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

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

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

Highly potent agonists of gonadotropin-releasing hormone (GnRH) have been shown to reduce pelvic pain due to endometriosis and the size and number of implants seen at laparoscopy. The accompanying symptoms and problems associated with the hypoestrogenism induced by the agonist have reduced its acceptability and raised questions about its safety. In an attempt to optimize this form of therapy, we treated eight women with endometriosis with daily subcutaneous injections of a potent agonist of GnRH plus a daily oral dose of 20-30 mg of medroxyprogesterone acetate for 24 weeks. Ovarian estrogen secretion was reduced to levels seen in castrated women throughout the course of treatment. Markers of hypoestrogenism, such as hot flashes and loss of calcium from bone, were diminished with this regimen compared with previous findings with GnRH agonist alone. Blinded evaluation of laparoscopic photographs failed to reveal improvement or suppression of active endometriosis. The results of this pilot study indicate that the addition of medroxyprogesterone acetate decreases the hypoestrogenic effects of GnRH agonist alone but fails to affect pain or endometriotic implants.
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PMID:Treatment of endometriosis with a long-acting gonadotropin-releasing hormone agonist plus medroxyprogesterone acetate. 213 65

Fifty-one women with pelvic endometriosis were treated with the gonadotropin-releasing hormone agonist (GnRHa) Buserelin (Hoechst Holland N.V., Amsterdam, The Netherlands) 300 micrograms three times a day intranasally for 6 months. Forty-nine women completed treatment; 42 were available for 6 months of follow-up following treatment. Symptoms showed prompt and significant improvement. Follow-up after treatment revealed persistent relief from dysmenorrhea and dyspareunia in, respectively, 58.6% and 88.2% of the women, whereas pelvic pain returned to pretreatment scores. Serum estradiol (E2) was suppressed to predominantly early follicular phase concentrations. Laparoscopy at the end of therapy showed significant reduction of scores for implants only. There was no relation between the degree of E2 suppression during therapy and the improvement of symptoms or the reduction of endometriosis. Statistical analysis in 22 infertile patients, of whom 7 conceived during follow-up, revealed no differences in E2 levels during therapy, improvement of symptoms, or reduction of endometriosis. Buserelin appears to be safe, well tolerated, and effective in the management of endometriosis and associated complaints.
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PMID:Endometriosis: treatment with gonadotropin-releasing hormone agonist Buserelin. 252 63

To compare treatment efficacy and safety parameters a total of 55 premenopausal women with histologically proven endometriosis (stage II-IV) were randomized to receive the LHRH-analogue depot triptorelin (n = 30) or the steroid danazol (n = 25) for a total of 24 weeks. Immediately after cessation of the endocrine therapy a second-look operation was performed. Four as well as 24 weeks after the end of treatment patients were seen for re-evaluation of clinical symptoms and safety parameters. Estradiol suppression was significantly more pronounced with triptorelin, while the free androgenic index rose with danazol. Both substances were equally effective in reducing endometriotic implants (58% and 51%, respectively). Dysmenorrhea was absent at the end of medical therapy in both treatment groups. Dyspareunia and pelvic pain decreased at least by 50%. Red blood count, thrombocytes, liver enzymes and the atherogenic index rose with danazol, while the urinary calcium/creatinine ratio showed a marked elevation with triptorelin. Adverse effects were mainly due to the hypoestrogenism of the LHRH analogue and the androgenic/anabolic properties of the steroid. Triptorelin and danazol are equally effective in treating endometriosis. Therefore, choice of treatment should be based on the patient's medical history and the pharmacological profile of each substance.
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PMID:A randomized, comparative trial of triptorelin depot (D-Trp6-LHRH) and danazol in the treatment of endometriosis. 778 64

Physicians are beginning more and more to understand pelvic pain syndrome (PPS). Transuterine pelvic venography shows that some women who suffer from chronic pelvic pain have moderate or severe congestion. On the other hand, laparoscopy indicates that some cases have no physical abnormalities. A psychological component is frequently involved, but automatically referring a woman with PPS to a psychiatrist is unproductive. Instead, physicians should involve a psychologist based at a gynecologic clinic, especially in the case of women with a history of sex abuse with a high somatization score. In the case of women who suffer from PPS but clearly show no apparent physical causes, physicians should not investigate any further, but instead reassure them. Reassurance usually results in alleviation of pain within 6 months. PPS only strikes premenopausal women, suggesting that ovarian activity may also be involved. Thus, treating women with hormones to suppress ovulation benefits some women. The medical community still does not know whether longterm treatment with gonadotropin-releasing hormone analogues and hormone replacement effectively eliminates pelvic pain. If the above treatments do not successfully treat PPS, physicians can perform a hysterectomy and bilateral oophorectomy and prescribe sufficient hormone replacement therapy to remove heretofore undetected disease (e.g., ovarian cysts, adenomyosis, and fibroids) in 33% of cases of idiopathic PPS and alleviate pelvic pain in 66% of such cases.
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PMID:The pelvic pain syndrome. 833 82

Endometriosis is a common disease that affects up to 5 million women in the United States. Specifically the prevalence of endometriosis is 1 in 15 (7%) women of reproductive age, and there is an associated incidence of infertility in as many as 30% to 40% of cases. The precise physiologic mechanism for the development of endometriosis lesions in the pelvis and abdominal cavity has not been elucidated. Substantial evidence exists, however, that endometriosis is dependent on estrogen for continued growth and proliferation. Therefore, suppression of the hypothalamic-pituitary-ovarian axis with analogues of a gonadotropin-releasing hormone is being increasingly undertaken. Since the most effective resolution of endometriosis occurs after oophorectomy or onset of menopause, the hypoestrogenic state induced by GnRH analogues is of major significance for patients with active disease. Medical therapy for endometriosis is often used as primary therapy for symptomatic disease or as an adjunct to surgical management of pelvic pain or infertility.
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PMID:Pathophysiology and management of endometriosis. 822 53

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

The complications during and following endoscopic excision of deep endometriosis were analysed. The data of 225 excisions performed in 212 women had been collected prospectively into a database immediately following surgery and during the follow-up visit. The data confirmed the association of severe pelvic pain and deep endometriosis, severe pelvic being the only indication for surgery in 67, 78 and 76% of women with type I (n = 99), type II (n = 55) and type III (n = 71) lesions respectively. They confirmed that type II and type III were the largest lesions and that they were found predominantly in revised American Fertility Society (AFS) class II. The duration of surgery decreased with expertise (P < 0.01), but increased when deeper or larger lesions were excised (P < 0.0001) and when cystic ovarian endometriosis was also present (P < 0.001). Excision was clinically judged to be complete in 94, 96 and 85% of women with type I, II or III lesions respectively. In order to achieve this, part of the bowel wall had to be resected in 6.3% and part of the posterior vaginal fornix in 13.6% of cases. This risk was associated mainly in type II or III lesions and with larger lesions (P = 0.001). This was not considered as a complication, since all lesions could be repaired endoscopically and since follow-up was uneventful. Complications were one ureter lesion and seven late bowel perforations with periotonitis. Our data did not permit the evaluation as to whether medical pretreatment could improve completeness of surgery or decrease the risk. They revealed, however, that in six of seven women with type III lesions--in whom excision was judged to be complete--no pretreatment had been given and that luteinizing hormone releasing hormone (LHRH) agonist treatment decreased the volume of type II lesions (P = 0.04). In conclusion, complete endoscopic excision could be performed in over 90% of women with deep endometriosis, but required bowel surgery in over 6% of cases. Ureter lesions were rare, but postoperative bowel perforations with periotonitis occurred in 2-3% of cases. Medical pretreatment is advocated since LHRH agonist treatment was shown to shrink the deep endometriotic lesion.
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PMID:Complications of CO2-laser endoscopic excision of deep endometriosis. 894 40

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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