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Gynecology

Pelvic Pain | Endometriosis

Gynecology

Pelvic Pain | Endometriosis

Chronic Pelvic Pain

Chronic Pelvic Pain – defined as pain originating below the belly button and lasting more then 6 months – can deeply impact patient’s lives. So, diagnosing the cause is key to improving your life and health. The leading cause of chronic pelvic pain is a condition called Endometriosis.

Endometriosis

Endometriosis is an often painful and frustrating condition where the tissue which lines the uterus – know as the endometrium- begins to grow outside in the abdominal cavity often involving the ovaries, bowel and pelvic lining.

The endometrium is the tissue which responds to an individual’s hormonal cycles and fills with blood then sheds it through the cervix during menstrual cycle. When endometrial tissue that is outside the uterus tried to shed this blood it becomes trapped in the tissue can causes sever pain and abscesses.

 

Common signs and symptoms of endometriosis include:

  • Painful periods (dysmenorrhea). Pelvic pain and cramping may begin before and extend several days into a menstrual period. You may also have lower back and abdominal pain.
  • Pain with intercourse. Pain during or after sex is common with endometriosis.
  • Pain with bowel movements or urination. You’re most likely to experience these symptoms during a menstrual period.
  • Excessive bleeding. You may experience occasional heavy menstrual periods or bleeding between periods (intermenstrual bleeding).
  • Infertility. Sometimes, endometriosis is first diagnosed in those seeking treatment for infertility.
  • Other signs and symptoms. You may experience fatigue, diarrhea, constipation, bloating or nausea, especially during menstrual periods.

The severity of your pain isn’t necessarily a reliable indicator of the extent of the condition. You could have mild endometriosis with severe pain, or you could have advanced endometriosis with little or no pain.

Endometriosis is sometimes mistaken for other conditions that can cause pelvic pain, such as pelvic inflammatory disease (PID) or ovarian cysts. It may be confused with irritable bowel syndrome (IBS), a condition that causes bouts of diarrhea, constipation and abdominal cramping. IBS can accompany endometriosis, which can complicate the diagnosis.

Several factors place you at greater risk of developing endometriosis, such as:[iii]

  • Never giving birth
  • Starting your period at an early age
  • Going through menopause at an older age
  • Short menstrual cycles — for instance, less than 27 days
  • Heavy menstrual periods that last longer than seven days
  • Having higher levels of estrogen in your body or a greater lifetime exposure to estrogen your body produces
  • Low body mass index
  • One or more relatives (mother, aunt or sister) with endometriosis
  • Any medical condition that prevents the normal passage of menstrual flow out of the body
  • Reproductive tract abnormalities

Be prepared when you go into your GYN’s office to discuss the type and location of the pain you are experiencing. This will help them eliminate other causes of your pelvic pain.

If your symptoms fit Endometriosis there are a number of tests that doctor may order to try and diagnose the condition and determine the best course of treatment: [iv]

  • Pelvic exam. During a pelvic exam, your doctor manually feels (palpates) areas in your pelvis for abnormalities, such as cysts on your reproductive organs or scars behind your uterus. Often it’s not possible to feel small areas of endometriosis unless they’ve caused a cyst to form.
  • Ultrasound. This test uses high-frequency sound waves to create images of the inside of your body. To capture the images, a device called a transducer is either pressed against your abdomen or inserted into your vagina (transvaginal ultrasound). Both types of ultrasound may be done to get the best view of the reproductive organs. A standard ultrasound imaging test won’t definitively tell your doctor whether you have endometriosis, but it can identify cysts associated with endometriosis (endometriomas).
  • Magnetic resonance imaging (MRI). An MRI is an exam that uses a magnetic field and radio waves to create detailed images of the organs and tissues within your body. For some, an MRI helps with surgical planning, giving your surgeon detailed information about the location and size of endometrial implants.
  • Laparoscopy. In some cases, your doctor may refer you to a surgeon for a procedure that allows the surgeon to view inside your abdomen (laparoscopy). While you’re under general anesthesia, your surgeon makes a tiny incision near your navel and inserts a slender viewing instrument (laparoscope), looking for signs of endometrial tissue outside the uterus.

    For a laparoscopy patients normally have a small does of general anesthetic so that they sleep through the procedure. Using a special needle, your surgeon expands your abdomen with a harmless gas so that the reproductive organs are easier to see. By making a small incision in the bellybutton the doctor inserts a tiny camera. By moving the laparoscope around, your surgeon can view the pelvic and other abdominal organs, looking for signs of endometrial tissue outside the uterus.

    If you have endometriosis, laparoscopy will provide you and your doctor with information about the location, extent and size of the endometrial buildup. This will allow you to make a definitive plan to treat your condition effectively.

    You and your doctor will discuss what treatments might be most helpful if you are diagnosed with endometriosis. Every case is different and so every treatment plan will vary according to your conditions and concerns. However, there are three main approaches to treating this condition.[v]

    Pain Medication: The most basic approach to endometriosis is to treat the symptoms with pain medication. Many over the counter medications which are commonly used for regular menstrual discomfort can ease the pain associate with endometriosis, however if this does not work then other approaches may be better for you.

    Hormone Therapies: There are a number of different hormonal therapies which have been found to slow or stop endometriosis. Medications which control or block estrogen levels or the production of ovarian stimulating hormones can be an effective treatment in some cases. Oral contraceptives, Depo provera, Gn- RH antagonists and agonists or Danazol may be recommended depending on your medical history. These medications work in different ways to reduce the stimulation and production of endometrial cells which will help reduce symptoms. These treatments do not cure endometriosis – but they do help control symptoms.

    Surgical Interventions: Conservative approaches to surgical treatment of Endometriosis are generally done through Laparoscopic surgery to remove cysts, adhesions and build up of endometrial tissue outside of the uterus. This is usually recommended for patients who wish to become pregnant because it preserves the uterus, fallopian tubes and ovaries. More radical approaches to surgical intervention would be a total hysterectomy – or removal of the uterus, cervix and ovaries. By removing the reproductive system – particularly both ovaries – the hormonal cycle which cause endometrial pain is also stopped. This is will cure the condition but is usually the last resort because after this procedure the patient will no longer be able to have children.

    Pelvic Inflammatory Disease

    Pelvic Inflammatory Disease (PID) is one of the more serious reasons that patients may experience Chronic Pelvic Pain.

    What is PID? According to the Center for Disease Control and Prevention (CDC), Pelvic Inflammatory Disease (PID) is a clinical syndrome that results from the ascension of microorganisms from the cervix and vagina to the upper genital tract. PID can lead to infertility and permanent damage of a woman’s reproductive organs.

    Signs and symptoms of pelvic inflammatory disease might include:

    • Pain in your lower abdomen and pelvis
    • Heavy vaginal discharge with an unpleasant odor
    • Abnormal uterine bleeding, especially during or after intercourse, or between menstrual cycles
    • Pain or bleeding during intercourse
    • Fever, sometimes with chills
    • Painful or difficult urination

    PID might cause only mild signs and symptoms or none at all. When severe, PID might cause fever, chills, severe lower abdominal or pelvic pain — especially during a pelvic exam — and bowel discomfort.

    Signs and symptoms of pelvic inflammatory disease might include:

    • Pain in your lower abdomen and pelvis
    • Heavy vaginal discharge with an unpleasant odor
    • Abnormal uterine bleeding, especially during or after intercourse, or between menstrual cycles
    • Pain or bleeding during intercourse
    • Fever, sometimes with chills
    • Painful or difficult urination

    PID might cause only mild signs and symptoms or none at all. When severe, PID might cause fever, chills, severe lower abdominal or pelvic pain — especially during a pelvic exam — and bowel discomfort.

    [iii]

    There are no tests for PID. A diagnosis is usually based on a combination of your medical history, physical exam, and other test results. You may not realize you have PID because your symptoms may be mild, or you may not experience any symptoms. However, if you do have symptoms, you may notice

    • Pain in your lower abdomen;
    • Fever;
    • An unusual discharge with a bad odor from your vagina;
    • Pain and/or bleeding when you have sex;
    • Burning sensation when you urinate; or
    • Bleeding between periods.

    [vi]

    Yes, if PID is diagnosed early, it can be treated. However, treatment won’t undo any damage that has already happened to your reproductive system. The longer you wait to get treated, the more likely it is that you will have complications from PID. While taking antibiotics, your symptoms may go away before the infection is cured. Even if symptoms go away, you should finish taking all of your medicine. Be sure to tell your recent sex partner(s), so they can get tested and treated for STDs, too. It is also very important that you and your partner both finish your treatment before having any kind of sex so that you don’t re-infect each other.

    You can get PID again if you get infected with an STD again. Also, if you have had PID before, you have a higher chance of getting it again.

    [vii] 

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