Evaluation of hysteroscopic findings related to chronic pelvic pain (original) (raw)
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Evaluation of hysteroscopy as a complementary exam in the investigation of chronic pelvic pain
Journal of Health & Biological Sciences, 2013
Introduction: Chronic pelvic pain (CPP) is a difficult condition to identify and many disorders are correlated. This study investigates the role of hysteroscopy as a complementary exam in the diagnosis of CPP. Methods: One hundred ninety-one medical records of women with indication to perform a hysteroscopy and presented CPP were reviewed. Results: The analysis showed abnormalities in 99 patients. Of these, more than 70% presented conditions that could cause CPP. Cervical stenosis and findings suggestive of adenomyosis were the most frequent ocurrences. Conclusions: Hysteroscopy is useful to detect pathological conditions of the cervix and uterine cavity that may coexist with chronic pelvic pain.
Focus on Primary Care: Chronic Pelvic Pain in Women
Obstetrical & Gynecological Survey, 2001
Chronic pelvic pain (CPP) is a major health problem. It is the reason for 10% of all outpatient visits to gynecologist as well as being responsible for approximately 40% of laparoscopies and 10% to 15% of hysterectomies. A significant number of patients have no obvious etiology for their pain at the time of laparoscopy. The condition may not be cured in a large number of patients. This is ultimately unsatisfying for both the patient and physician. Although CPP may not be curable, it can be managed so those patients attain normal or near-normal levels of functions. To identify and review the methods used for diagnosis and treatment of chronic pelvic pain in women, a MEDLINE and Cochrane systematic review search from 1980 to 2000 was performed to collect information and evidence on diagnosis and treatment of women suffering from chronic pelvic pain. Target Audience: Obstetricians & Gynecologists, Family Physicians Learning Objectives: After completion of this article, the reader will be able to define the entity of chronic pelvic pain, describe the anatomic pathways that transmit pelvic pain, and review the various treatment options for patients with chronic pelvic pain.
Role of Hysteroscopy in Gynecological Conditions
World Journal of Laparoscopic Surgery with DVD, 2014
Introduction: Hysteroscopy offers a valuable extension of the gynecologist armamentarium, as uterine cavity can be explored in detail for making exact diagnosis. Hysteroscopy can be used for diagnosis as well as management of various gynecological problems. A study was conducted to evaluate the role of hysteroscopy in gynecological conditions. Materials and methods: A prospective clinical study was conducted in the Department of Gynecology, Hindu Rao Hospital. Total 69 patients with abnormal uterine bleeding attending gynecology outpatient department were selected and subjected to hysteroscopic exami nation after detail history, examination and consent. Subjects were divided into six groups as per their history and examination. Observation: In group I (DUB) 40.5%, in group II (infertility) 21.7%, in group III (postmenopausal bleeding) 11.6%, in group IV (suspected leiomyoma) 11.6%, in group V (lost IUCD) 7.3% and in group VI (secondary amenorrhea) 7.3% patients were there. Abnormal hysteroscopic findings were observed as follows, in group I: 85.71%, group II: 80%, group III: 80%, group IV: 62.5%, group V: 60%, group VI: 60% had. Out of 69 patients, in 73.91% patient's intrauterine pathology was seen on hysteroscopic examination. In our study commonest cause of abnormal bleeding was endometrial hyperplasia (28.5%), endometrial polyp (18%), proliferative endometrium (28.59%), endocervical polyp (3.6%), submucous myoma (3.6%) and atrophic endometrium (3.6%) patients. In patients with lost IUCD, removal of IUCD was done and adhesionolysis was performed in patient with secondary amenorrhea. Conclusion: Hysteroscopy is simple, safe, quick, and economical technique which allows exploration of uterine cavity in precise manner with speed and safety. Diagnostic and operative procedures can be performed in the same time.
Incidence of Chronic Pelvic Pain in Females Attending a Gynaecology Outpatient Department
European medical journal, 2023
Background and Aims: Chronic pelvic pain (CPP) is a persistent pelvic pain that leads to reduced work performance and impaired quality of life in females. Nearly 15% of females report time off from paid work and around 45% report reduced work productivity. There is a paucity of studies to address the issue, especially with a multidisciplinary and multifactorial view. Various gynaecological disorders are associated with CPP such as endometriosis, adenomyosis, adhesions, chronic pelvic inflammatory disease, and pelvic congestion syndrome. The objective is to determine the frequency of CPP in females attending gynaecologic outpatient departments. Materials and Methods: A total of 201 patients aged 14-48 years attending the gynaecologic outpatient department for gynaecological disorders with complaints of lower abdominal pain were included in this study. Patients enrolled in the study were assessed by a detailed history and pelvic examination, and a structured questionnaire was filled out. Data were analysed using the statistical package for social sciences version 23.0 (International Business Machines Corporation, Armonk, New York, USA). Results: The mean age of the patients was 32.39±6.98 years. The frequency of CPP in females was observed as 95.52% (95% confidence interval: 91.67-97.93%) The rate of CPP was significantly high in females with parity ≤5 and those who had a duration of pain lower than 36 months. In multivariate analysis, adjusted odds ratio by stepwise logistic regression model showed that parity (parity 0-1) and duration of pain (≤36 months) were significantly associated with CPP in females. Conclusion: The study indicates that the most common gynaecological causes of CPP in females attending the outpatient department were those with endometriosis followed by adenomyosis. The management of CPP needs patient-centred care with a multidisciplinary approach. This will lead to early and effective management.
An odyssey through chronic pelvic pain in women
Frontiers in Women’s Health
The five common conditions encountered in patients with chronic pelvic pain (CPP) consist of endometriosis, interstitial cystitis, pelvic floor dysfunction, irritable bowel syndrome and pudendal nerve entrapment. The most unrecognised cause of CPP is the latter which affects only 4% of patients. A thorough work up of patient's pain is necessary prior to subjecting patients to any intervention including surgery as over 40% of gynaecological laparoscopies are performed for long standing pelvic pain. CPP is of multi-source origin which makes it difficult in formulating a plan of care for patients with this condition. If one source of the pain is detected, it is important to rule out other conditions that may also be contributing. All practitioners treating patients with CPP have to be knowledgeable about all of the potential causes of pelvic pain and addressing only the commonest cause like endometriosis is not adequate.
EDITORIAL COMMENT: We accepted this paper for publication because severe chronic pelvic pain, often with associated secondary dysmenorrhoea and dyspareunia, is a dificult gynaecological problem to deal with, and is not uncommon. The women are usually premenopausal and bimanual palpation of the uterus reproduces the pain they complain ofthe uterus seems tender but the explanation could be that described in this paper. In these women the uterus is freely mobile and there is no palpable adnexal pathology, and as noted by the author; laparoscopic findings are normal. It is widely believed that it is the ovaries and not the uterus (or the contents of its supporting ligaments) that are the cause of this syndrome, and when hysterectomy is contemplated, the question of whether to perform bilateral o0phorectom.y arises. Hysterectomy alone is often curative of pain in these patients (A) but the lesser procedure described here warrants consideration in patients with chronic severe pelvic pain. To establish that the proposed operation is effective, it would be necessary to perform a properly designed blinded randomized controlled trial, with the control women having a 'placebo 'operation (e.g. anaesthetic/sedation, local analgesia infiltration, incision of vagina without plicating the uterosacral ligaments). We believe that such a trial is feasible. (A) Hillis SD, Marchbanks PA, Peteeon HB. The effectiveness of hysterectomy for chronic pelvic pain. Obstet Gynecol 1995; 86:941-945.
Chronic female pelvic pain--part 1: clinical pathoanatomy and examination of the pelvic region
Pain practice : the official journal of World Institute of Pain, 2012
Chronic pelvic pain is defined as the presence of pain in the pelvic girdle region for over a 6-month period and can arise from the gynecologic, urologic, gastrointestinal, and musculoskeletal systems. As 15% of women experience pelvic pain at some time in their lives with yearly direct medical costs estimated at $2.8 billion, effective evaluation and management strategies of this condition are necessary. This merits a thorough discussion of a systematic approach to the evaluation of chronic pelvic pain conditions, including a careful history-taking and clinical examination. The challenge of accurately diagnosing chronic pelvic pain resides in the degree of peripheral and central sensitization of the nervous system associated with the chronicity of the symptoms, as well as the potential influence of the affective and biopsychosocial factors on symptom development as persistence. Once the musculoskeletal origin of the symptoms is identified, a clinical examination schema that is base...
Indications of diagnostic hysteroscopy, a brief review of the literature
Gynecological Surgery, 2012
Plenty of authors propose outpatient hysteroscopy as the gold standard diagnostic method for the evaluation of endometrial pathology. This statement has been strengthened in the recent years due to the wide use of smaller diameter hysteroscopic devices, which have made the dilation of the cervix and the use of anesthesia unnecessary. The main purpose of this paper is to summarize the indications of diagnostic hysteroscopy. In this review, we used the most recent publications in MEDLINE and Cochrane Library in order to specify the indications of diagnostic hysteroscopy and the experience that have been obtained till today in the management of certain pathological uterine conditions. The key words we used were diagnostic hysteroscopy, abnormal uterine bleeding, infertility, endometrial cancer. Hysteroscopy provides an accurate method of evaluation and direct visualization of the endometrial cavity and moreover directed biopsy and sampling of suspected lesions. Last years with the continuous development in the hysteroscopy devices, plenty of women benefit surgical hysteroscopy techniques for uterine abnormalities. Hysteroscopy is useful for the diagnosis in patients with abnormal uterine bleeding, with endometrial cancer and in infertile women. Hysteroscopy has the unique advantage of combining a thorough procedure with great diagnostic accuracy. The only disadvantage is that hysteroscopy requires specific teaching and training and has a long learning curve.
Chronic pelvic pain in women of reproductive and post-reproductive age: a population-based study
European Journal of Pain, 2016
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Abnormal uterine bleeding is a frequent condition that can negatively affect the physical, emotional, sexual and professional aspects of women, reducing their quality of life and can lead to anemia. It is necessary to be aware of when patients have severe and acute bleeding, they need urgent treatment, with volumetric replacement and hemostatic substances. Often, situations arise that require prolonged treatment and others in which surgical treatment is necessary. Called endometrial ablation whose surgical technique is capable of destroying or resecting the endometrium, indicated in cases of abnormal uterine bleeding without improving with clinical treatment or with contraindication to it. It is an alternative to hysterectomy in the treatment of benign pathologies, being less invasive and less aggressive, with less morbidity and mortality and with considerable cost reduction. Objective: This study aims to analyze the main indications and procedures used for the study of varieties of pathologies diagnosed by hysteroscopy performed in service between the years 2019 and 2020. Methodology : This is a bibliographic, qualitative and descriptive review that will be carried out through books, reading and analysis of national and international scientific articles, course completion works through consultations in the electronic databases, Pubmed, Virtual Health Library, including electronic journals specialized in the area. For this, this research was divided into two moments that refer: the bibliographic research and case study, using the data collection technique through the results obtained from the patients' exams. Results: The results attested that the presence of endometrial polyps, followed by the atrophic endometrium, integrated the most frequent histological and hysteroscopic diagnoses. Polyps and functional endometrium prevailed in younger patients, while in older women, polyps and endometrial atrophy predominated, both through hysteroscopy and endometrial histology.