Pelvic Pain Arising from Endometriosis

In: Management of Chronic Pelvic Pain · 2021 · pp. 85–97 · doi:10.1017/9781108877084.009 · W3134479166
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Endometriosis, a common cause of pelvic pain, is surgically diagnosed and inadequately treated medically, with surgical resection offering temporary relief and potential recurrence.

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This chapter in a practical manual addresses pelvic pain arising from endometriosis within a broader framework of chronic pelvic pain management, using high-level synthesis of diagnostic and treatment considerations rather than original experimental data. It states that endometriosis is most accurately diagnosed surgically with tissue biopsy, and that medical therapies commonly depend on creating a hypoestrogenic state that provides temporary relief with symptom return after discontinuation. The chapter further emphasizes that skilled surgical resection can be effective but recurrence is likely within a few years, that deep infiltrating endometriosis often requires highly knowledgeable surgeons or specialized centers, and that additional procedures like presacral neurectomy are controversial. It also notes that meticulous removal of ovarian endometriomas is important in infertility and many pelvic pain patients because simple drainage can lead to rapid return of the endometrioma. This paper is centrally about endometriosis — it is a chapter focused on pelvic pain arising from endometriosis.

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Abstract

Endometriosis is the most common gynecological condition leading to pelvic pain and often it is the only one recognized by gynecologists. In many cases it coexists with pelvic floor muscle spasm, interstitial cystitis/bladder pain syndrome and irritable bowel syndrome and often all four are called “evil quadruplets.” Endometriosis can be diagnosed only surgically, and pathology confirmed tissue biopsy is by far the most accurate way of diagnosis. Unfortunately, all medical treatments of endometriosis are quite inadequate because they all rely on causing a hypoestrogenic state that only provides temporary relief of pain, and soon after medication is discontinued, symptoms return. Development of drugs addressing the cause of the disease is currently not possible because the cause of the disease is known. Multiple existing theories fail to explain all the cases, leading to the possibility that different etiologies may lead to a presence of endometrial glands and stroma in the peritoneal cavity and outside. Surgical resection of endometriosis in skilled hands is effective but patients need to be warned that disease will most likely return within a few years of initial surgery. Deep infiltrating endometriosis requires a very knowledgeable surgeon and often specialized center for treatment. Additional procedures such as presacral neurectomy, although controversial and potentially risky, may alleviate dysmenorrhea symptoms in some patients. Meticulous removal of ovarian endometriomas is a must in all infertility patients and most pelvic pain patients as simple drainage will result in almost immediate return of endometrioma.
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Management of Chronic Pelvic Pain Buy print or eBook [Opens in a new window] A Practical Manual - Management of Chronic Pelvic Pain - Management of Chronic Pelvic Pain - Copyright page - Contents - Contributors - Foreword - Chapter 1 Introduction to Chronic Pelvic Pain - Chapter 2 Neurobiological Basis of Pelvic Pain - Chapter 3 History and Evaluation of Patients with Chronic Pelvic Pain - Chapter 4 Psychological Assessment of a Female Patient with Chronic Pelvic Pain - Chapter 5 Musculoskeletal Assessment for Patients with Pelvic Pain - Chapter 6 Pharmacological Management of Patients with Pelvic Pain - Chapter 7 Evidence for Surgery for Pelvic Pain - Chapter 8 Pelvic Pain Arising from Endometriosis - Chapter 9 Bladder Pain Syndrome - Chapter 10 Pelvic Pain Arising from Pelvic Congestion Syndrome - Chapter 11 Irritable Bowel Syndrome - Chapter 12 Vulvodynia - Chapter 13 Pelvic Pain Arising from Adhesive Disease - Chapter 14 Pelvic Pain Arising from Ovarian Remnant Syndrome - Chapter 15 Pudendal Neuralgia - Chapter 16 Other Peripheral Pelvic Neuralgias - Chapter 17 Chronic Pain After Gynecological Surgery - Chapter 18 Pain Arising from Pelvic Mesh Implants - Chapter 19 Treatment of Sexual Dysfunction Arising from Chronic Pelvic Pain - Chapter 20 Physical Therapy Interventions for Musculoskeletal Impairments in Pelvic Pain - Chapter 21 If Everything Else Fails - Index - References Published online by Cambridge University Press: 08 March 2021 Edited by Book contents - Management of Chronic Pelvic Pain - Management of Chronic Pelvic Pain - Copyright page - Contents - Contributors - Foreword - Chapter 1 Introduction to Chronic Pelvic Pain - Chapter 2 Neurobiological Basis of Pelvic Pain - Chapter 3 History and Evaluation of Patients with Chronic Pelvic Pain - Chapter 4 Psychological Assessment of a Female Patient with Chronic Pelvic Pain - Chapter 5 Musculoskeletal Assessment for Patients with Pelvic Pain - Chapter 6 Pharmacological Management of Patients with Pelvic Pain - Chapter 7 Evidence for Surgery for Pelvic Pain - Chapter 8 Pelvic Pain Arising from Endometriosis - Chapter 9 Bladder Pain Syndrome - Chapter 10 Pelvic Pain Arising from Pelvic Congestion Syndrome - Chapter 11 Irritable Bowel Syndrome - Chapter 12 Vulvodynia - Chapter 13 Pelvic Pain Arising from Adhesive Disease - Chapter 14 Pelvic Pain Arising from Ovarian Remnant Syndrome - Chapter 15 Pudendal Neuralgia - Chapter 16 Other Peripheral Pelvic Neuralgias - Chapter 17 Chronic Pain After Gynecological Surgery - Chapter 18 Pain Arising from Pelvic Mesh Implants - Chapter 19 Treatment of Sexual Dysfunction Arising from Chronic Pelvic Pain - Chapter 20 Physical Therapy Interventions for Musculoskeletal Impairments in Pelvic Pain - Chapter 21 If Everything Else Fails - Index - References Endometriosis is the most common gynecological condition leading to pelvic pain and often it is the only one recognized by gynecologists. In many cases it coexists with pelvic floor muscle spasm, interstitial cystitis/bladder pain syndrome and irritable bowel syndrome and often all four are called “evil quadruplets.” Endometriosis can be diagnosed only surgically, and pathology confirmed tissue biopsy is by far the most accurate way of diagnosis. Unfortunately, all medical treatments of endometriosis are quite inadequate because they all rely on causing a hypoestrogenic state that only provides temporary relief of pain, and soon after medication is discontinued, symptoms return. Development of drugs addressing the cause of the disease is currently not possible because the cause of the disease is known. Multiple existing theories fail to explain all the cases, leading to the possibility that different etiologies may lead to a presence of endometrial glands and stroma in the peritoneal cavity and outside. Surgical resection of endometriosis in skilled hands is effective but patients need to be warned that disease will most likely return within a few years of initial surgery. Deep infiltrating endometriosis requires a very knowledgeable surgeon and often specialized center for treatment. Additional procedures such as presacral neurectomy, although controversial and potentially risky, may alleviate dysmenorrhea symptoms in some patients. Meticulous removal of ovarian endometriomas is a must in all infertility patients and most pelvic pain patients as simple drainage will result in almost immediate return of endometrioma. - Type - Chapter - Information - Management of Chronic Pelvic PainA Practical Manual, pp. 85 - 97Publisher: Cambridge University PressPrint publication year: 2021 Carter, JE. Laparoscopic treatment for chronic pelvic pain: results from three-year follow-up. J Am Assoc Gynecol Laparosc. 1994;1(4, Part 2):S6–7.Google Scholar Eskenazi, B, Warner, ML. 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Fertil Steril. 2010;93(1):52–6.Google Scholar Dunselman, GA, Vermeulen, N, Becker, C, Calhaz-Jorge, C, D’Hooghe, T, De Bie, B, ; European Society of Human Reproduction and Embryology. ESHRE guideline: management of women with endometriosis. Hum Reprod. 2014;29(3):400–12.CrossRefGoogle ScholarPubMed Moulder, JK, Siedhoff, MT, Melvin, KL, Jarvis, EG, Hobbs, KA, Garrett, J.I. Risk of appendiceal endometriosis among women with deep-infiltrating endometriosis. nt J Gynaecol Obstet. 2017;139(2):149–54.Google ScholarPubMed Knabben, L, Imboden, S, Fellmann, B, Nirgianakis, K, Kuhn, A, Mueller, MD. Urinary tract endometriosis in patients with deep infiltrating endometriosis: prevalence, symptoms, management, and proposal for a new clinical classification. Fertil Steril. 2015;103(1):147–52.CrossRefGoogle ScholarPubMed Maccagnano, C, Pellucchi, F, Rocchini, L, et al. Ureteral endometriosis: proposal for a diagnostic and therapeutic algorithm with a review of the literature. Urol Int. 2013;91:1–9.CrossRefGoogle ScholarPubMed Yildirim, D, Tatar, C, Doğan, O, et al. Post cesarean scar endometriosis. Turk J Obstet Gynecol. 2018;15:33–8.Google Scholar Accessibility compliance for the HTML of this chapter is currently unknown and may be updated in the future. To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle. Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply. Find out more about the Kindle Personal Document Service. - Pelvic Pain Arising from Endometriosis - - Book: Management of Chronic Pelvic Pain - Online publication: 08 March 2021 To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox. - Pelvic Pain Arising from Endometriosis - - Book: Management of Chronic Pelvic Pain - Online publication: 08 March 2021 To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive. - Pelvic Pain Arising from Endometriosis - - Book: Management of Chronic Pelvic Pain - Online publication: 08 March 2021

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endometriosisdie_deep_infiltratingendometriomadysmenorrheainterstitial_cystitisirritable_bowel_syndromeinfertility

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