Chronic
pelvic pain has a prevalence of 15% to 30% of reproductive-age women. It causes a sizable minority of all gynecological visits, and is responsible for much physical and psychological suffering. Although laparoscopic inspection, plus treatment, for
pelvic pain has been considered ideal, it is often unnecessary, fruitless, and even hazardous, besides being expensive. Therefore, empirical medical
therapy has much to recommend it. Foremost is the fact that
endometriosis is the most frequent source of chronic
pelvic pain, and responds well to medical treatment. In fact,
GnRH analogs (agonists) used for 6 months can reduce AFS
endometriosis scores by one-half, with cure rates at 5 years of three-fourths of responders who had minimal disease and one-third of responders with severe disease.
Danazol and
oral contraceptives plus
NSAIDs have been used, too. The latter treatment is best reserved for cases involving
dysmenorrhea. The objections to empirical treatment-lack of exact knowledge of the entity being treated and the potential of overlooking
cancer-are discussed here in the context of
pain treatment, with an emphasis on history taking, diagnostic imaging, and careful observation.