Role of a symptom-based algorithmic approach to chronic pelvic pain.
OBJECTIVE
Chronic pelvic pain (CPP) is a disorder that has a significant impact on the patient's quality of life. Laparoscopic diagnosis can be disappointing, and recurrence is common after surgical treatment. A symptom-based algorithmic approach to treatment of CPP is presented that is safe and cost-effective.


METHODS
This approach is oriented towards making a potential clinical diagnosis of endometriosis. It relies on a structured evaluation of the patient and administration of medical therapy including GnRH agonists to selected patients. Evaluation begins with a history and physical examination; selected cases receive specific therapy. Non-responders undergo appropriate laboratory and imaging studies. If results remain negative, it is possible to make a clinical diagnosis of endometriosis and begin empiric treatment.


RESULTS
Early results strongly indicate that using this approach allowed clinicians to make highly accurate diagnoses (correct in 85-90% of cases).


CONCLUSIONS
Use of this approach will minimize the need for surgery.
Winkel
C A
CA
Department of Obstetrics and Gynecology, Georgetown University Medical Center, Washington, DC, USA.winkelc@gunet.georgetown.edu
D000465:Algorithms; D002908:Chronic Disease; D004715:Endometriosis / Q000191:economics / Q000473:pathology / Q000628:therapy*; D005260:Female; D006801:Humans; D017699:Pelvic Pain / Q000191:economics / Q000473:pathology / Q000628:therapy*