MANAGEMENT OF CHRONIC PELVIC PAIN IN WOMEN AGED 25 AND UNDER
Chronic pelvic pain (CPP) is noncyclical pelvic pain in young females, which lasts longer than 6 months, and affects between 5.7 to 26.6% of the female population. The gold standard investigation is diagnostic laparoscopy. However due to the risks of surgical procedures and low pick up rate, diagnosis of CPP can often be very difficult for clinicians and frustrating for patients. Thus Royal College of Obstetrics and Gynaecology (RCOG) Greentop guideline 41, 2012, recommended a comprehensive list of investigations and treatments prior to surgical evaluation. Accurate diagnosis and effective management is very important in improving a woman‘s quality of life.
1.The diagnostic accuracy of gynaecological investigations in CPP patients.
2.The percentage of patients, who underwent the recommended investigations prior to diagnostic laparoscopy
3.The percentage of patients, who received the recommended treatments prior to diagnostic laparoscopy
4.The complication rate of diagnostic laparoscopy
The RCOG Greentop guideline 41 2012
100% of patients should have had the recommended investigations prior to diagnostic laparoscopy.
100% of patients should have had the recommended treatments prior to diagnostic laparoscopy
Number of patients: 61 patients; aged 25 and under
Period: 1st June 2014 to 31st May 2016
Inclusion criteria: patients aged 25 or under with a long history of CPP, and did not have a laparoscopy within the last 2 years
Investigations: infection screen and ultrasound imaging
Treatments: 3-6 month trial of hormone therapy and adequate analgesia.
19 (31%) patients have pathology on diagnostic laparoscopy, mainly endometriosis
5 (8%) patients were referred with less than 6 months history of CPP
20 (33%) patients presented with a 2-5 years history of CPP
Patients with chronic pelvic pain can present with a wide array of symptoms, with dyspareunia being the most common after chronic pelvic pain (fig 1).
20 (33%) patients did not have all the recommended investigations, and 5 (8%) patients had no investigations at all prior to the laparoscopy.
Only 37 (61%) patients received the recommended trial of hormone therapy prior to laparoscopy.
2 (3%) patient received empirical treatment for a suspected PID without confirmation of diagnosis
No complications were found from diagnostic laparoscopies
There is no correlation between presenting symptoms and the diagnosis on laparoscopy.
Detection rate of pathology on laparoscopy for women with CPP remains low, as only one third of cases have a confirmed diagnosis.
The adherence to RCOG guidelines is suboptimal.
There are many inconsistencies in management of patients with CPP.
Diagnostic laparoscopy remains a safe investigation if performed by experienced clinicians
The referral to secondary care should only be made if there is at least six months history of pelvic pain, and basic clinical investigations have been performed.
In secondary care, non-invasive investigations and treatments should be offered prior to surgical intervention,due to the poor pick up rate of laparoscopy.