High probability of endometriosis

1. Nonsteroidal anti-inflammatory medications should be prescribed at doses in the upper end of the dose range (eg, ibuprofen 800 mg orally every six hours). If the first NSAID tried is not effective, another should be given.

2. Oral contraceptive pills (OCPs) prescribed as monthly cycles.

3. OCPs prescribed as "long cycles," with three to four months of continuous dosing of the active pill followed by one week off the pill are effective in women who fail cyclic therapy.

4. OCPs and NSAIDS can be prescribed individually or in combination.

Summary of Recommendations for Treatment of Chronic Pelvic Pain American College of Obstetricians and Gynecologists

Intervention

Indication

Combined oral contraceptive pills

Primary dysmenorrhea

GnRH agonists

Endometriosis, irritable bowel syndrome (may be given empirically in women with symptoms consistent with endometriosis)

Nonsteroidal antiinflammatory drugs

Dysmenorrhea, moderate pain

Progestins (daily, high dose)

Endometriosis, pelvic congestion syndrome

Laparoscopic ablation/resection of endometriosis

Stage I-III endometriosis

Intervention

Indication

Presacral neurectomy

Centrally located dysmenorrhea

Uterine nerve ablation

Centrally located dysmenorrhea

Adjunctive psychotherapy

CPP

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