Login

Chronic Pelvic Pain

Definition:

Intermittent or constant pain in the lower abdomen or pelvis of at least 6 months’ duration, not occurring exclusively with menstruation or intercourse and not associated with pregnancy.

Refer to General Gynae Clinic

Information to include when referring

  • Indication of parity
  • Describe symptoms and effect on QOL, duration, relation to cycle
  • Her concerns
  • Irritable Bowel Syndrome (IBS) considered and treated
    • Doesn’t have pain on defecation / change in stool
    • ‘trial of dietary modification / antispasmodic unhelpful’
  • Any significant abnormal smears
  • Relevent past medical / surgical history
    • PID
    • Previous abdominal surgery
  • Current regular medication 

Investigations prior to referral

  • Swabs (Chlamydia / HVS)
  • Pelvic USS

Desirable Information

  • Smear history (including last smear & result) the patient will still be seen without this but if you can retrieve it automatically it speeds up the appointment
  • Treatment so far
    • Eg COCP  / Mirena
  • Expectations of referral

Red Flag Symptoms

If >50 years with persistent / frequent (>12 times per month) symptoms of abdominal distension / bloating, feeling full and/or loss of appetite, pelvic or abdominal pain, increased urinary urgency and / or frequency consider serum Ca125.  If >35 IU/L arrange urgent pelvic USS and refer urgently if suggestive of ovarian cancer

Reference:

RCOG Greentop Guideline No 41 April 2005 ‘The initial management of chronic pelvic pain’

NICE Guideline April 2011 Ovarian Cancer The recognition and initial management of ovarian cancer

Download Chronic Pelvic Pain PDF