Page 20 - ESHRE2019
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Proposed diagnostic approach to dysmenorrhea and/or CPP
Gynecologic
• Endometriosis
• Adenomyosis
• Adhesions
• Uterine fibroids
• Pelvic congestion • Ovarian remnant
Urologic
• Interstitial Cystitis/Painful Bladder Syndrome
• Urethral syndrome • Chronic UTI
• Bladder stones
Gastrointestinal
• IBS
• Chronic constipation • Chronic appendicitis • IBD
• Hernias
• Diverticular disease
Musculoskeletal
• Pelvic floor myalgia • Trigger points
• Low back pain
• Disc disease
• SI joint disease • Coccydynia
Peripheral nerves
•Peripheral nerve injury
Begin with • gold‐standard• therapies for all contributing factors
•Hormonal suppression •Diet •Surgery •Elmiron
•Mast cell inhibitors •Bladder instillations
•Diet
•Stimulants •Bulking agents •Anti-spasmodics
•Physical therapy •Nerve blocks •Muscle relaxants •Surgical release •injections
Decision for surgery in women with dysmenorrhea or CPP
Comprehensive evaluation for all sources of dysmenorrhea or CPP
yes
Laparoscopy
yes
no
Persistent or enlarging complex adnexal mass Clinical signs of obstruction (urinary tract, bowel)?
Continue empiric therapy & regularly reassess
Persistent pain, Unresponsive to NSAIDs and other eligible medical therapies?
15
yes
NSAIDs & treatment of COPCs
no
NSAIDs & treatment of COPCs
+ Empiric hormone suppression
no
Actively trying for pregnancy?
