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  2. 2. CHRONIC PELVIC PAINGynecologic etiologies Gastrointestinal tract Endometriosis  Irritable bowel syndrome Pelvic inflammatory disease  Inflammatory bowel disease Adhesions  Diverticular colitis  Colon cancer Pelvic congestion syndrome  Chronic intestinal pseudo-obstruction Adenomyosis  Chronic constipation Ovarian cancer  Celiac disease Ovarian remnant and residual ovary syndrome Leiomyoma DysmenorrheaUrinary tract Interstitial cystitis/painful bladder syndrome
  3. 3. CAUSES cont’dMusculoskeletal system Mental health issues Fibromyalgia  Somatization disorder Coccydynia, piriformis/  Opiate dependency levator ani syndrome,  Physical and sexual pelvic floor tension myalgia abuse Posture  Depression Chronic abdominal wall  Sleep disorders pain Osteitis pubis
  4. 4. ENDOMETRIOSIS A common health problem among women of reproductive age. Endometrial-like glands and stroma grow in an extrauterine site.
  5. 5. ETIOLOGY Various theories regarding its etiology. Menstrual flow that produces a greater volume of retrograde menstruation may increase the risk of developing the disease. Early menarche, Regular cycles (especially with an absence of amenorrhea caused by pregnancy), longer and heavier flow are also associated factors.
  6. 6. ETIOLOGY cont’d Endometriosis is an estrogen-dependent disease Factors that reduce estrogen levels (e.g., menstrual disorders, decreased body-fat content and smoking) are associated with a reduced risk for developing the condition.
  7. 7. SIGNS AND SYMPTOMS Clinical manifestations of endometriosis vary and may be unpredictable in presentation and course. Dysmenorrhea, chronic pelvic pain, Dyspareunia, Uterosacral ligament nodularity Adnexal mass. Asymptomatic in many women
  8. 8. Pelvic Pain Pelvic pain caused by endometriosis falls into three categories:1. Secondary dysmenorrhea, with pain commencing before the onset of the menstrual cycle;2. Deep dyspareunia that is exaggerated during menses; or3. Sacral backache with menses.
  9. 9. Pain con’d The pain associated with endometriosis has little relationship to the type of lesions seen by laparoscopy. It has been shown that the depth of endometriosis lesions correlate with severity of pain. It is thought that painful lesions are those that involve peritoneal surfaces innervated by peripheral spinal nerves, not those innervated by the autonomic nervous system.
  10. 10. DIAGNOSIS A histologic examination should be done to confirm the presence of endometrial lesions.
  11. 11. TREATMENT Current evidence suggests that pain caused by endometriosis can be managed medically. Progestins, danazol, oral contraceptives, nonsteroidal anti- inflammatory drugs and gonadotropin-releasing hormone (GnRH) agonists.
  12. 12.  No medical therapy has been proved to eradicate the lesions.
  13. 13. SURGERY Surgery for women with endometrial pain is associated with significant reduction in pain during the first six months following surgery. up to 44 percent of women experience a recurrence of symptoms within one year. Data about whether surgical therapy influences long- term therapy are lacking, and there are no data to indicate whether medical or surgical therapy results in better fertility outcomes.