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

From August 1988-June 1989, 983 physicians participated in a phase IV trial by following 7759 women using the monophasic oral contraceptive (OC), Demulen 1/35 (1 mg ethynodiol diacetate and 35 ug ethinyl estradiol) to evaluate its efficacy and safety. The total number of cycles for the study stood at 21,440. In addition, the total woman-years stood at 1787. Only 6382 patients could be evaluated for safety. 4.4% of the patients had adverse reactions to the OC, but only 1.7% of all patients stopped taking it. The leading side effects included nausea (67 cases), headache (45), amenorrhea (42), emotional changes (30), breast pain (19), dysmenorrhea (12), and 11 cases of weight gain, abdominal/pelvic pain, and bloating. Of the 280 reported adverse reactions, only 87 (31%) were considered severe. The leading serious adverse reactions were depression (10) and hypertension (6). Only 5412 patients could be used to determine efficacy. The physicians initially reported 121 (2.2%) pregnancies during the study. The researchers learned that 33 of the 84 returned 2nd questionnaires (response rate, 70%) reported that the women conceived after enrollment but before taking the OC. 36 conceived while taking it, but 8 did not take it daily. Noncompliance may have contributed to pregnancy for the remaining 28 cases. Therefore the 36 confirmed pregnancies made for a failure rate of .7%. 85.7% of the pregnancies happened in the 1st 3 months of taking the OC. Either patient noncompliance or true medication failure accounted for treatment failure. Therefore it is important for physicians to instruct patients on how to take OCs correctly.
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PMID:Efficacy and safety of ethynodiol diacetate, 1 mg, with ethinyl estradiol, 35 micrograms, with an emphasis on contraceptive efficacy. A phase IV trial. 204 81

Twenty-three patients with laparoscopically diagnosed endometriosis and pelvic pain were allocated randomly to treatment with cyproterone acetate 27 mg plus ethinyl estradiol 0.035 mg/day (11 patients) or danazol 600 mg/day (12 patients). All women received treatment for 6 months, except for one in the cyproterone group who suspended treatment for nonmedical reasons and was excluded from analysis of the results. The clinical condition and pain symptoms were monitored in all patients for 1 year after treatment suspension. The intensity of pelvic pain at diagnosis, during treatment, and at follow-up was evaluated by a multidimensional verbal score and an analogue scale. At the end of treatment, a repeat laparoscopy was performed in those patients who agreed (four in the cyproterone group, five in the danazol group); the results showed a partial regression of endometriotic lesions in both groups, with no significant differences between them. Dysmenorrhea disappeared in all patients during treatment. At 6 months after suspension, dysmenorrhea recurred in 66% of the cyproterone group and 58% of the danazol group, and at 1 year in 89 and 92%, respectively. Intermenstrual pelvic pain improved markedly during treatment in both groups; 6 months after treatment withdrawal it was present in four cyproterone subjects and four danazol group patients, whereas after 1 year, only one woman in the danazol group did not have this symptom. Deep dyspareunia was less affected by treatment, and 6 months later had recurred in all the women.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Comparison of cyproterone acetate and danazol in the treatment of pelvic pain associated with endometriosis. 252 84

490 women who used Stediril (.5 mg norgestrel and .05 mg ethinyl estradiol, combined) for a total of 5600 cycles or 466 woman-years over a 3 year period are presented. They all took the pills primairly for contraception; most were 20-30 years old, and took Stediril 3-6 months. Some other indications were 119 cases of menstrual irregularity, 15 of spaniomenorrhea, 14 of premenstrual syndrome and 3 of acne, all relieved. 46 of 50 cases of menorrhagia, 83 of 89 of dysmenorrhea and 32 of 34 with pelvic pain were relieved. Withdrawal bleeding was usually less than before and tended to diminish with time. There were 46 women with nausea, 3 of whom stopped Stediril. Migraines sometimes a ppeared, sometimes disappeared, but often occurred regularly on the first day between pill cycles. 52 women complained of breast congestion for the first time. Weight rose in 2301, fell in 98 and stayed constant in 134 after 3 months: weight was easily controlled with diet and appetite supressant drugs. No hypertension was observed. There were 19 single cycles of amenorrhea, several cases of persistant amenorrhea and 4 cases of amenorrhea after stopping. 2-3% of cycles were marked by metrorrhagia; 63 women had spotting, 8 had significant metrorrhagia; 7 had metrorrhagia followed by withdrawal bleeding in that cycle. 1 woman had a thromboembolism of the left leg after 2 pill cycles during which she gained 3 kg. There was 1 pregnancy due to irregular pill use.
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PMID:[Clinical study of an estro-progestative association in low doses. Experience of 3 years (490 patients-5600 cycles)]. 426 90

102 patients using Trinordiol, a triphasic oral contraceptive (OC) containing ethinyl estradiol and d-norgestrel, were followed for 932 cycles in a study of secondary effects. Follow-up visits were scheduled after 1,3, and 6 months and every 6 months thereafter. 26 patients discontinued use of the pills during the study after using them for a total of 159 cycles. 5 discontinued because of abdominal pain, 1 for breast tenderness, and 1 because of headaches or migraines. 7 discontinued because of metrorrhagia, 4 for weight gain, 3 for amenorrhea, 2 for nausea and vomiting, and 1 each for nervousness, water retention, acne, desire for pregnancy, leaving the country, hypertension, and unknown motivation. the average age of patients was 23.6 years, with a range from 14-48. 76% were aged 15-29 years. 52.9% were nulliparas. 58.8% were Belgian, 21.6% were from Mediterranean Europe, 10.8% were Moroccan, and 7.9% were from black Africa. Only 1 patient, a 37 year old, developed hypertension. 15 patients gained more than 2 kg and 17 lost more than 2 kg. 15.8% complained of spotting during the 1st cycle compared to 3.1% during the 6th cycle, 5.2% during cycle 7-12, and 9.1% during cycle 13-30. Among 35 patients who did not discontinue treatment, 7 complained of amenorrhea and 1 of scanty menstrual bleeding, 14 of pain including 7 cases of pelvic pain, 2 of dysmenorrhea, 3 of breast tenderness, and 2 of headaches, 15 of leukorrhea, 3 of nausea, 2 of dizziness, and 1 each of fatigue, acne, galactorrhea, and cutaneous pruritus. 1 case of myoma at the level of the uterine cornu was identified after 24 cycles of treatment. In all, 61 patients had some complaint, while 41 were totally satisfied. No patient became pregnant during the study.
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PMID:[Clinical study of the secondary effects associated with taking a triphasic anti-ovulatory contraceptive]. 670 4

1 out of 4-5 women develop uterine leiomyomata, the most common solid pelvic tumors in women. This paper assesses the reports of 4714 myomectomies and records of 59 personal cases. Townsend et al. suggested that leiomyomata are unicellular in origin. Estrogen, growth hormone, and progesterone may influence the growth of the tumors. In the performance of myomectomy, the 2 major technical concerns are the minimization of blood loss and the prevention of postoperative adhesions. Although most leiomyomata are asymptomatic and grow slowly, 20-50% of the tumors are estimated to produce symptoms, the severity of which depends upon the number, size, and location of the tumors. The symptoms include menorrhagia, infertility, fetal wastage, pelvic pain/pressure, polycythemia, ascites, impingement, and related complications (e.g., ulceration and infection, fever, pain, uterine inversion, sarcomatous change). Asymptomatic patients with uteri of less than 10-12 weeks' gestational size require no more than observation at 6-month intervals regardless of fertility status. For women with uteri of 10-12 weeks gestational size or longer, management will depend on the patient's desire for fertility. Women desirous of fertility should have a 6-12 month trial for conception. If tumor growth is rapid, myometomy may be performed earlier. Women not desirous of fertility (e.g., pre- and post-menopausal) should have total abdominal hysterectomy and bilateral salpingo-oophorectomy. For symptomatic patients desirous of fertility, myomectomy using the transabdominal approach or hysteroscopy should be performed. For symptomatic patients not desiring fertility, dilatation and curettage and hysterectomy should be performed. With regard to oral contraceptive use, no studies have yet demonstrated that women on oral pills are at increased risk for growth of these tumors. Low-dose contraceptives should not be contraindicated in patients with leiomyomata if they desire to use this form of contraceptive. With IUD users, the device should be discontinued if bleeding occurs.
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PMID:Uterine leiomyomata: etiology, symptomatology, and management. 702 95

Physicians can play an important role in the prevention of infertility through aggressive treatment of pelvic infections and improved surgical techniques. The cause of infertility can be diagnosed 90 percent of the time. Ovulation, tubal, peritoneal, uterine, and cervical factors should be evaluated. Sperm-cervical mucus interaction should be assessed. Basal body temperature charts are simple and reliable. An endometrical biopsy should be timed for 8 to 10 days after ovulation, histologically dated, and compared with basal body temperatures. Tubal factors are best assessed by hysterosalpingogram and treated by microsurgery. The incidence of pelvic factors increases with age, prior infection, previous surgery, and pelvic pain. Cervical mucus can be studied and changes quantitated by using a simple scoring system. Uterine anomalies increase pregnancy risk but do not usually cause infertility. Clomiphene therapy should be limited to women who ovulate infrequently or not at all. Estrogen improves cervical mucus production; progesterone treats luteal phase defects. Infertile patients are often angry, anxious, and depressed, and additional time should be set aside during an office visit for optimum communication.
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PMID:Female infertility. 710 67

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

Endometriosis in women older than 40 years of age presents unique therapeutic challenges to the practicing physician. Management requires the evaluation of reproductive goals and a determination of the objectives of therapy, including symptomatic relief and avoidance or delay of recurrence of disease. Important considerations in this age group include diminished fertility and impending menopause. The diagnosis and treatment for endometriosis-associated infertility must be undertaken in an expedient manner. Assisted reproductive technologies may be effective therapies for these patients. Conservative surgery may be necessary to preserve reproductive potential, but definitive surgery may be indicated in women with long-standing pelvic pain. Estrogen replacement therapy may be used in menopausal women with a history of endometriosis.
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PMID:Management of endometriosis in women older than 40 years of age. 836 37

Physicians at the University of Milan in Italy compared data on 29 endometrial patients who received 3.6 mg goserelin in a 28-day subcutaneous depot formulation for 6 months to treat nonmenstrual pelvic pain, dysmenorrhea, and pain during coitus (dyspareunia) with data on 28 other endometrial patients treated with a low-dose monophasic oral contraceptive (OC) (.02 mg ethinyl estradiol and 0.15 mg desogestrel) for 6 months. They followed the women for 6 months after treatment ended. The physicians wanted to determine the efficacy of goserelin, a gonadotropin-releasing hormone (GnRH) agonist, versus a low dose OC to relieve pelvic pain in patients with endometriosis and to compare pain recurrence after drug withdrawal. (GnRH agonists are current medical treatments for pelvic pain, but they have several side effects and are expensive; and therefore their use is restricted.) At the end of treatment, both goserelin and the low-dose OC significantly reduced dyspareunia (p .01), especially goserelin according to the linear analog scale (pain symptom score, 1.8 points lower). Both treatments improved nonmenstrual pain equally at the end of treatment (p .01). The low-dose OC reduced dysmenorrhea greatly at the end of treatment (p .01). The researchers could not evaluate dysmenorrhea in goserelin cases, since these patients experienced amenorrhea. The only persistent significant reduction at the end of follow-up occurred with dyspareunia in goserelin patients (p .05). In the other patients, pelvic pain returned to baseline levels 6 months after treatment ended. The severity of pelvic pain did not differ between groups 6 months after follow-up. These results suggested that low-dose OCs may be an effective alternative treatment for dysmenorrhea and nonmenstrual pelvic pain linked to endometriosis.
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PMID:A gonadotropin-releasing hormone agonist versus a low-dose oral contraceptive for pelvic pain associated with endometriosis. 851 62

Estrogen-dependent diseases often regress when estrogen production is reduced. Endometriosis is an estrogen-responsive disease, and the pelvic pain associated with it improves when estrogen production is reduced with bilateral oophorectomy or chronic gonadotropin releasing hormone (GnRH) agonist treatment. Unfortunately, reduction of estrogen production is associated with adverse side effects, such as vasomotor symptoms and bone loss. In women with endometriosis and pelvic pain, the combination of bilateral oophorectomy plus postoperative low-dose estrogen treatment produces sustained improvement in pain symptoms and reduces the hypoestrogenic side effects associated with bilateral oophorectomy. In a parallel manner, chronic GnRH agonist treatment plus low-dose steroid therapy (estrogen plus progestin or progestin only) is effective in the treatment of pelvic pain caused by endometriosis and reduces the hypoestrogenic effects associated with hypoestrogenism caused by the GnRH agonist. Since chronic GnRH agonist treatment is reversible and avoids surgery, it may become an important alternative to bilateral oophorectomy for the treatment of endometriosis.
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PMID:Endometriosis and the estrogen threshold theory. Relation to surgical and medical treatment. 956 63


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