HOW SHOULD WE APPROACH THE MANAGEMENT OF PELVIC PAIN

Pelvic pain is a common debilitating condition. Most investigations ar e invasive, expensive and usually negative. Although a positive diagno sis of endometriosis justifies a recognized treatment programme, the m ajority of women with negative investigations are left without a diagn osis and often accused of psychological abnormalities. The reasons for the negative investigations are just as likely to be due to the inade quate techniques of the operator as the lack of pathological signs. Th e early use of menstrual suppression with GnRH analogue allows pain re lief sooner in the majority of sufferers and separates those with pain related to the menstrual cycle, from whatever cause, from those whose pain is not related to pelvic physiology and who would not benefit fr om further medication or operative therapy. The majority, who have obt ained relief from the analogue therapy, then have time to discuss alte rnative long-term treatments without the feeling of desperation that c hronic monthly pelvic pain can produce.