TAILIEUCHUNG - Chapter 051. Menstrual Disorders and Pelvic Pain (Part 4)

Polycystic Ovarian Syndrome: Treatment The major abnormality in patients with PCOS is the failure of regular, predictable ovulation. Thus, these patients are at risk for the development of dysfunctional bleeding and endometrial hyperplasia associated with unopposed estrogen exposure. Endometrial protection can be achieved with the use of oral contraceptives or progestins (medroxyprogesterone acetate, 5–10 mg, or prometrium, 200 mg daily for 10–14 days of each month). Oral contraceptives are also useful for management of hyperandrogenic symptoms, as is spironolactone, which functions as a weak androgen receptor antagonist. Management of the associated metabolic syndrome may be appropriate for some patients. | Chapter 051. Menstrual Disorders and Pelvic Pain Part 4 Polycystic Ovarian Syndrome Treatment The major abnormality in patients with PCOS is the failure of regular predictable ovulation. Thus these patients are at risk for the development of dysfunctional bleeding and endometrial hyperplasia associated with unopposed estrogen exposure. Endometrial protection can be achieved with the use of oral contraceptives or progestins medroxyprogesterone acetate 5-10 mg or prometrium 200 mg daily for 10-14 days of each month . Oral contraceptives are also useful for management of hyperandrogenic symptoms as is spironolactone which functions as a weak androgen receptor antagonist. Management of the associated metabolic syndrome may be appropriate for some patients Chap. 236 . For patients interested in fertility weight control is a critical first step. Clomiphene citrate is highly effective as first-line treatment with or without the addition of metformin. Exogenous gonadotropins can be used by experienced practitioners. Pelvic Pain The mechanisms causing pelvic pain are similar to those causing abdominal pain Chap. 14 and include inflammation of the parietal peritoneum obstruction of hollow viscera vascular disturbances and pain originating in the abdominal wall. Pelvic pain may reflect pelvic disease per se but may also reflect extrapelvic disorders that refer pain to the pelvis. In up to 60 of cases pelvic pain can be attributed to gastrointestinal problems including appendicitis cholecystitis infections intestinal obstruction diverticulitis or inflammatory bowel disease. Urinary tract and musculoskeletal disorders are also common causes of pelvic pain. Approach to the Patient Pelvic Pain A thorough history including the type location radiation and status with respect to increasing or decreasing severity can help to identify the cause of acute pelvic pain. Specific associations with vaginal bleeding sexual activity defecation urination movement or eating should be .