Nutcracker syndrome: a case-based review

Maharaj, D; Mohammed, SR; Caesar, K; Dindyal, S

doi:10.1308/rcsann.2023.0090

Cited by 2 publications

(1 citation statement)

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“…However, if pain relief is insufficient after three months of treatment, although it is difficult to define what is insufficient, diagnosis and treatment should be reconsidered. Other causes of pelvic pain might exist, such as venous congestion, adenomyosis, vascular pain such as Nutcrackers syndrome [56][57][58] and many others. Surgery is also an option for patients who do not tolerate the side effects of hormonal medications.…”

Section: Clinical Considerations Of Medical Therapymentioning

confidence: 99%

Endometriosis and Pelvic Pain: Understanding Medical Treatment.

Koninckx,

Ussia,

Viganò

et al. 2024

Preprint

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Peritoneal fluid is an ovarian exudate from the growing follicle or corpus luteum. Therefore, the free concentrations of estrogens and progesterone are always much higher than in plasma, especially after ovulation. The peritoneum is not vascularised, and peritoneal implants and the superficial portion of deep endometriosis are likely influenced mainly by peritoneal fluid. Follicular phase progesterone concentrations are as high as during the luteal phase in plasma. This explains that most peritoneal implants are rarely proliferative and out of phase with the endometrium. From some 5 mm of depth onwards, endometriosis is rather influenced by plasma hormone concentra-tions, and the deeper parts can be proliferative as the endometrium. Because of these progesterone concentrations, progesterone resistance has to be postulated, permitting endometriosis lesions to initiate and develop. This opens the discussion of whether endometriosis is similar to the basal endometrium. These peritoneal fluid concentrations are important to understand the natural history and medical therapy of endometriosis. Most medical therapies decrease ovarian function and affect peritoneal fluid steroid hormone concentrations. It is suggested that the efficacy of medical therapy for endometriosis-associated pain is a consequence of the decreased estrogen concentrations in the peritoneal cavity and that the local effect of progestins may not be determinant for pain relief. If this is true, a history of endometriosis should not be considered a contraindication for hormone re-placement therapy.

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Section: Clinical Considerations Of Medical Therapymentioning

confidence: 99%