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

Endometriosis is a common finding at laparoscopy. In order to make a correct diagnosis and institute appropriate management it is recommended that laparoscopy be performed on all patients with chronic pelvic pain and on most patients with infertility or acute pelvic pain.
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PMID:Incidence of endometriosis in diagnostic laparoscopy. 125 48

The aim of the paper was the analysis of 1450 laparoscopic procedures performed in the Clinic of Gynecology--IOG PMA in Szczecin in the years from 1974 to 1992. The above number include 320 laparoscopic operations. In the analyzed three five-year periods, the number of laparoscopies increased twofold, while in the years 1989-1992 it constituted 26.8% of all the operative procedures. Indication for laparoscopy in 74.6% of cases was sterility, in 13.38% pelvic pain of undefined etiology, in 7.7% ectopic pregnancy, 1.8% oncologic indications, in 0.5% internal ones, in 0.3% sterilization and others in 1.6%. Among operative laparoscopies electrocoagulation of endometriosis was carried out in 46.6% of cases, resection of intraperitoneal adhesions in 27.5%, in the region of abdominal orifices of oviducts in 7.5%, ectopic pregnancy operations in 7.2%, excision of ovarian cysts in 6.6% as well as extirpation of myomas in 4.7%. At the analyzed period the following complications were disclosed, namely: interstitial lesion in 2 cases, hemorrhage from inferior epigastric artery in 1 and subcutaneous emphysema in 34 cases.
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PMID:[Nineteen years of laparoscopy in the gynecology clinic IPG PAM]. 130 76

This case of postmenopausal endometrioma following hormonal replacement therapy (HRT) demonstrates the often forgotten possibility of reactivation of endometriosis with HRT. The diagnosis of endometriosis should be considered in a postmenopausal woman who presents with pelvic pain and mass whilst on HRT.
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PMID:Postmenopausal endometrioma and hormonal replacement therapy. 133 26

CA-125 levels in menstrual discharge were determined in 55 patients with chronic pelvic pain to evaluate whether this test would be useful in differentiating between pelvic pain due to endometriosis and other causes. Of the 28 women with endometriosis, 25 (89%) had CA-125 concentration greater than or equal to 72,000 units/ml. The frequencies of elevated levels in Stage I, Stage II and Stages III/IV were 85.7, 85.7 and 92.8%, respectively. When used for the detection of endometriosis, the test had a sensitivity of 89.3% and a specificity of 96.3%. These results suggest that CA-125 in menstrual discharge may be helpful in the evaluation of women with chronic pelvic pain.
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PMID:CA-125 in menstrual discharge in patients with chronic pelvic pain. 134 98

In the period 1988-1990 this prospective study of 33 women with moderate or severe endometriosis who underwent laparoscopy for infertility and/or chronic pelvic pain, was conducted to evaluate the efficacy of aspirating endometriotic cysts followed by administration of a gonadotropin releasing hormone (GnRH) agonist in reducing the size of ovarian endometriomas. The cysts (mean diameter, 4.5 cm; range, 2-7; unilateral, 21 cases; bilateral, 12 cases) were punctured, aspirated, washed and emptied completely. After laparoscopy, 15 subjects received goserelin administered as a 28-day subcutaneous depot for three months, whereas 18 patients undergoing simple observation constituted internal controls. Ultrasound scans were performed before and at one, three and six months after laparoscopy. One case and three controls requested surgery between the four- and five-month follow-up scans and did not complete the study. All the other women had recurrent cysts at the six-month scan. There were no significant differences in mean endometrioma diameter between the two groups at any observation time nor between prelaparoscopic and six-month ultrasound examinations within each treatment group. We conclude that aspiration and washing of endometriotic cysts, combined with postoperative administration of GnRH agonists or not, is ineffective.
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PMID:Laparoscopic aspiration of ovarian endometriomas. Effect with postoperative gonadotropin releasing hormone agonist treatment. 138 5

Uterine suspension has been advocated as an adjunctive procedure at the time of conservative surgery for endometriosis but has seldom been used at the time of CO2 laser laparoscopic treatment of endometriosis. In this study of 225 patients treated for cul-de-sac endometriosis by CO2 laser laparoscopy between 1984 and 1989 uterine suspension was performed as an adjunctive procedure at the time of laparoscopy. The result was a cumulative pregnancy rate of 80.0%. Life-table analysis was performed, and monthly fecundity rates were calculated as 15.58%, 6.29%, 17.86% and 7.89% for Revised American Fertility Society (RAFS) endometriosis stages I to IV respectively. CO2 laser laparoscopy and laparoscopic uterine suspension alleviated preoperative pelvic pain complaints in 94% of the patients. Monthly fecundity rates for RAFS stage I endometriosis, which exceeded previously reported rates following expectant management, medical management and conservative surgery, were attributed to laparoscopic uterine suspension, which had not been previously reported as an adjunct to CO2 laser laparoscopy.
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PMID:Laparoscopic uterine suspension as an adjunctive procedure at the time of laser laparoscopy for the treatment of endometriosis. 145 94

A national multicentre trial was organized in order to compare the efficacy and safety of leuprorelin acetate depot and danazol in the treatment of endometriosis. Sixty-seven patients with pelvic endometriosis of different severity at laparoscopy were included in the study and followed during the 24 weeks of treatment. Leuprorelin acetate depot 3.75 mg was injected every 24 days, while the daily dose of danazol was 600-800 mg. At the end of the study objective improvements induced by the two drugs were observed by a second laparoscopic examination. In addition, at regular intervals during the study semiquantitative evaluation of subjective symptoms were monitored. Scoring the final objective changes in the two patient groups revealed no significant difference, however the women treated with leuprorelin acetate depot registered significantly better control of pelvic pain. Due to its efficacy, tolerability and ease of use, leuprorelin acetate appears to be an excellent drug for the treatment of endometriosis.
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PMID:Leuprorelin acetate depot vs danazol in the treatment of endometriosis: results of an open multicentre trial. 153 20

During the past decade, the development of various gonadotrophin-releasing hormone (Gn-RH) agonists, which induce reversible hypo-oestrogenism has opened a new area in the medical management of endometriosis. In an open, multicentre phase III study, the efficacy, tolerance and safety of the Gn-RH agonist leuprorelin acetate were tested. The preliminary results of 104 women treated in seven German centres are presented. Pelvic endometriosis was diagnosed by laparoscopy and classified according to the American Fertility Society scoring system: 33% of patients had minimal, 22% mild, 28% moderate and 8% severe endometriosis and in 9% no pathological results were obtained. The patients' mean age was 30 +/- 6 years and 66 had infertility problems. Treatment was started within the first 3 days of the menstrual cycle and consisted of a subcutaneous injection of leuprorelin acetate 3.75 mg, repeated once monthly over 24 weeks. A follow-up period of 12 months after the last injection has been completed in 70 patients, including a second laparoscopy. At all visits, symptoms were evaluated, physical examinations performed, and blood samples collected for haematological screening, serum chemistry determinations and measurement of the gonadotrophins oestradiol and progesterone and leuprorelin acetate. The median score at laparoscopy fell from 12 before operation to 8 after operation and 2 after treatment with leuprorelin acetate. Of the total number of patients, 89% had improvements in their endometriosis, 8% a deterioration and 3% no change. Patients reported improvement in the following: dysmenorrhoea 93%, dyspareunia 62% and pelvic pain 70%. However, all women complained of at least one of the following symptoms: hot flushes 86%, sleep disturbance 62%, sweating 61%, headache 41%, nausea 32% and depression 20%. Fifty-five percent of patients reported additional side effects such as vaginal dryness, fatigue and lower abdominal pain. After the third injection, amenorrhoea persisted in 94% of the women. Four weeks after the first leuprorelin acetate injection median concentrations of oestradiol fell from 45 pg/ml to 11 pg/ml, follicle-stimulating hormone from 7 U/L to 3 U/L and luteinising hormone from 5 U/L to 1 U/L and remained almost unchanged over the observation period. During the 6 months' treatment, laboratory parameters showed no significant deviations from normal; only total cholesterol, high-density lipoprotein cholesterol and alkaline phosphatase increased. Treatment results were judged as good and satisfactory in 82% and 11% of cases, respectively. On the basis of this study, it can be concluded that leuprorelin acetate treatment is safe, well tolerated and effective in the medical management of endometriosis and endometriosis-related complaints.
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PMID:Treatment of endometriosis with leuprorelin acetate depot: a German multicentre study. 153 21

Endometriosis results in significant pelvic pain, dysmenorrhea, and infertility. Recognition of the signs and symptoms of endometriosis can result in early diagnosis and treatment. Management includes surgical intervention to debulk large lesions and pharmacologic therapy to produce a medical oophorectomy. Primary care physicians should suspect endometriosis in infertile patients with pelvic pain.
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PMID:Endometriosis. Diagnostic clues and new treatment options. 153 42

In women with recurrent pelvic pain caused by endometriosis, hormonal therapy with a gonadotropin-releasing hormone agonist is an effective alternative to surgical therapy. The basis for medical treatment of endometriosis is that endometriosis lesions are dependent on estradiol for continued growth. Further, end organ tissue varies in its sensitivity to estradiol. This forms the basis of the estrogen threshold hypothesis, that is, that a concentration of estradiol that will partially prevent bone loss may not stimulate endometrial growth. Thus there is a hierarchy of organ response to estradiol such that calcium metabolism is most sensitive followed by gonadotropin secretion, vaginal epithelial growth, lipid metabolism, and liver protein production. Similarly, breast cancer is most sensitive and endometriosis is least sensitive to estrogen. These differences may allow the design of regimens with a gonadotropin-releasing hormone agonist that maintain a therapeutic response and ameliorate potential adverse effects.
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PMID:Hormone treatment of endometriosis: the estrogen threshold hypothesis. 153 60


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