in the treatment of pelvic pain associated with minimal, mild and moderate endometriosis. Fertil Steril 62 696-700... 

Uterine leiomyomas, or fibroids, are the most common type of solid tumors in adult women, clinically apparent in at least 25% of those of reproductive age [24-26]. Abnormal menstrual bleeding, pelvic pain, and infertility are the most commonly experienced symptoms in these women. Uterine fibroids are the leading cause of hysterectomies performed in the United States, accounting for over 200,000 of these procedures each year. Other invasive surgical interventions for the treatment of uterine fibroids include myomectomy and uterine artery embolization. Leiomyomas are estrogen-responsive tumors that can be treated... 

Significant adverse reactions include edema vaginitis nervousness emotional lability hepatic dysfunction elevated blood pressure pelvic pain carpal tunnel syndrome sleep disorders fatigue tremor visual disturbances anxiety depression gastroenteritis. 

Pelvic pain, retained placenta, severe genital bleeding, shock, fetal bradycardia, and fetal and maternal death have been reported. 

The idea of reduced adrenal capacity as a possible model for PTSD has also been recently raised by Heim et ah, who concluded that low cortisol may not be a unique feature of PTSD, but may represent a more universal phenomenon related to bodily disorders, having an etiology related to chronic stress (Heim et al. 2000). There are numerous stress-related disorders such as chronic fatigue syndrome, fibromyalgia, rheumatoid arthritis, chronic pain syndromes, and other disorders that are characterized by hypocortisolism. In one study, Heim et al. showed decreased cortisol responses to low-dose DEX, but failed to observe blunted ACTH responses to CRF in women with chronic pelvic pain, some of whom had PTSD, compared to women with infertility (Heim et al. 1998). Since the data were not analyzed on the basis of the subgroup with and without trauma and/or PTSD, it is not possible to directly compare results of that study to other reports examining PTSD directly. 

Heim C, Ehlert U, Rexhausen J, Hanker JP, Hellhammer DH (1998) Abuse-related post-traumatic stress disorder and alterations of the hypothalamic-pituitary-adrenal axis in women with chronic pelvic pain. Psychosom Med 60 309-318 Heim C, Ehlert U, Hellhammer DH (2000) The potential role of hypocortisolism in the pathophysiology of stress-related bodily disorders. Psychoneuroendocrinology 25 1 -35 Heim C, Newport DJ, BonsaU R, MiUer AH, Nemeroff CB (2001) Altered pituitary-adrenal axis responses to provocative challenge tests in adult survivors of childhood abuse. Am J Psychiatry 158 575-581... 

A 62-year-old man with a history of benign hypertrophic prostate (BPH) has deep pelvic pain and a low-grade fever. He has a history of chronic bilateral osteoarthritis of the knees and was recently diagnosed with diet-controllable diabetes mellitus. The patient denies any drug allergy but is an active smoker and drinks three or four cans of beers daily. 

Endometriosis is abnormal growth of endometrial tissue in the peritoneal cavity. Women with this disorder have dysmenorrhea, dyspareunia, chronic pelvic pain, and infertility. Danazol (Danocrine) is a 2,3-isoxazol derivative of 17a-ethynyl testosterone (ethisterone) that has weak virilizing and protein anabolic properties. It is effective in endometriosis through its negative feedback... 

Category III prostatitis/chronic pelvic pain syndrome. Extract, administered to men 24 to 58 years old (mean age 43.2), diagnosed with category III prostatitis (CP)/ chronic pelvic pain syndrome (CPPS), at a dose of 325 mg daily for 1 year, produced no appreciable long-term improvement. There was a decrease of mean total National Institutes of Health Chronic Prostatitis Symptom Index score from from 24.7 to 24.6 in the saw palmetto arm (p = 0.41). There were three cases of headache in the saw palmetto group. At the end of the trial, 13 of 32... 

SR050 Kaplan, S. A., M. A. Volpe, and A. E. SR059 Te. A prospective, 1-year trial using saw palmetto versus finasteride in the treatment of category III prostatitis/ chronic pelvic pain syndrome. J Urol 2004 171(1) 284-288. 

Constipation, abdominal pain, anorexia, bone pain, pharyngitis, dizziness, rash, dry mouth, peripheral edema, pelvic pain, depression, chest pain, paresthesia... 

Soreness, swelling, pelvic pain, or cramping rarely occurs. 

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