Acute Pelvic Pain: Treatment Treatment of acute pelvic pain depends on the suspected etiology but may require surgical or gynecologic intervention. Conservative management is an important consideration for ovarian cysts, if torsion is not suspected, to avoid unnecessary pelvic surgery and the subsequent risk of infertility due to adhesions. The majority of unruptured ectopic pregnancies are now treated with methotrexate, which is effective in 84–96% of cases. However, surgical treatment may be required. Chronic Pelvic Pain Some women experience discomfort at the time of ovulation (mittelschmerz). Pain can be quite intense but is generally of short duration. The mechanism is thought to involve rapid expansion of the dominant follicle, although. | Chapter 051. Menstrual Disorders and Pelvic Pain Part 5 Acute Pelvic Pain Treatment Treatment of acute pelvic pain depends on the suspected etiology but may require surgical or gynecologic intervention. Conservative management is an important consideration for ovarian cysts if torsion is not suspected to avoid unnecessary pelvic surgery and the subsequent risk of infertility due to adhesions. The majority of unruptured ectopic pregnancies are now treated with methotrexate which is effective in 84-96 of cases. However surgical treatment may be required. Chronic Pelvic Pain Some women experience discomfort at the time of ovulation mittelschmerz . Pain can be quite intense but is generally of short duration. The mechanism is thought to involve rapid expansion of the dominant follicle although it may also be caused by peritoneal irritation by follicular fluid released at the time of ovulation. Many women experience premenstrual symptoms such as breast discomfort food cravings and abdominal bloating or discomfort. These moliminal symptoms are a good predictor of ovulation although their absence is less helpful. Dysmenorrhea Dysmenorrhea refers to the crampy lower abdominal discomfort that begins with the onset of menstrual bleeding and gradually decreases over the next 12-72 h. It may be associated with nausea diarrhea fatigue and headache and occurs in 60-93 of adolescents beginning with the establishment of regular ovulatory cycles. Its prevalence decreases after pregnancy and with the use of oral contraceptives. Primary dysmenorrhea results from increased stores of prostaglandin precursors which are generated by sequential stimulation of the uterus by estrogen and progesterone. During menstruation these precursors are converted to prostaglandins which cause intense uterine contractions decreased blood flow and increased peripheral nerve hypersensitivity resulting in pain. Secondary dysmenorrhea is caused by underlying pelvic pathology. Endometriosis results from the
