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©2013 UpToDate ® Print Email Summary of recommendations for treatment of chronic pelvic pain from the American College of Obstetricians and Gynecologists Recommendations based on good, consistent scientific evidence (level A) 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 anit-inflammatory drugs Dysmenorrhea, moderate pain Progestins (daily, high dose) Endometriosis, pelvic congestion syndrome Laparoscopic ablation/resection of endometriosis Stage I-III endometriosis Presacral neurectomy Centrally located dysmenorrhea Uterine nerve ablation Not indicated [1] Adjunctive psychotherapy CPP References: Daniels J, Gray R, Hills RK, et al. Laparoscopic uterosacral nerve ablation for alleviating chronic pelvic pain: a randomized controlled trial. JAMA 2009; 302:955. ACOG chronic pelvic pain level B and C recommendations Recommendations based on limited or inconsistent scientific evidence (level B) Intervention Indication GnRH agonists CPP other than endometriosis Adhesiolysis CPP attributed to dense bowel adhesions Hysterectomy Reproductive tract symptoms Sacral nerve stimulation CPP Physical therapy CPP Nutritional supplementation with vitamin B1 or magnesium Dysmenorrhea Injection of trigger points CPP Application of magnets to trigger points Acupuncture, acupressor, transcutaneous nerve stimulation Primary dysmenorrhea Recommendations based on consensus and expert opinion (level C) Intervention Indication Antidepressants CPP Opioids CPP Adapted and modified from Clinical Management Guidelines for Obstetrician-Gynecologists. Number 51, March 2004: Chronic Pelvic Pain. Obstet Gynecol 2004; 103:589.
©2013 UpToDate ® Print Email Summary of recommendations for treatment of chronic pelvic pain from the American College of Obstetricians and Gynecologists Recommendations based on good, consistent scientific evidence (level A) 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 anit-inflammatory drugs Dysmenorrhea, moderate pain Progestins (daily, high dose) Endometriosis, pelvic congestion syndrome Laparoscopic ablation/resection of endometriosis Stage I-III endometriosis Presacral neurectomy Centrally located dysmenorrhea Uterine nerve ablation Not indicated [1] Adjunctive psychotherapy CPP References: Daniels J, Gray R, Hills RK, et al. Laparoscopic uterosacral nerve ablation for alleviating chronic pelvic pain: a randomized controlled trial. JAMA 2009; 302:955.