The Management of Chronic Gynecologic Conditions During COVID and Beyond - Episode 15

Benefits of Recognizing Persistent Pelvic Pain and HMB

March 15, 2021
Ayman Al-Hendy, MD, PhD

,
Linda Bradley, MD

,
Stacey Missmer, ScD

,
Eric Surrey, MD

Supported by: AbbVie

To read an article summarizing key points from this video series, click here.

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Eric Surrey, MD, shares his thoughts on the benefits of recognition and direct communication to patients about persistent pelvic pain and heavy menstrual bleeding.

Ayman Al-Hendy, MD, PhD: Eric, I’m going to give you the last word. If you can briefly discuss the benefit of recognizing direct communication with the patient about these symptoms: the persistent pelvic pain, and the heavy menstrual bleeding.

Eric Surrey, MD: Thank you. It’s so rare I get the last word, so thank you. I’m sure I won’t. Clearly, with any medical condition, intervening earlier, doesn’t matter what the condition is. As soon as you can intervene, the less invasive the treatment will be and the less complicated the treatment will be; it might even be able to be very simple. As both Linda and Stacey have beautifully stated, there has to be communication. On the clinician side, there has to be the time taken to elicit the information, and it has to be the ability to validate the patient’s concerns. Also particularly, it’s not just the adolescents who may not know that this isn’t normal. It can be the woman in her twenties who says, “I’ve always had pelvic pain, my mom has pelvic pain, and my sisters both say this is my normal.” It’s not normal, and I think you have to drill down on the questions more. Do you have pain with your periods? Not really. Go further than that. It takes effort and it takes time, but it’s very critical to elicit this.

I think as Dr Bradley beautifully stated, one thing we mustn’t do, is just have a knee-jerk start of therapy without ruling out other causes, particularly pelvic pain and particularly uterine bleeding. Fibroid doesn’t equal bleeding. A patient can have endometrial hyperplasia. Don’t start a treatment until you know that you’re treating the right thing or you feel very confident about it.

I think with regard to persistent symptoms, I would just say it’s important to, again, as we’ve talked multiple times, find out what the patient’s goals are and address them in a realistic fashion. When we look at life-long because we’re hopefully taking care of patients and hopefully the problem has changed, but OB/GYN, the beauty of our field is to have a life-long relationship with patients, particularly those that are in general OB/GYN. The needs will change. Treating the high school student who can’t go to school because of pelvic pain becomes somebody who wants to get pregnant, so these needs change over time.

I would say first, don’t persist in therapies that are ineffective. It’s frustrating to you, to the patient, and it’s just bad medicine. Secondly, make sure you’re treating the right goal because the patient’s goals will change over time. Thirdly, provide access to the patient and provide appropriate follow-up. If you start a new therapy, it should be relatively soon thereafter. As she becomes more stable, you can stretch this out, but give her access. It doesn’t necessarily have to be you, the physician. There can be physician extenders who are part of our resources to help the patient who can call in to talk to someone to see if she actually needs to be seen. Nowadays, of course, we see many less patients, but as Linda has very accurately said, there’s some things you just can’t do over a computer.

Ayman Al-Hendy, MD, PhD: Absolutely. This has been an excellent discussion, and we hope that you found the information to be valuable to your clinical practice. Thank you all for watching this Contemporary OB/GYN KCast Program from MJH Studios. Thank you.

Transcript edited for clarity.


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