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Chronic pelvic pain

Six months or more — a symptom, not a diagnosis.

Source: RCOG GTG 41
  • Screen for STIs; transvaginal scan; MRI for adenomyosis or deep endometriosis.
  • Cyclical pain: hormonal treatment for 3–6 months before laparoscopy.
  • Laparoscopy is second line: death about 1 in 10,000, injury about 2.4 in 1000; a third to half are normal.
  • IBS: antispasmodics. Neuropathic pain: amitriptyline or gabapentin. Avoid regular opioids.
  • Pain clinic or multidisciplinary team if poorly controlled.
A summary for trained clinicians. Always check the full guideline, the patient in front of you and your hospital's protocol. Spotted an error? Tell us.