1. Pelvic pain associated with severe dysmenorrhea and/or pain at the time of ovulation is likely due to endometriosis or adenomyosis. Women with endometriosis report premenstrual spotting, dyspareunia, dyschezia, poor relief of symptoms with nonsteroidal anti-inflammatory drugs, progressively worsening symptoms, inability to attend work or school during menses, and the presence of pelvic pain unrelated to menses more often than women with primary dysmenorrhea.
2. Nonhormonally responsive diseases should be considered for pain that is not related to menses, including chronic pelvic inflammatory disease, adhesions/inflammation from previous pelvic surgery, irritable bowel syndrome, diver-ticulitis, fibromyalgia, and interstitial cystitis.
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