Pelvic pain

Pelvic Pain

Endometriosis: A cause of pelvic pain

Pelvic pain is often the common complaint which brings a patient to the Doctor. However, this type of pain is not as simple as we used to think. It is quite complex and is defined as ‘an unpleasant sensory and emotional experience
associated with actual or potential tissue damage, or described in terms of such damage’ (IASP, 2015). Pain can be acute or chronic.

Gynaecological causes of pelvic pain are numerous and they include ovulation, dysmenorrhea, ectopic pregnancy, pelvic inflammatory disease, fibroid with degenerative changes, endometriosis, just to name a few.

Endometriosis is the presence of endometrial tissue outside the cavity of the uterus and is one of the causes of pelvic pain affecting an estimated 10-15% of women of reproductive age. 2 It is a gynaecological condition characterized by cyclical pain that occurs along with menses (dysmenorrhea).

When the endometrial tissue is present in the brain or the lungs the patient may experience cyclical seizures (catamenial seizures) and hemoptysis (coughing out blood). All these occur along with menstruation as the endometrial tissues in these abnormal places also respond to hormones and undergo cyclical changes like the normal endometrial lining of the uterus.

The diagnosis of endometriosis is a bit challenging as up to 20% of these women will also have other conditions that may cause chronic pain such as irritable bowel syndrome, painful bladder, pelvic inflammatory disease, migraine, etc. 1 Thus, because so many other conditions must be ruled out, the diagnosis of endometriosis is often delayed and may be as long as 11years. 4 Delayed diagnosis may lead to further complications such as adhesion of the
uterine tubes which further worsens fertility prognosis.

Abdominopelvic ultrasound has been shown to be inaccurate in the diagnosis of endometriosis as most of patients will come out with a normal scan. 5 Laparoscopy remains the gold standard for the diagnosis of endometriosis. However, it must be done by an expert to avoid false
negative results. 1

With laparoscopy other causes of pelvic pain apart from endometriosis can also be diagnosed and possibly treated. Laparoscopy also has an
added advantage of been therapeutic. Thus, in the hands of a qualified Gynaecologist the diagnosis and treatment can be done simultaneously. This helps reduce the number of hospital visits, and reduce the cost of care. A study conducted in Canada among 342 women who were infertile revealed a higher chance of getting pregnant after operative laparoscopy compared to diagnostic laparoscopy. 6

In conclusion, endometriosis is one of the causes of chronic pelvic pain in women of reproductive age, often associated with infertility with significant impact on physical and social well-being. A meticulous history and
examination complemented with laparoscopy by a specialist Gynaecologist will ensure timely diagnosis and prompt treatment. Furthermore, endometriosis is important part of the story of chronic pelvic pain, but a multi-disciplinary team of physiotherapist, dietician, and pain physician are required for management of chronic pelvic pain.

We are very proud to provide complete care to patient with understanding her problem, wishes, priorities and personalised treatment.

Bibliography

  1. Pugsley Z, Ballard K. Management of endometriosis in general practice: the pathway to diagnosis. The British
    Journal of General Practice. 2007;57(539):470-476.
  2. Yi KW, Shin JH, Park MS, Kim T, Kim SH, Hur JY. Association of body mass index with severity of  endometriosis in Korean women. Int J Gynaecol Obstet. 2009;105:39–42. doi: 10.1016/j.ijgo.2008.11.001
  3. Hsu AL, Khachikyan I, Stratton P. Invasive and non-invasive methods for the diagnosis of endometriosis. Clinical obstetrics and gynecology.2010;53(2):413-419. doi:10.1097/GRF.0b013e3181db7ce8.
  4. Riazi H, Tehranian N, Ziaei S, Mohammadi E, Hajizadeh E, Montazeri A. Clinical diagnosis of pelvic
    endometriosis: a scoping review. BMC Women’s Health. 2015;15:39. doi:10.1186/s12905-015-0196-z.
  5. Moore J, Copley S, Morris J, et al. A systematic review of the accuracy of ultrasound in the diagnosis of
    endometriosis. Ultrasound Obstet Gynecol. 2002;20:630–634
  6. OLIVE D, PRITTS E. The Treatment of Endometriosis. Annals of the New York Academy of Sciences. 2002;955(1):360- 372. doi:10.1111/j.1749-6632.2002.tb02797.x.