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Pain medicine Terapia 2023, 6 ( 425 ) :  84  -  89

Endometriosis – the most common cause of pelvic pain, how to recognize and treat it?

Summary: Endometriosis is the most common cause of pelvic chronic pain syndrome and infertility in women of reproductive age. The problem concerns approx 6–10% of women, although this value may be underestimated. Endometriosis is characterized by the presence of endometrial glands and stroma outside the uterine cavity. Endometriosis focals are hormonally dependent on estrogen. There are many theories about the origin of endometriosis and many theories why it causes severe pain in a significant percentage of women. Nowadays, the diagnosis of endometriosis is based on a carefully collected medical history, clinical examination (gynecological examination) and pelvic ultrasound examination. In the diagnosis of endometriosis, the required intraoperative diagnosis and histopathological confirmation of the disease are currently not necessary. Treatment of pain in endometriosis is pharmacological treatment. In pharmacotherapy, we use continuous or intermittent hormonal treatment with estrogen-progesterone drugs. In the treatment of acute pain, we use non-steroidal anti-inflammatory drugs (NSAIDs) (keeping in mind their potential side effects). If symptoms of depression, anxiety or neuropathic pain coexist, we use antidepressants with a double mechanism of action (amitriptyline, duloxetine, milnacipran (drug unavailable in Poland) and anticonvulsants (gabapentin or pregabalin). Among the invasive methods we use: pudendal nerve blocks, Walter's ganglion blocks, blockade of the upper and lower hypogastric plexus Indications for surgical treatment are discussed in detail in this paper.
Keywords: pelvis, pain, endometriosis, diagnosis, ultrasonography, symptoms, treatment

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