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Query: UMLS:C0030794 (pelvic pain)
 4,056 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Physicians recruited 6 women aged 17-40 years with cyclic pelvic pain due to endometriosis for a prospective open trial conducted at the Clinical Research Center in San Diego, California. They wanted to assess endocrine and clinical responses to daily administration of 100 mg/d of RU-486 for 3 months. They all experienced amenorrhea during treatment. Moreover, urinary ovarian steroid metabolites were acyclic indicating anovulation. Mean luteinizing hormone (LH; p.02) and LH pulse (p.05) amplitude increased after treatment with RU-486, yet the LH pulse frequency did not change. Further, serum cortisol (p.01) and adrenocorticotropic hormone (p.05) also increased indicating that RU- 486 had an antiglucocorticoid effect. Menstrual cyclicity returned immediately after terminating treatment. 2 patients even became pregnant. Further, all patients reported less pelvic pain during treatment yet the extent of endometriosis did not improve. Indeed most received alternative treatment for endometriosis prior to enrollment in this study with no reduction in pain. The researchers could not determine the mechanism of pain relief or chronic anovulation, however. Further studies using lower doses and longer term therapy with RU-486 in patients with endometriosis are needed.
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PMID:Endocrine responses to long-term administration of the antiprogesterone RU486 in patients with pelvic endometriosis. 171 96

Endometriosis is one of the most common conditions encountered in gynecology and the field of infertility. The clinical presentation depends on the location and the extent of disease, but the severity of symptoms does not correlate directly with the extent of disease. Symptoms of genital endometriosis may be categorized as menstrual dysfunction, ovulatory dysfunction, and reproductive dysfunction. With menstrual dysfunction, the frequent clinical symptoms are cyclic pelvic pain, dysmenorrhea, and dyspareunia. Endometriosis is commonly found to be the cause in younger patients with pain and dysmenorrhea, particularly when the clinician is aware of the appearance of atypical lesions. Types of ovulatory dysfunction reported to be associated with endometriosis include anovulation, premenstrual spotting, luteal phase defects, and LUF syndrome. The data are not sufficient to determine the prevalence of endometriosis, luteal phase defects, and hyperprolactinemia. With LUF syndrome, there are data to support an association, but more data on the frequency of LUF in consecutive normal cycles compared to consecutive cycles in women with endometriosis would be beneficial. A higher rate of infertility is reported in couples with endometriosis. Two approaches are used to evaluate spontaneous abortions and endometriosis. In retrospective studies, the abortion rates are higher in couples with endometriosis; however, when the pregnancy outcomes in untreated couples are studied, there is less evidence to support the association of a higher spontaneous abortion rate. Formerly, the diagnosis of endometriosis depended on the appearance of typical lesions. With the recognition of early or atypical lesions the histologic confirmation of glands and stroma is assuming a more prominent role. Noninvasive techniques such as assays of endometrial antibodies or CA-125 have certain limitations in terms of producing false-positive results and lacking predictability in early stages of disease. Ultrasonography and MRI give additional and confirmatory information. Most noninvasive techniques are ancillary in diagnosis and management. It still needs to be determined whether their routine use will give enough added information to justify their cost. Currently, the diagnosis of endometriosis is best made by histologic evidence of glands and stroma.
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PMID:Clinical presentation and diagnosis of endometriosis. 266 21

In the absence of a precise definition, the terms "ovarian dystrophy" are often erroneously used. Therefore we propose a more modern terminology which allows to distinguish two types of ovarian follicle pathology: the microfollicular disease results from a follicular arrest of maturation, leading to an accumulation of immature microfollicles in the ovarian cortex. The clinical correlate is anovulation. This disease encompasses two aetiologic entities: polycystic ovarian disease (PCO) and the multifollicular ovaries (MFO), which were previously gathered under the label of "endocrinal ovarian dystrophy"; the macrofollicular disease results from the excessive growth of one or several follicles with or without luteinisation. Its clinical correlate is pelvic pain. It includes three main aetiologies: macropolycystic ovaries, functional cysts and LUF syndrome. These could also be termed "mechanical or local dystrophy". This new classification allows to consider two distinct anatomical entities which represent the whole of functional ovarian pathology.
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PMID:[Polycystic ovaries: an imprecise ultrasonographic definition]. 762 85

In Sweden, clinicians took blood samples every other day during one menstrual cycle from 12 healthy women aged 19-42 taking no medication and during a second menstrual cycle from 9 of these women while using a combined oral contraceptive (OC) (150 mcg desogestrel + 30 mcg ethinyl estradiol). They also took samples from a second group of 7 women, 26-42 years old, with a long history of posterior pelvic pains and symptoms in the lower lumbar region during 2 consecutive menstrual cycles. The 7 women did not use OCs but did take paracetamol. The researchers aimed to measure the serum relaxin levels in all the women to determine whether OCs inhibit relaxin secretion and to determine whether changes in relaxin secretion causes posterior pelvic pain. 7 of the 12 healthy women had detectable levels of relaxin during either the follicular or luteal phases or both phases of the menstrual cycle. Relaxin secreted during both phases suggests that the corpus luteum is not the only source of relaxin in nonpregnant women, as commonly believed. As estradiol levels increased so did the relaxin levels (r = 0.44; p 0.05). During OC use, 6 of the 9 women had detectable levels of relaxin. The mean relaxin levels were higher during OC use than during the non-OC cycle (range, 20-255 vs. 20-135 ng/l), except during days 26-32. In fact, the number of relaxin measurements above the detection limit (20 ng/l) during OC use (i.e., anovulation) was much higher than during the normal ovulatory cycle (40 vs. 20; p 0.001). It appears that relaxin secretion does not depend on ovulation. The positive correlation between estradiol and relaxin levels and the increased relaxin levels during OC use suggests that estradiol and ethinyl estradiol regulate relaxin synthesis. All 7 women with posterior pelvic pain had detectable serum relaxin levels. They had detectable relaxin levels significantly more often than did healthy women (p 0.001). Further research is needed to understand the pathophysiological role of relaxin in lower back pain.
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PMID:Serum levels of relaxin during the menstrual cycle and oral contraceptive use. 778 17

The levonorgestrel intrauterine system (LNG-IUS) is an underused contraceptive method in adolescent populations. In addition to being a highly effective, reversible, long-acting contraception, the LNG-IUS has many noncontraceptive health benefits including reduced menstrual bleeding, decreased dysmenorrhea and pelvic pain related to endometriosis, and menstruation suppression in teens with physical or developmental disabilities. The LNG-IUS can also provide endometrial protection in teens with chronic anovulation, and may be used to treat endometrial hyperplasia and cancer. This review examines the evidence supporting the use of the LNG-IUS in adolescents for these noncontraceptive benefits.
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PMID:Use of levonorgestrel intrauterine system for medical indications in adolescents. 2353 58