Chronic pelvic pain and endometriosis
Chronic pelvic pain and endometriosis remain two of the most perplexing problems in gynecology. In some women with both conditions, endometriosis may not be the cause of their pain. The clinical dilemma lies in determining when the pain is caused by endometriosis. Other common causes of chronic pelvic pain should be considered. In those patients found to have endometriosis, three criteria may be used to determine if some or all of the chronic pelvic pain can be appropriately attributed to endometriosis. First the pelvic pain should be cyclic, since endometriosis is a hormonally responsive disease. Second, endometriosis should be diagnosed surgically to avoid overdiagnosing this condition. Finally, medical or surgical treatment of endometriosis should result in prolonged pain relief. Application of these evidence-based criteria serves as a reminder that endometriosis may often be asymptomatic, even in some women with chronic pelvic pain. These criteria may also assist the gynecologist in determining which women are likely to have resolution of their pain with the definitive surgical therapy of hysterectomy.
