CPP-Chronic Pelvic Pain

 

Chr Pelvic pain (CPP) where all possible noninvasive tests have been done but no definite cause could be established with certainly in such cases in  absence of  palpable pelvic pathology (T O Mass) / subfertility problem one can offer trail of medl tr of endometriosis before invasive  procedure is approved (   diagnostic laparoscopy) .It also happens albeit rarely that Opinions of Urologist, Orthopedic surgeon and Colorectal surgeon have been taken but  no definite cause could be established.

 Put under such circumstances can we prescribe Dienogest or say other drugs specifically designed as medical managements of endometriosis like B) Danazol B) Gn RH agonist C) Progesterone 

Let us see what Gambone JC¹, Mittman BS, Munro MG, Scialli AR, Winkel CA; Chronic Pelvic Pain/Endometriosis Working Group doctors opine in 2002??

Fertil Steril. 2002 Nov;78(5):961-72.

Consensus statement for the management of chronic pelvic pain and endometriosis: proceedings of an expert-panel consensus process.

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For women in whom endometriosis is the suspected cause of the pain, laparoscopic confirmation of the diagnosis is unnecessary, and a trial of medical therapy, including second-line therapies such as danazol, GnRH agonists, and progestins, is justified provided that there are no other indications for surgery such as the presence of a suspicious adnexal mass.

  Committee Opinion 1  : When surgery is necessary, laparoscopic approaches seem to offer comparable clinical outcomes to those performed via laparotomy, but with reduced morbidity.

Committee Opinion 2 :-The balance of evidence supports the use of adjuvant postoperative medical therapy after conservative surgery for CPP.

Committee Opinion 3 :There is some evidence that adjuvant presacral neurectomy adds benefit for midline pain, but currently, there is inadequate evidence to support the use of uterosacral nerve ablation or uterine suspension.

Committee Opinion 4 : Hysterectomy alone has undocumented value in the surgical management of women with endometriosis-associated CPP.

PMID:

 

12413979