Management of Pelvic Pain from Dysmenorrhea or Endometriosis

Laeth Nasir, Edward T Bope
The Journal of the American Board of Family Practice · 2004 · vol. 17(90001) , pp. S43–S47 · doi:10.3122/jabfm.17.suppl_1.s43 · PMID:15575029 · W2124102979
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

Overweight and obesity were significantly associated with higher odds of hypertension, diabetes, and comorbidity among adults in Bangladesh, according to analysis of national survey data.

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This paper reviews management strategies for pelvic pain due to primary dysmenorrhea and endometriosis, focusing on high-level approaches used in outpatient/family practice settings. It summarizes evidence that pain in primary dysmenorrhea is mediated by prostaglandins and is usually resolved with NSAIDs or COX-2–specific inhibitors started around menses, with oral contraceptives or medroxyprogesterone added when needed; alternative modalities (e.g., heat, TENS, acupuncture, supplements) are also discussed. For endometriosis, it describes options including NSAIDs/COX-2 inhibitors, hormonal manipulation (OCPs, progestins, danazol, GnRH agonists) and surgery, and notes that empiric treatment can be effective in carefully screened low-risk patients, with the caveat that concomitant infection or pregnancy must be excluded and some regimens have limitations such as recurrence after GnRH agonists. This paper is centrally about endometriosis—summarizing evidence-based medical and surgical management approaches for endometriosis-related pelvic pain.

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Abstract

Objectives The study aimed to determine the association of overweight and obesity with hypertension, diabetes and comorbidity among the adults of Bangladesh. Study design This study used cross-sectional data from the nationally representative Bangladesh Demographic and Health Survey conducted in 2017–2018. The main outcome variables were hypertension, diabetes and comorbidity. Comorbidity was defined as the coexistence of hypertension and diabetes. Overweight and obesity, as measured by body mass index, were the main explanatory variables. The strength of the association was determined using the adjusted multiple logistic regression models. Setting Rural and urban areas in Bangladesh. Participants The study included a total of 11 881 adults (5241 men and 6640 women) aged 18 years or older. Results The prevalence of hypertension, diabetes and comorbidity among the sample population were 28.5%, 9.9% and 4.5%, respectively. Among the respondents, 20.1% were overweight and 4.1% were obese. The risk of hypertension was 2.47 times more likely in the overweight group (adjusted OR (AOR) 2.47; 95% CI 2.22 to 2.75) and 2.65 times more likely in the obese group (AOR 2.65; 95% CI 2.16 to 3.26) compared with the normal or underweight group. Adults who were overweight and obese had 59% (AOR 1.59; 95% CI 1.37 to 1.84) and 88% (AOR 1.88; 95% CI 1.46 to 2.42) higher odds of having diabetes, respectively, than normal or underweight adults. Moreover, the risk of comorbidity was 2.21 times higher in overweight adults (AOR 2.21; 95% CI 1.81 to 2.71) and 2.86 times higher in obese adults (AOR 2.86; 95% CI 2.09 to 3.91) compared with normal or underweight adults. Conclusions Using large-scale nationally representative data, we found that overweight and obesity were significantly associated with hypertension, diabetes and comorbidity. So, nationally representative data can be used for programme planning to prevent and treat these chronic conditions.
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Conclusion

Evidence supports the use of traditional NSAIDs and the COX-2 specific inhibitors in the treatment of pain associated with primary dysmenorrhea and endometriosis. High levels of effectiveness can be expected for both disorders, meaning that many women could find relief. Although endometriosis treatment has traditionally followed a surgical di- agnosis, there is also evidence to support treating Figure 2. Endometriosis treatment algorithm. S46 JABFP November–December 2004 Vol. 17 Supplement http://www.jabfp.org copyright. on 12 June 2026 by guest. Protected byhttp://www.jabfm.org/ J Am Board Fam Pract: first published as 10.3122/jabfm.17.suppl_1.S43 on 1 December 2004. Downloaded from endometriosis empirically in carefully screened women. Beyond NSAIDs and COX-2-specific in- hibitors, there are several medications that may help. Invasive procedures and surgical cures should be reserved for those who are not improved by the algorithms presented here.

References

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Condition tags

dysmenorrheaendometriosischronic_pelvic_pain

MeSH descriptors

Dysmenorrhea Endometriosis Pelvic Pain Algorithms Anti-Inflammatory Agents, Non-Steroidal Anti-Inflammatory Agents, Non-Steroidal Cyclooxygenase 2 Dysmenorrhea Endometriosis Female Humans Membrane Proteins Pelvic Pain Pelvic Pain Practice Guidelines as Topic Prostaglandin-Endoperoxide Synthases Prostaglandin-Endoperoxide Synthases

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