Chronic Pelvic Pain

Chronic pelvic pain (CPP) is defined as pelvic pain lasting more than 6 months. Some authors add the additional criteria that the pain be noncyclic. It is one of the most common presenting complaints in gynecologic practice, affecting as many as one in seven American women. Chronic pelvic pain comprises up to 10% of outpatient gynecologic visits, accounts for 20% of laparoscopies, and results in 12% (75,000 / year) of all hysterectomies performed annually in the United States. Estimated annual direct medical costs for outpatient visits for chronic pelvic pain in the United States among women 18 to 50 years old is estimated to be $881.5 million. It is often an extremely frustrating condition for both patient and care provider because in many cases an etiology cannot be identified and there is no apparent pathology. Treatment of presumed underlying conditions is frequently ineffective, and the “pain itself becomes the illness.” Because the cause often cannot be identified, chronic pelvic pain is frequently attributed to psychogenic causes. Although these may play a role in chronic pelvic pain for some women with lack of an identifiable cause, this does not necessarily equate with a psychosomatic origin for this complaint. Common Read more […]

Botanical Treatment Of Chronic Pelvic Pain

Effective botanical treatment of chronic pelvic pain requires a clear understanding of possible etiologies and the appropriate treatment of the underlying cause of the pain. For patients with diagnosed gynecologic conditions associated with pelvic pain, readers are referred to the relevant chapters in this textbook, such as, dysmenorrhea, interstitial cystitis, uterine fibroids, endometriosis, and so forth. Treatments discussed in the following may be used as adjunct palliative therapies for pain, inflammation, and concomitant symptoms in these conditions. In the absence of a clearly identified pathology, the practitioner can approach treatment symptomatically via specific botanical treatments for pain reduction, and attempt to address mechanisms that may be associated with CPP, for example, inflammation. One theory of chronic pelvic pain that was popular among physicians in the early-and mid-twentieth century, and that is still considered a possibility, is that of pelvic congestion syndrome. Women with this syndrome, which is poorly defined, are thought to exhibit many of the symptoms associated with CPP, including aching and dragging sensations in the lower back, lower abdomen, and pelvis, dysmenorrhea, and dyspareunia. Read more […]

Botanical Treatment Of Chronic Pelvic Pain: Marijuana

One herb, not available widely (or at least, legally available) for clinical use that has clinically demonstrated significant uterine antispasmodic and analgesic effects is Cannabis indica, more commonly referred to as marijuana. This controversial medicinal plant and recrea-tionally used herb has a long history of use for relief of uterine spasms and dysmenorrhea, considered by the Eclectics to be a “soothing uterine tonic.” In fact, its use is ancient, with references and artifacts of its use found widely in Middle Eastern, Ayurvedic, and Semitic writings, continuing through to its medical use in Europe well into the late nineteenth century for the treatment of a variety of gynecologic and obstetric conditions, not limited to but including dysmenorrhea. A pharmaceutical product from the late nineteenth century, Dysmenine Compound, produced by the Keysall Pharmical Company, Kansas City, MO, contained Cannabis, Cypripedium, Scutellaria, Pulsatilla, Viburnum prunifolium, Caulophyllum, Viburnum opulus, and Capsicum. The compound was indicated for dysmenorrhea, menstrual colic, and cramps. Indeed, this formula is not very different from one that might be prescribed by herbalists today (see sample formulae in the following); Read more […]

Botanical Treatment Of Chronic Pelvic Pain: Motherwort

Motherwort (Leonurus cardiaca) is a classic herb for the treatment of pelvic pain. Its actions appear to modulate both relaxant and contractile activity of the uterus, perhaps with an overall effect of regulating a balance between the two for effective uterine muscle activity. The commonly used Western species L. cardiaca has barely been evaluated for its effects in gynecology, whereas Chinese species have been evaluated in several investigations and have been found to have stimulating effects on the myometrium in vivo. The effect on the uterine smooth muscle may be related to alteration of the ion concentration in relation to myoelectric activity, resulting in the increase of myoelectric activity of pace setter cells as well as in the acceleration of depolarization of spike activity. Leonurine, a plant alkaloid present in Chinese motherwort, has demonstrated some efficacy as a vascular smooth tone inhibitor, possibly through inhibition of Ca+ influx and the release of intracellular Ca+. It is uncertain whether these findings and effects can be extrapolated to effects on uterine vascular tone. Other studies have demonstrated interesting effects on mediators of the inflammatory and coagulation pathways in relationship Read more […]

Botanical Treatment Of Chronic Pelvic Pain: Anti-inflammatories

Dong Quai Dong quai possesses antispasmodic, analgesic, anti-inflammatory antioxidant, uterine tonic, as well as specific immunomodulatory effects (see Plant Profiles). Immunostimulatory and anti-inflammatory effects have been attributed to isolated ferulic acid. It has been used traditionally in Chinese medicine for the treatment of “blood vacuity” and “blood stasis,” which may be considered related tochronic pelvic pain. Evening Primrose Oil It is thought that the use of evening primrose oil (evening primrose oil), with its high gamma linoleic acid content, may preferentially promote the synthesis of anti-inflammatory prostaglandin series over inflammatory prostaglandins. One critical review of the effects of evening primrose oil for the treatment of PMS concluded that there was no benefit. However, in a study of women (n = 40) who experienced symptoms of irritable bowel syndrome (IBS) just prior to and at the onset of menstruation, 53% reported an improvement in symptoms, whereas no improvement was seen in the placebo group. Improvement generally took 2 to 3 months to become apparent. Blood analysis at the beginning and end of treatment revealed significant improvement in fatty acid imbalances in the evening primrose Read more […]

Formulae For Chronic Pelvic Pain Treatment

The following is a small selection of possible formulae to illustrate formulation strategies for chronic pelvic pain treatment. These various formulae can be used concurrently, or elements from several may be combined to create a unique formula for individual patients. Other herbs discussed above may be substituted if they are more specifically indicated to a particular patient’s presenting picture. Further, chronic pelvic pain treatment, as discussed, almost invariably requires readers to refer to other relevant sections of this site for treatment options, for example, dysmenorrhea or interstitial cystitis. Formulae for Chronic Pelvic Pain General Tincture for CPP: Uterine Tonic / Antispasmodic Blue cohosh (Caulophyllum thalictroides) 20 mL Cramp bark (Viburnum opulus) 20 mL Peony (Paeonia lactiflora) 20 mL Motherwort (Leonurus cardiaca) 15 mL Horse chestnut (Aesculus hippocastanum) 15 mL Yarrow (Achillea millefolium) 10 mL Total: 100 mL Dose: 5 mL twice daily This formula is an example of one that combines a variety of actions into a general formula that can be used long-term and daily for the treatment of chronic pelvic pain for women with Read more […]

Chronic Pelvic Pain: Additional Therapies

Muscle Relaxation and Re-education, Biofeedback, and Electrical Stimulation Muscle tension in the pelvis, hips, and lower back may be caused by, or lead to CPP. Helping a woman to identify and relax tension, become aware of and adjust her body mechanics and standing and sitting posture, and wear appropriate shoes to minimize postural problems can help to reduce pain caused by structural imbalances. Pelvic relaxation training techniques should be taught and practiced regularly. Much of this can be done at home, but physical therapy can be helpful if there is limited joint movement or muscular problems. Prolonged sitting or standing can aggravate CPP, so patients may need suggestions and supportive counseling for modifying jobs or activities that require positions that exacerbate the problem. Exercises such as running or high-impact aerobics also may be aggravating, and should be replaced with gentler, relaxing forms of exercise, for example, walking, tai chi, yoga, or dance. Physical therapy for the treatment of musculoskeletal problems or postural problems can be beneficial for women with CPP. Biofeedback machines can be effective in helping women to identify and improve the effectiveness of pelvic muscle relaxation Read more […]


Endometriosis is one of the most common gynecologic problems in the United States and a leading gynecologic cause of both hospitalization and hysterectomy. Women with symptomatic endometriosis face chronic and sometimes debilitating pain; asymptomatic and symptomatic women alike may experience significant fertility problems due to this condition. The least-biased estimate for the overall prevalence of endometriosis in reproductive-age women is about 10%. Endometriosis is defined as the presence and growth of endometrial tissue in locations outside of the uterus. These cells may appear on the ovaries, fallopian tubes, bowel, bladder, peritoneal tissue, ligaments, or other structures in the abdominal cavity, and rarely may occur at other sites, including the nasal and respiratory passages leading to nosebleeds or pink frothy sputum at the time of the menses. Displaced endometrial tissue responds to cyclic hormonal changes, proliferating and shedding outside of the uterus. The bleeding is accompanied by inflammation caused by irritation of local tissue, such as, the peritoneum. Recurrent inflammation can cause scarring and adhesions that can cause pain and dysfunction of other affected sites. Endometriosis is common in Read more […]

Endometriosis: Conventional Treatment Approaches

Medical treatment of endometriosis includes both pharmaceutical and surgical approaches. Pharmaceutical treatments provide only suppression of the disease; they do not exact a cure. Decisions regarding treatment are based on endometriosis severity and staging, symptom picture, and ultimately, the woman’s needs and goals, for example, desire for children in the future. For women experiencing mild symptoms (or none) and for women who are close to menopause, the appropriate treatment may be to do nothing. For women with mild to moderate symptoms, and those who desire pregnancy, the appropriate pharmacologic therapy should be considered, and if necessary, can be combined with conservative surgery. It should be noted that, in spite of medical treatment, endometriosis has a high recurrence rate of 5% to 20% unless total hysterectomy and bilateral oophorectomy are performed. With pharmacologic interventions, pain typically resumes upon cessation of medications, although initially with pain that is less intense than prior to treatment. Pain relief, pregnancy rates, and recurrence rates are similar with all treatment methods. The goal of pharmaceutical treatment is to interrupt patterns of endometrial stimulation and bleeding. Read more […]

Grapeseed extract: Uses. Dosage

Clinical Use Free radical damage has been strongly associated with virtually every chronic degenerative disease, including cardiovascular disease, arthritis and cancer. Clearly, due to the potent antioxidant activity of grapeseed, its therapeutic potential is quite broad. Most clinical studies have been conducted in Europe using a commercial product known as Endotelon┬«. Due to the poor bioavailability of high-molecular-weight proanthocyanidins, it is advised that products containing chiefly low-molecular-weight PCs be used in practice. FLUID RETENTION, PERIPHERAL VENOUS INSUFFICIENCY AND CAPILLARY RESISTANCE Several clinical studies have investigated the use of grapeseed extract in fluid retention, capillary resistance or venous insufficiency, producing positive results. Hormone replacement therapy and fluctuations in hormone levels can produce symptoms of venous insufficiency in some women. One large study involving 4729 subjects with peripheral venous insufficiency due to HRT showed that grapeseed extract decreased the sensation of heaviness in the legs in just over half the subjects by day 45 whereas 89.4% of subjects experienced an improvement by day 90. According to an open multicentre study of women aged Read more […]