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

Adenomyosis was present in 161 of 1619 consecutive hysterectomy specimens. Adenomyosis coexisted with other pelvic pathology in 97 women and was the only histologic finding in 64 women. Most patients were 35 to 50 years of age, parous, white, had not taken steroid hormones, had not had uterine surgery, and complained of abnormal uterine bleeding and/or pelvic pain. Adenomyosis was most associated with leiomyomata, endometrial hyperplasia and carcinoma, and endometriosis. The clinical signs of uterine enlargement and tenderness were rarely observed. The diagnosis was suspected preoperatively in 10% of women. At surgery, adenomyosis was not recognized in 65% of patients. Adenomyosis is a disease of unknown etiology whose uncharacteristic clinical profile and frequent association with more obvious pelvic pathology make it a neglected diagnosis.
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PMID:Adenomyosis: a neglected diagnosis. 90 5

Few previous studies have examined the relationship between the preoperative and pathologic diagnoses for hysterectomy. To determine the percentage of preoperative diagnoses that were confirmed by pathologic examination, we analyzed data from the Collaborative Review of Sterilization, a multicenter study of hysterectomies and tubal sterilizations in women aged 15 to 44 years. Data were collected from patient interviews and chart reviews. Of the 1851 women included in this study, 1283 (69%) had abdominal hysterectomies and 568 (31%) had vaginal hysterectomies. Overall, 52% of the hysterectomies were performed for a preoperative diagnosis that could potentially be confirmed by pathologic examination. Pathologic examination actually confirmed the preoperative diagnosis of endometrial hyperplasia in 95% of the cases, cervical intraepithelial neoplasia in 89%, leiomyomas in 84%, pelvic inflammatory disease in 75%, adenomyosis in 48%, and endometriosis in 47%. Among all of the potentially confirmable diagnoses, 80% were confirmed. The remaining 48% of the women who had hysterectomies had preoperative diagnoses that were not amenable to confirmation by pathology. Most of these were for one of three diagnoses: menstrual bleeding disorders, pelvic pain, or pelvic relaxation. In 47% of these cases, pathologic examination showed leiomyoma or adenomyosis; no abnormalities were found in 38% of these cases.
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PMID:Confirmation of the preoperative diagnoses for hysterectomy. 648 93

We analysed the indications to myomectomy in females in reproductive age and estimated efficasy of this treatment. 112 patients aged 23-45 were analysed. Most common indication to this procedure were: menorrhagia--45.54%, myoma found at gynecological examination--21.43%, adnexal mass--20.54% and pelvic pain--15.18%. 54.46% patients were parous, 34.82% nulligravid and 10.72% had a history of spontaneous abortion. There was low percentage of intraoperation complications--2.67%, as well as postoperation complications--3.57%. More than 5 years follow-up revealed recurrent myoma in 14.28% females and in 6.25% hysterectomy was performed. Cervical polypus was found in 8.04%, endometrial hyperplasia in 2.68%. 18.75% patients had menorrhagia and 5.36% abdominal pain. Successful pregnancies have occurred in 42.11% infertile women prior to surgery but with patent fallopian tubes. Our study shows that myomectomy is safe and well accepted method of treatment for uterine myomas however always stands a risk of recurrents.
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PMID:[Surgical treatment of uterine myoma: need for surgery and long-term results]. 977 Aug 40

This article provides a perspective on the use of the levonorgestrel-releasing intrauterine system as a contraceptive method and as therapy in different situations, as well as presenting the corresponding controversies and unresolved issues. All studies have reported high contraceptive efficacy, an improvement in menstrual blood loss in women with idiopathic menorrhagia, menorrhagia due to thrombophilic diseases and fibroids, and excellent endometrial protection during postmenopausal estrogen therapy. Moreover, the device is able to reduce pelvic pain and dysmenorrhea as well as improve the staging of endometriosis and adenomyosis, and to control, albeit partially, endometrial hyperplasia. The expectation is that in years to come the number of hysterectomies and female sterilizations will fall due to increased use of the device, including use by patients with endometriosis and HIV-positive women. It would also be desirable to develop a smaller device for postmenopausal women and nulligravidas.
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PMID:Levonorgestrel-releasing intrauterine system: uses and controversies. 1857 44

Ovarian cancers are the most lethal gynecologic malignancies and are rarely diagnosed in their early stages. The most common of these tumors--serous papillary carcinoma--is generally asymptomatic in the early stages. Non serous carcinomas (endometrioid and clear-cell carcinomas) have a higher chance of early diagnosis, as the associated endometriosis can cause pelvic pain, while endometrial hyperplasia/neoplasia can lead to vaginal bleeding. In addition, serous papillary carcinomas tend to be bilateral with peritoneal involvement, while non serous papillary carcinomas are often unilateral. Non serous papillary carcinomas tend to occur in younger, hyperestrogenic, often infertile patients. Serous papillary carcinomas potentially arise from dysplastic epithelial cells lining the ovarian surface and inclusion cysts, while the substrate of non serous papillary tumors is atypical endometriotic tissue. Tumor markers also tend to differ between the two forms of ovarian cancer. Pelvic laparoscopy and prophylactic oophorectomy have offered new insights into the mechanisms and early stages of ovarian malignancies.
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PMID:[Stage I ovarian carcinoma: two distinct malignancies?]. 1866 67

The most frequent symptom with leiomyoma is menometrorrhagia. However, it can be responsible of pelvic pain, dysmenorrhea or urinary and digestive compression when it is particularly voluminous. These recommandations were made in order to review medical management of fibroids. If no therapy is able to have them disappear, various drugs may reduce their related symptoms. Tranexamic acid, non-steroidal anti-inflammatory drugs and high dose of oestrogen may be useful in the management of acute hemorrhagic disorders. Progestin, such as lynestrenol induces small reduction in leiomyoma volume and moderate increase in hemoglobin level before surgery. Pregnane and nor-pregnane may improve menstrual bleeding in short or mild delays. The use of Gonadotropin Releasing Hormone (GnRH) agonists can reduce menstrual bleeding with hemoglobin recovery. Add-back therapy using tibolone seems interesting since secondary effects encountered with GnRH agonists may be reduced. Levonorgestrel-releasing intrauterine system is proven to reduce increased menstrual bleeding and restore hemoglobin level. Aminoglutethimide and fadrozole have been underevaluated to conclude when letrozole seems as efficient as GnRH agonists to reduce leiomyoma volume and provide less hot flushes. Anastrozol is associated with reduction in leiomyomata volume, pain and menstrual bleeding. Mifepristone reduces the size of uterine leiomyomata, improves symptomatology, but could be associated with development of endometrial hyperplasia. SPRM evaluated in females have shown to improve leiomyoma related symptomatology. Danazol could be useful to reduce leiomyoma related symptoms in short terms. Tamoxifen and raloxifen show modest overall benefit. Because of insufficient data concerning fulvestrant, pirfenidone or interferon, their prescription cannot be recommended in patients with leiomyomata.
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PMID:[Role of medical treatment for symptomatic leiomyoma management in premenopausal women]. 2207 Oct 15

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

Endometriosis involving the mucosa of the intestines is rare, but may lead to diagnostic pitfalls. We reviewed 15 cases (seven biopsies and eight resections) from 14 patients. The patients' mean age is 48 years (31-66 years). Presenting symptoms included lower gastrointestinal bleeding, pelvic pain, rectal urgency, abdominal mass, and bowel obstruction. In the majority of cases, the lesion was located in the rectum (73%) with the remainder in the sigmoid colon (20%) and ileum (7%). The most common indication for biopsy was a polypoid lesion seen endoscopically (eight cases). For patients who underwent resections, the most common clinical impression was colonic carcinoma (75%), due to mass lesions and stricture as the most common macroscopic findings. Histologically, one case had stromal endometriosis only, but the remaining 14 cases had both endometrial glands and stroma. Epithelial metaplasia was present in all cases, mostly tubal metaplasia (ciliated epithelium). Hybrid glands and replacement of the surface epithelium by endometrial epithelium were also seen. Crypt architectural distortion, cryptitis, and crypt abscesses were seen in some cases, mimicking chronic active colitis or enteritis. A panel of immunohistochemical stains (CK7, CK20, CDX2, and ER) was found to be useful in biopsies with suspected endometriosis demonstrating unusual histology or only containing endometrioid stroma tissue. Vascular involvement by endometriosis was identified in one case. Endometrial hyperplasia (n=2) and cancer (n=1) were also seen in the ectopic tissue. All patients were alive at follow-up (3-216 months, mean 67 months).
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PMID:Endometriosis involving the mucosa of the intestinal tract: a clinicopathologic study of 15 cases. 2357 18

The most frequent symptom with leiomyoma is menometrorrhagia. However, it can be responsible of pelvic pain, dysmenorrhea or urinary and digestive compression when it is particularly voluminous. If no therapy is able to have them disappear, various drugs may reduce their related symptoms. Tranexamic acid, non-steroidal anti-inflammatory drugs and high dose of oestrogen may be useful in the management of acute hemorrhagic disorders. Progestin, such as lynestrenol induces small reduction in leiomyoma volume and moderate increase in hemoglobin level before surgery. Pregnane and nor-pregnane may improve menstrual bleeding in short or mild delays. The use of GnRH agonists can reduce menstrual bleeding with hemoglobin recovery. Add-back therapy using tibolone seems interesting since secondary effects encountered with GnRH agonists may be reduced. Levonorgestrel-releasing intrauterine system is proven to reduce increased menstrual bleeding and restore hemoglobin level. Aminoglutethimide and fadrozole have been underevaluated to conclude when letrozole seems as efficient as GnRH agonists to reduce leiomyoma volume and provide less hotflushes. Anastrozol is associated with reduction in leiomyomata volume, pain and menstrual bleeding. Mifepristone reduces the size of uterine leiomyomata, improves symptomatology, but could be associated with development of endometrial hyperplasia. SPRM evaluated in females have shown to improve leiomyoma related symptomatology. Ulipristal could be useful to reduce leiomyoma related symptoms in short terms.
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PMID:[Medical treatment of symptomatic uterine leiomyomata in premenopausal woman]. 2360 54

Although adolescent pregnancy and birth rates have been declining since the early 1990s, the rate of intrauterine device (IUD) use in adolescents remain low. IUDs are a highly effective contraceptive method with a failure rate of less than 1%. There are currently 5 IUDs available and marketed in the United States: the nonhormonal copper-containing IUD (Paragard Copper T380A; Ortho-McNeil) and 4 hormonal levonorgestrel-releasing intrauterine systems (LNG-IUDs). IUDs can be used in adolescents, and the LNG-IUD has many noncontraceptive benefits including the treatment of heavy menstrual bleeding, dysmenorrhea, pelvic pain/endometriosis, and endometrial hyperplasia/endometrial cancer. In addition, the LNG-IUD is an effective tool for suppression of menses.
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PMID:Intrauterine Devices: Effective Contraception with Noncontraceptive Benefits for Adolescents. 3158 15


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