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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 an enigmatic disease found in as many as 30% of reproductive age women. The symptoms for women who suffer from this malady vary but may include subfertility or chronic pelvic pain. Because endometriosis lesions rely on estradiol for growth, most of the existing drug regimens work by creating hypoestrogenism. Unfortunately, this leads to untoward side effects and alterations in ovulation and, subsequently, fertility potential. Newer drugs are currently under investigation that either create hypoestrogenemia more efficaciously or do not alter ovulation but still affect the growth of endometriosis. They target some of the pathophysiological pathways that are only now being elucidated, and include gonadotropin-releasing hormone antagonists, aromatase inhibitors, selective progesterone receptor modulators, angiogenesis inhibitors, matrix metalloprotease inhibitors, estrogen receptor beta-agonists and immune modulators.
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PMID:Investigational drugs for endometriosis. 1654 89

Endometriosis, a common cause of morbidity in reproductive age females, results in pelvic pain and infertility. Effective, evidence-based treatments of endometriosis-associated infertility include conservative surgical therapy and assisted reproductive technologies. In early stage endometriosis ovulation induction, with or without intrauterine insemination, improves pregnancy rates. In early stage disease in vitro fertilization reduces time to pregnancy as compared to controls, but does not increase the chance of pregnancy after three years. Endometriosis-associated pain can be approached with surgical or medical therapies. Conservative surgery maintains the reproductive organs and is an effective mode of treatment for endometriosis-associated pain. A more radical surgical approach of hysterectomy with bilateral salpingo-oophorectomy, not investigated in randomized controlled trials, remains a mainstay of therapy for endometriosis-associated pain in patients who have completed child-bearing. Current medical therapies rely upon interruption of normal cyclic, ovarian hormone production resulting in an environment not conducive to the growth of endometriosis. The current accepted therapies for endometriosis include danazol, progestational agents, oral contraceptive agents, and gonadotropin-releasing hormone analogues which all function similarly in relieving pain. The new era of genomics promises to help characterize endometriosis and allow one to tailor therapies based on a woman's symptoms and reproductive goals.
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PMID:A review of current management of endometriosis in 2006: an evidence-based approach. 1668 Nov 64

Signs and symptoms of endometriosis are nonspecific, and an acceptably accurate noninvasive diagnostic test has yet to be reported. Serum markers do not provide adequate diagnostic accuracy. The preferred method for diagnosis of endometriosis is surgical visual inspection of pelvic organs with histologic confirmation. Such diagnosis requires an experienced surgeon because the varied appearance of the disease allows less-obvious lesions to be overlooked. Empiric use of nonsteroidal anti-inflammatory drugs or acetaminophen is a reasonable symptomatic treatment, but the effectiveness of these agents has not been well-studied. Oral contraceptive pills, medroxyprogesterone acetate, and intrauterine levonorgestrel are relatively effective for pain relief. Danazol and various gonadotropin-releasing hormone analogues also are effective but may have significant side effects. There is limited evidence that surgical ablation of endometriotic deposits may decrease pain and increase fertility rates in women with endometriosis. Presacral neurectomy is particularly beneficial in women with midline pelvic pain. Hysterectomy and bilateral salpingo-oophorectomy definitively treat pain from endometriosis at 10 years in 90 percent of patients.
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PMID:Diagnosis and management of endometriosis. 1693 79

Endometriosis is a condition characterized by ectopic endometrial tissues located outside of the uterus, most commonly found on the pelvic peritoneum or ovary. Endometriosis, which occurs in 7-10% of women in the general population and 71-87% of women with chronic pelvic pain, is associated with dysmenorrhea, chronic pelvic pain, and infertility. There is considerable debate about the effectiveness of various interventions for endometriosis. This review discusses the benefits and drawbacks of pharmacologic and surgical treatments for the pain associated with endometriosis. Laparoscopic surgery has been demonstrated to relieve the pain associated with endometriosis. Hormonal therapies, such as gonadotropin-releasing hormone (GnRH) analogues or the weak androgen danazol, have also been effective at relieving the pain associated with endometriosis. Oral contraceptives appear to be as effective as GnRH analogues for pain relief. Although both surgical and pharmacologic treatments have been effective for relief of the pain associated with endometriosis, the recurrence rate remains significant. The management of pain associated with endometriosis has thus not been satisfied. Larger unified clinical trials are needed to evaluate the effectiveness of new treatments in managing the pain associated with endometriosis.
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PMID:Management of the pain associated with endometriosis: an update of the painful problems. 1707 94

Dysmenorrhea occurs in the majority of adolescent girls and is the leading cause of recurrent short-term school absence in this group. In the vast majority of cases, a presumptive diagnosis of primary dysmenorrhea can be made based on a typical history of low anterior pelvic pain coinciding with the onset of menses and lasting 1-3 days with a negative physical examination. Risk factors for primary dysmenorrhea include nulliparity, heavy menstrual flow, and smoking. Poor mental health and social supports are other associations. Empiric therapy for primary dysmenorrhea can be initiated without diagnostic testing. Effective therapies include NSAIDs, oral contraceptives, and pharmacologic suppression of menstrual cycles. In atypical, severe, or refractory cases, imaging and/or laparoscopy should be performed to investigate secondary causes of dysmenorrhea. The most common cause of secondary dysmenorrhea is endometriosis, the treatment of which may include medical and surgical approaches. Pharmacologic treatment of young women with pain related to endometriosis is similar to treatment of primary dysmenorrhea but may infrequently include gonadotropin-releasing hormone agonists in severe refractory cases.
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PMID:Dysmenorrhea in adolescents: diagnosis and treatment. 1816 3

The etiology of chronic pelvic pain in women is poorly understood. Although a specific diagnosis is not found in the majority of cases, some common diagnoses include endometriosis, adhesions, irritable bowel syndrome, and interstitial cystitis. The initial history and physical examination can narrow the diagnostic possibilities, guide any subsequent evaluation, and rule out malignancy or significant systemic disease. If the initial evaluation does not reveal a specific diagnosis, a limited laboratory and ultrasound evaluation can clarify the diagnosis, as well as rule out serious disease and reassure the patient. Few treatment modalities have demonstrated benefit for the symptoms of chronic pelvic pain. The evidence supports the use of oral medroxyprogesterone, goserelin, adhesiolysis for severe adhesions, and a multidisciplinary treatment approach for patients without a specific diagnosis. Less supporting evidence is available for oral analgesics, combined oral contraceptive pills, gonadotropin-releasing hormone agonists, intramuscular medroxyprogesterone, trigger point and botulinum A toxin injections, neuromodulative therapies, and hysterectomy.
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PMID:Chronic pelvic pain in women. 1858 34

Endometriosis is a common, benign and chronic gynecological disorder. It is also an estrogen-dependent disorder that can result in substantial morbidity, including pelvic pain, pro gressive dysmenorrhea, dyspareunia, infertility and repeat surgeries. Endometriosis is often treated surgically upon diag nosis but with a higher rate of recurrence, suggesting that a combination of surgical and medical management might provide better outcomes. The primary goal of medical treatment for endometriosis is to halt the growth and activity of endometriosis lesions. The most widely utilized medical treat ment for endometriosis involves use of gonadotropin-releasing hormone (GnRH) agonists and oral contraceptives. Conventional agents also include androgen derivates and progestins. Due to the chronic nature of this disease, long-term or Dr. Hong-Yuan Huang repeated courses of medication may be required to control its related symptoms. Increasing knowledge about the pathogenesis of endometriosis at the cellular and molecular levels may give us the opportunity to use new, specific agents for treatment, including aromatase inhibitors, progesterone antagonists, selective progesterone receptor modulators, GnRH antagonists, intrauterine releasing systems with progestin and new pharmaceutical agents affecting inflammation, angiogenesis, and matrix metalloproteinase activity. Many of these promising new agents may prevent or inhibit the development of endometriosis. Further clinical trials may determine if these new therapies are superior to current medical treatment strategies for endometriosis.
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PMID:Medical treatment of endometriosis. 1909 89

We report the case of a patient with adenomyosis complicated by deep vein thrombosis in whom low-dose gonadotropin-releasing hormone agonist (GnRHa) therapy was useful as a uterus-conserving therapeutic option. The patient was a 34-year-old nulliparous woman who presented with edema and pain in the left lower leg. The patient had been treated with four cycles of GnRHa therapy for adenomyosis and repeatedly experienced chronic pelvic pain, dysmenorrhea and anemia due to hypermenorrhea. Leg venography confirmed deep vein thrombosis, and thrombolytic therapy was performed to eliminate symptoms. Because the patient strongly wanted to conserve the uterus, low-dose GnRHa therapy was initiated. The patient is currently taking 450 microg/day buserelin acetate nasally (regular dose: 900 microg/day), and estradiol levels have been maintained at 24-50 pg/ml. Anemia, leg numbness and chronic pelvic pain have dissipated, and the patient has not experienced estrogen deficiency symptoms for more than two years.
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PMID:Successful long-term management of adenomyosis associated with deep thrombosis by low-dose gonadotropin-releasing hormone agonist therapy. 1968 58

Endometriosis is one of the most common gynecological diseases and is frequently associated with pelvic pain and infertility. Surgical and endocrine therapies successfully suppress pelvic pain, but it often recurs after completion of treatment. To maintain relief from pelvic pain while minimizing hypoestrogenic side effects, several regimens are proposed. Oral contraceptives plus dienogest, a novel progestogen, or a gonadotropin-releasing hormone agonist with estrogen supplementation (add-back therapy) can be used in long-term administration. The relief from pelvic pain achieved with a gonadotropin-releasing hormone agonist can be sustained by long-term administration of a tapered dose of danazol or medium-to-low doses of oral contraceptives. Local treatment with the levonorgestrel-releasing intrauterine system is an option for long-term suppression of pelvic pain.
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PMID:[Maintenance therapy for endometriosis]. 2007 11

Most surgical procedures performed by obstetrician-gynecologists are associated with pelvic adhesions that cause subsequent serious sequelae, including small bowel obstruction, infertility, chronic pelvic pain, and difficulty in postoperative treatment, including complexity during subsequent surgical procedures. This study was conducted to determine if gonadotropin-releasing hormone analogues (GnRHa) affect the expressing tissue-type plasminogen activator (t-PA) and its inhibitor-1 (PAI-1) in peritoneal cells in culture. Human peritoneal Met5A cells were used to examine the effects of GnRHa leuprolide, buserelin and goserelin on the levels of t-PA and PA-1. Antigen concentrations were measured in conditioned media and cell lysates by real-time PCR and ELISA. GnRH receptor (GnRHR) mRNA was determined by RT-PCR. GnRHR mRNA was detected in Met5A cells. Exposure of Met5A cells to GnRHa induced a rapid decrease of PAI-1 level in cultured medium but not in cell lysate (protein and mRNA). These effects of GnRHa on PAI-1 were not associated with any changes in t-PA level. These results suggest that GnRHa may be an effective stimulator of local peritoneal fibrinolytic activity, as it decreases PAI-1 secretion in peritoneal Met5A cells by a mechanism linked to GnRHR.
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PMID:GnRH receptor and peritoneal plasmin activity. 2023 28


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