Detecting Ovarian Cancer: Symptoms and Testing

The symptoms of ovarian cancer can be vague, making it difficult to detect in its early stages. Patients may present with persistent bloating, abdominal or pelvic pain, and difficulty eating. Women over the age of 50 who experience these symptoms more than 12 times a month or for more than a month should be offered CA125 testing. If the CA125 level is 35 IU/mL or greater, an urgent ultrasound scan of the pelvis should be arranged.

It is important to note that symptoms of ovarian cancer can overlap with less serious conditions, such as irritable bowel syndrome (IBS). However, IBS rarely arises for the first time in women over 50, so persistent symptoms should be investigated further.

Patients who suspect they may have Coeliac disease should be tested before starting a gluten-free diet. The tTG antibody test will produce a negative result if the patient is not consuming gluten, so a daily gluten-containing diet should be followed for at least 6 weeks prior to testing. By being aware of these symptoms and testing options, healthcare professionals can help detect ovarian cancer early and improve patient outcomes.

Copper IUD as Emergency Contraception in the UK

A copper-containing intrauterine device (IUD) can be used as emergency contraception in the UK. It can be inserted within 120 hours (five days) of the first episode of unprotected sexual intercourse or up to five days after the earliest expected date of ovulation, regardless of the number of episodes or time since unprotected sex. A negative pregnancy test is not required before insertion of the copper IUD as emergency contraception.

It is important to note that the copper IUD should not be used from 48 hours to four weeks postpartum, as it falls under the UK medical eligibility criteria category 3. This means that it is advised not to be used during this time. Additionally, there is no need for the patient to have taken the progesterone emergency contraception pill beforehand as they will be using the copper device as their emergency contraception. Overall, the copper IUD is a safe and effective option for emergency contraception in the UK.

Patients with recurrent vaginal candidiasis, defined as experiencing four or more documented episodes in one year with at least partial symptom resolution between episodes, should be considered for an induction-maintenance regime of oral fluconazole, according to NICE guidance. This involves prescribing an induction course of three doses of oral fluconazole 150 mg taken three days apart or an intravaginal antifungal for 10-14 days, followed by a maintenance regimen of six months of treatment with an oral or intravaginal antifungal.

While topical antifungals can be used for uncomplicated episodes of vaginal thrush, prescribing a course of topical treatment would be inappropriate for patients with recurrent symptoms. Instead, the induction-maintenance regime should be used.

Referral to gynaecology or dermatology may be appropriate for patients aged 12-15 years old, those with doubt about the diagnosis, those with unexplained treatment failure, or those with a non-albicans Candida species identified. Swabbing the discharge to confirm the diagnosis is important, but treatment should not be delayed for symptomatic patients. Therefore, starting treatment with the induction-maintenance protocol is appropriate for patients with recurrent infections.

Vaginal candidiasis, commonly known as ‘thrush’, is a prevalent condition that many women self-diagnose and treat. Candida albicans is responsible for 80% of cases, while other candida species cause the remaining 20%. Although most women have no predisposing factors, certain conditions such as diabetes mellitus, drug use (antibiotics, steroids), pregnancy, and immunosuppression (HIV) may increase the likelihood of developing vaginal candidiasis. Symptoms include non-offensive discharge resembling cottage cheese, vulvitis, dyspareunia, dysuria, itching, vulval erythema, fissuring, and satellite lesions.

Routine high vaginal swabs are not necessary if the clinical features are consistent with candidiasis. Treatment options include local or oral therapy. The NICE Clinical Knowledge Summaries recommends oral fluconazole 150 mg as a single dose as the first-line treatment. If oral therapy is contraindicated, a single dose of clotrimazole 500 mg intravaginal pessary may be used. If vulval symptoms are present, a topical imidazole may be added to an oral or intravaginal antifungal. Pregnant women should only use local treatments such as cream or pessaries, as oral treatments are not recommended.

Recurrent vaginal candidiasis is defined as four or more episodes per year by BASHH. Compliance with previous treatment should be checked, and the diagnosis of candidiasis should be confirmed. A high vaginal swab for microscopy and culture may be necessary, and a blood glucose test should be performed to exclude diabetes. Differential diagnoses such as lichen sclerosus should also be ruled out. An induction-maintenance regime may be used, consisting of oral fluconazole every three days for three doses as induction, followed by oral fluconazole weekly for six months as maintenance.

The approach to managing secondary dysmenorrhoea varies depending on the root cause.

Understanding Dysmenorrhoea

Dysmenorrhoea is a medical condition that is characterized by excessive pain during the menstrual period. It is classified into two types: primary and secondary dysmenorrhoea. Primary dysmenorrhoea affects up to 50% of menstruating women and usually appears within 1-2 years of the menarche. It is caused by excessive endometrial prostaglandin production. The pain typically starts just before or within a few hours of the period starting and is felt as suprapubic cramping pains that may radiate to the back or down the thigh. NSAIDs such as mefenamic acid and ibuprofen are effective in up to 80% of women, while combined oral contraceptive pills are used second line.

On the other hand, secondary dysmenorrhoea typically develops many years after the menarche and is the result of an underlying pathology. The pain usually starts 3-4 days before the onset of the period. Causes of secondary dysmenorrhoea include endometriosis, adenomyosis, pelvic inflammatory disease, intrauterine devices, and fibroids. Clinical Knowledge Summaries recommend referring all patients with secondary dysmenorrhoea to gynaecology for investigation. It is important to note that the intrauterine system (Mirena) may help dysmenorrhoea, but normal copper coils may worsen the condition.

If you experience ovarian hyperstimulation syndrome, your chances of developing ovarian torsion are higher. This is because the ovary becomes enlarged, which increases the risk of torsion. If you experience sudden pelvic pain and vomiting on one side, it may be a sign of ovarian torsion.

While an ovarian cyst can cause pelvic pain, the sudden onset of pain suggests a cyst accident, such as rupture, haemorrhage, or torsion.

Pelvic inflammatory disease typically causes pelvic pain, fever, and abnormal vaginal bleeding.

Appendicitis usually causes pain in the right iliac fossa.

Understanding Ovarian Torsion

Ovarian torsion is a condition where the ovary twists on its supporting ligaments, leading to a compromised blood supply. This can result in partial or complete torsion of the ovary. When the fallopian tube is also affected, it is referred to as adnexal torsion. The condition is commonly associated with ovarian masses, pregnancy, and ovarian hyperstimulation syndrome. Women of reproductive age are also at risk of developing ovarian torsion.

The most common symptom of ovarian torsion is sudden, severe abdominal pain that is often colicky in nature. Other symptoms include vomiting, distress, and in some cases, fever. Adnexal tenderness may be detected during a vaginal examination. Ultrasound may reveal free fluid or a whirlpool sign. Laparoscopy is usually both diagnostic and therapeutic for ovarian torsion.

Understanding Mastitis: Symptoms, Management, and Risks

Mastitis is a condition that occurs when the breast tissue becomes inflamed, and it is commonly associated with breastfeeding. It affects approximately 1 in 10 women and is characterized by symptoms such as a painful, tender, and red hot breast, as well as fever and general malaise.

The first-line management of mastitis is to continue breastfeeding, and simple measures such as analgesia and warm compresses can also be helpful. However, if a woman is systemically unwell, has a nipple fissure, or if symptoms do not improve after 12-24 hours of effective milk removal, treatment with antibiotics may be necessary. The most common organism causing infective mastitis is Staphylococcus aureus, and the first-line antibiotic is oral flucloxacillin for 10-14 days. It is important to note that breastfeeding or expressing should continue during antibiotic treatment.

If left untreated, mastitis can lead to the development of a breast abscess, which may require incision and drainage. Therefore, it is crucial to seek medical attention if symptoms persist or worsen. By understanding the symptoms, management, and risks associated with mastitis, women can take proactive steps to address this condition and ensure their overall health and well-being.

Breast Cancer Screening and Familial Risk Factors

Breast cancer screening is offered to women aged 50-70 years through the NHS Breast Screening Programme, with mammograms offered every three years. While the effectiveness of breast screening is debated, it is estimated that the programme saves around 1,400 lives annually. Women over 70 years may still have mammograms but are encouraged to make their own appointments.

For those with familial risk factors, NICE guidelines recommend referral to a breast clinic for further assessment. Those with one first-degree or second-degree relative diagnosed with breast cancer do not need referral unless certain factors are present in the family history, such as early age of diagnosis, bilateral breast cancer, male breast cancer, ovarian cancer, Jewish ancestry, or complicated patterns of multiple cancers at a young age. Women with an increased risk of breast cancer due to family history may be offered screening from a younger age.

Polycystic ovarian syndrome (PCOS) is diagnosed based on the Rotterdam criteria, which requires the presence of at least two of the following: oligo/anovulation, clinical and/or biochemical hyperandrogenism, and polycystic ovaries on ultrasound scanning. Patients may be asymptomatic or present with menstrual disturbance, infertility, obesity, male pattern hair loss, hirsutism, and acne. Blood tests can support the diagnosis, with elevated LH and testosterone levels being common findings. Mild prolactinaemia and insulin resistance may also be present. Ultrasound scanning is not necessary if the diagnosis is obvious on clinical and biochemical grounds. Confirming the diagnosis is important to rule out other potential causes and to monitor for associated health problems such as diabetes, cardiovascular disease, and endometrial cancer. Women with PCOS should have regular periods or progesterone-induced withdrawal bleeds to reduce the risk of endometrial hyperplasia and cancer.

Contraindications for Combined Oral Contraceptive Pill

The decision to prescribe the combined oral contraceptive pill is based on the UK Medical Eligibility Criteria (UKMEC), which categorizes potential cautions and contraindications on a four-point scale. UKMEC 1 represents a condition for which there is no restriction for the use of the contraceptive method, while UKMEC 4 represents an unacceptable health risk. Examples of UKMEC 3 conditions include controlled hypertension, immobility, and a family history of thromboembolic disease in first-degree relatives under 45 years old. Examples of UKMEC 4 conditions include a history of thromboembolic disease or thrombogenic mutation, breast cancer, and uncontrolled hypertension.

In 2016, the UKMEC was updated to reflect that breastfeeding between 6 weeks and 6 months postpartum is now classified as UKMEC 2 instead of UKMEC 3. Diabetes mellitus diagnosed over 20 years ago is classified as UKMEC 3 or 4 depending on severity. It is important for healthcare providers to consider these contraindications when deciding whether to prescribe the combined oral contraceptive pill to their patients.

There is not enough evidence to recommend any specific treatment for recurrent BV in primary care. However, in women with an intrauterine contraceptive device and persistent BV, it may be advisable to remove the device and suggest an alternative form of contraception.

Bacterial vaginosis (BV) is a condition where there is an overgrowth of anaerobic organisms, particularly Gardnerella vaginalis, in the vagina. This leads to a decrease in the amount of lactobacilli, which produce lactic acid, resulting in an increase in vaginal pH. BV is not a sexually transmitted infection, but it is commonly seen in sexually active women. Symptoms include a fishy-smelling vaginal discharge, although some women may not experience any symptoms at all. Diagnosis is made using Amsel’s criteria, which includes the presence of thin, white discharge, clue cells on microscopy, a vaginal pH greater than 4.5, and a positive whiff test. Treatment involves oral metronidazole for 5-7 days, with a cure rate of 70-80%. However, relapse rates are high, with over 50% of women experiencing a recurrence within 3 months. Topical metronidazole or clindamycin may be used as alternatives.

Bacterial vaginosis during pregnancy can increase the risk of preterm labor, low birth weight, chorioamnionitis, and late miscarriage. It was previously recommended to avoid oral metronidazole in the first trimester and use topical clindamycin instead. However, recent guidelines suggest that oral metronidazole can be used throughout pregnancy. The British National Formulary (BNF) still advises against using high-dose metronidazole regimens. Clue cells, which are vaginal epithelial cells covered with bacteria, can be seen on microscopy in women with BV.

The use of SSRI medications, either continuously or during the luteal phase, may be beneficial in managing premenstrual syndrome (PMS). This is especially true for patients who have not seen improvement with first-line treatments such as combined oral contraceptive pills. Co-cyprindiol, levonorgestrel-releasing intrauterine systems, mirtazapine, and copper coils are not indicated for the management of PMS.

Understanding Premenstrual Syndrome (PMS)

Premenstrual syndrome (PMS) is a condition that affects women during the luteal phase of their menstrual cycle. It is characterized by emotional and physical symptoms that can range from mild to severe. PMS only occurs in women who have ovulatory menstrual cycles and doesn’t occur before puberty, during pregnancy, or after menopause.

Emotional symptoms of PMS include anxiety, stress, fatigue, and mood swings. Physical symptoms may include bloating and breast pain. The severity of symptoms varies from woman to woman, and management options depend on the severity of symptoms.

Mild symptoms can be managed with lifestyle advice, such as getting enough sleep, exercising regularly, and avoiding smoking and alcohol. Specific advice includes eating regular, frequent, small, balanced meals that are rich in complex carbohydrates.

Moderate symptoms may benefit from a new-generation combined oral contraceptive pill (COCP), such as Yasmin® (drospirenone 3 mg and ethinylestradiol 0.030 mg). Severe symptoms may benefit from a selective serotonin reuptake inhibitor (SSRI), which can be taken continuously or just during the luteal phase of the menstrual cycle (for example, days 15-28, depending on the length of the cycle). Understanding PMS and its management options can help women better cope with this condition.

When starting the combined oral contraceptive pill, it is important to inform women that there is a slight increase in the risk of breast and cervical cancer. However, it is also important to note that the pill is protective against ovarian and endometrial cancer.

Pros and Cons of the Combined Oral Contraceptive Pill

The combined oral contraceptive pill is a highly effective method of birth control with a failure rate of less than one per 100 woman years. It is a convenient option that doesn’t interfere with sexual activity and its contraceptive effects are reversible upon stopping. Additionally, it can make periods regular, lighter, and less painful, and may reduce the risk of ovarian, endometrial, and colorectal cancer. It may also protect against pelvic inflammatory disease, ovarian cysts, benign breast disease, and acne vulgaris.

However, there are also some disadvantages to consider. One of the main drawbacks is that people may forget to take it, which can reduce its effectiveness. It also offers no protection against sexually transmitted infections, so additional precautions may be necessary. There is an increased risk of venous thromboembolic disease, breast and cervical cancer, stroke, and ischaemic heart disease, especially in smokers. Temporary side effects such as headache, nausea, and breast tenderness may also be experienced.

Despite some reports of weight gain, a Cochrane review did not find a causal relationship between the combined oral contraceptive pill and weight gain. Overall, the combined oral contraceptive pill can be a safe and effective option for birth control, but it is important to weigh the pros and cons and discuss any concerns with a healthcare provider.

According to BASHH, recurrent vaginal candidiasis is characterized by experiencing four or more episodes per year. This criterion is significant as it helps determine the need for prophylactic treatment to prevent future recurrences.

Vaginal candidiasis, commonly known as ‘thrush’, is a prevalent condition that many women self-diagnose and treat. Candida albicans is responsible for 80% of cases, while other candida species cause the remaining 20%. Although most women have no predisposing factors, certain conditions such as diabetes mellitus, drug use (antibiotics, steroids), pregnancy, and immunosuppression (HIV) may increase the likelihood of developing vaginal candidiasis. Symptoms include non-offensive discharge resembling cottage cheese, vulvitis, dyspareunia, dysuria, itching, vulval erythema, fissuring, and satellite lesions.

Routine high vaginal swabs are not necessary if the clinical features are consistent with candidiasis. Treatment options include local or oral therapy. The NICE Clinical Knowledge Summaries recommends oral fluconazole 150 mg as a single dose as the first-line treatment. If oral therapy is contraindicated, a single dose of clotrimazole 500 mg intravaginal pessary may be used. If vulval symptoms are present, a topical imidazole may be added to an oral or intravaginal antifungal. Pregnant women should only use local treatments such as cream or pessaries, as oral treatments are not recommended.

Recurrent vaginal candidiasis is defined as four or more episodes per year by BASHH. Compliance with previous treatment should be checked, and the diagnosis of candidiasis should be confirmed. A high vaginal swab for microscopy and culture may be necessary, and a blood glucose test should be performed to exclude diabetes. Differential diagnoses such as lichen sclerosus should also be ruled out. An induction-maintenance regime may be used, consisting of oral fluconazole every three days for three doses as induction, followed by oral fluconazole weekly for six months as maintenance.

The correct answer is to double the dose of levonorgestrel to 3 mg by mouth for this patient, as she has a weight of over 70kg, despite having a healthy BMI. This information is based on the BNF guidelines.

Inserting a copper intrauterine device would not be the best option for this patient, as she already has plans for levonorgestrel device insertion and may be using it for additional hormonal benefits, such as reducing the heaviness of her bleeding.

Inserting the levonorgestrel uterine system would not provide the emergency contraception required for this patient, as it takes about 7 days to become effective. Therefore, it is not appropriate in this situation.

The standard dose of levonorgestrel 1.5mg would be given to females who weigh less than 70 kg or have a BMI less than 26. However, in this case, it would be inappropriate due to the patient’s weight being over 70kg.

It would be risky to suggest to this patient that she doesn’t need to take another form of emergency contraception, as the initial pill may not have prevented ovulation during this cycle.

Emergency contraception is available in the UK through two methods: emergency hormonal contraception and intrauterine device (IUD). Emergency hormonal contraception includes two types of pills: levonorgestrel and ulipristal. Levonorgestrel works by stopping ovulation and inhibiting implantation, and should be taken as soon as possible after unprotected sexual intercourse (UPSI) for maximum efficacy. The single dose of levonorgestrel is 1.5mg, but should be doubled for those with a BMI over 26 or weight over 70kg. It is safe and well-tolerated, but may cause vomiting in around 1% of women. Ulipristal, on the other hand, is a selective progesterone receptor modulator that inhibits ovulation. It should be taken within 120 hours after intercourse, and may reduce the effectiveness of hormonal contraception. The most effective method of emergency contraception is the copper IUD, which may inhibit fertilization or implantation. It must be inserted within 5 days of UPSI, or up to 5 days after the likely ovulation date. Prophylactic antibiotics may be given if the patient is at high-risk of sexually transmitted infection. The IUD is 99% effective regardless of where it is used in the cycle, and may be left in-situ for long-term contraception.

Suspected Inflammatory Breast Cancer

This patient’s medical history raises concerns for inflammatory breast cancer, a rare but easily missed subtype of breast cancer. Despite accounting for only 1-5% of cases, inflammatory breast cancer can be difficult to diagnose and is often initially misdiagnosed as mastitis. The patient’s unilateral nipple retraction, which she attributes to breastfeeding, is also a suspicious sign. Therefore, it is crucial to have a high level of suspicion and refer the patient to a breast clinic urgently.

In this scenario, advising the patient to stop breastfeeding, massage the nipple, or use a breast shield would not be appropriate. Referring routinely without considering the severity of the potential diagnosis would also not be appropriate. It is essential to prioritize the patient’s health and well-being by taking swift and appropriate action.

To avoid the need for additional barrier contraception, the woman should begin taking the pill immediately as she is currently menstruating and therefore not at risk of pregnancy. The combined contraceptive pill, except for Qlaira and Zoely, can be started within the first five days of a menstrual cycle without requiring further contraception. If started on day six or later, seven days of barrier contraception or abstinence is recommended. Waiting until day eight or the next menstrual period is unnecessary as the starting rules remain the same.

Pros and Cons of the Combined Oral Contraceptive Pill

The combined oral contraceptive pill is a highly effective method of birth control with a failure rate of less than one per 100 woman years. It is a convenient option that doesn’t interfere with sexual activity and its contraceptive effects are reversible upon stopping. Additionally, it can make periods regular, lighter, and less painful, and may reduce the risk of ovarian, endometrial, and colorectal cancer. It may also protect against pelvic inflammatory disease, ovarian cysts, benign breast disease, and acne vulgaris.

However, there are also some disadvantages to consider. One of the main drawbacks is that people may forget to take it, which can reduce its effectiveness. It also offers no protection against sexually transmitted infections, so additional precautions may be necessary. There is an increased risk of venous thromboembolic disease, breast and cervical cancer, stroke, and ischaemic heart disease, especially in smokers. Temporary side effects such as headache, nausea, and breast tenderness may also be experienced.

Despite some reports of weight gain, a Cochrane review did not find a causal relationship between the combined oral contraceptive pill and weight gain. Overall, the combined oral contraceptive pill can be a safe and effective option for birth control, but it is important to weigh the pros and cons and discuss any concerns with a healthcare provider.

Treatment for Dyspareunia in postmenopausal Women

This postmenopausal woman is experiencing dyspareunia due to atrophic vaginitis caused by a lack of estrogen. While topical or systemic hormone replacement therapy can be effective treatments, this patient specifically doesn’t want hormonal treatment. In this case, the best option is Sylk moisturizer, one of two non-hormonal preparations available for vaginal atrophy. Replens is the other option.

It’s important to note that KY jelly is a lubricant only and doesn’t come with an applicator. Sylk and Replens are classified as vaginal moisturizers, which can be applied every few days and provide long-lasting relief, including relief of itching. KY jelly, on the other hand, is only effective until the water evaporates, which is typically within an hour.

In summary, for postmenopausal women experiencing dyspareunia due to atrophic vaginitis, non-hormonal vaginal moisturizers like Sylk and Replens can be effective treatments.

Due to the presence of positive antiphospholipid antibodies in systemic lupus erythematosus (SLE), the use of the combined oral contraceptive pill (COCP) is classified as UK Medical Eligibility Criteria for Contraceptive Use UKMEC 4, which is an absolute contraindication. The risk of arterial and venous thrombosis is unacceptably high, and alternative contraceptive options should be considered. It should be noted that the isolated presence of antiphospholipid antibodies, but not the diagnosis of antiphospholipid syndrome, is also classified as UKMEC 4. If the patient had SLE without antiphospholipid antibodies or did not test positive again after 12 weeks, the use of the COCP would be classified as UKMEC 2. The statement that the advantages of using the pill generally outweigh the risks is not correct, as this is equivalent to UKMEC 2. The statement that the risks usually outweigh the advantages of using the COCP is also not correct, as this is equivalent to UKMEC 3. Finally, the statement that there is no risk or contraindication to restarting the COCP is not correct, as this is equivalent to UKMEC 1.

Contraindications for Combined Oral Contraceptive Pill

The decision to prescribe the combined oral contraceptive pill is based on the UK Medical Eligibility Criteria (UKMEC), which categorizes potential cautions and contraindications on a four-point scale. UKMEC 1 represents a condition for which there is no restriction for the use of the contraceptive method, while UKMEC 4 represents an unacceptable health risk. Examples of UKMEC 3 conditions include controlled hypertension, immobility, and a family history of thromboembolic disease in first-degree relatives under 45 years old. Examples of UKMEC 4 conditions include a history of thromboembolic disease or thrombogenic mutation, breast cancer, and uncontrolled hypertension.

In 2016, the UKMEC was updated to reflect that breastfeeding between 6 weeks and 6 months postpartum is now classified as UKMEC 2 instead of UKMEC 3. Diabetes mellitus diagnosed over 20 years ago is classified as UKMEC 3 or 4 depending on severity. It is important for healthcare providers to consider these contraindications when deciding whether to prescribe the combined oral contraceptive pill to their patients.

Management of Unscheduled Bleeding in a Young Lady on Depo-Provera Injection

This patient is a young lady who has been experiencing unscheduled bleeding after being put on the Depo-Provera injection. However, she has no red flag symptoms and is up-to-date with her cervical smears, which provides reassurance to her history. At this stage, blood tests and a pelvic ultrasound scan are not necessary, but may be considered later on. Referral to a gynaecologist is not indicated as there are no alarming symptoms present.

It is important to follow advice from the cervical screening hub regarding cervical smears and not order one sooner than indicated. If any alarming symptoms arise, referral to a gynaecologist is recommended. For women experiencing unscheduled bleeding while on a progesterone-only injectable and who are medically eligible, a combined oral contraceptive can be offered for three months in the usual cyclic manner. The longer-term use of the combined contraceptive pill with the injectable progesterone is a matter of clinical judgement.

Mild cases of pelvic inflammatory disease do not require removal of intrauterine contraceptive devices.

Pelvic inflammatory disease (PID) is a condition where the female pelvic organs, including the uterus, fallopian tubes, ovaries, and surrounding peritoneum, become infected and inflamed. It is typically caused by an infection that spreads from the endocervix. The most common causative organism is Chlamydia trachomatis, followed by Neisseria gonorrhoeae, Mycoplasma genitalium, and Mycoplasma hominis. Symptoms of PID include lower abdominal pain, fever, dyspareunia, dysuria, menstrual irregularities, vaginal or cervical discharge, and cervical excitation.

To diagnose PID, a pregnancy test should be done to rule out an ectopic pregnancy, and a high vaginal swab should be taken to screen for Chlamydia and Gonorrhoea. However, these tests may often be negative, so consensus guidelines recommend having a low threshold for treatment due to the potential complications of untreated PID. Management typically involves oral ofloxacin and oral metronidazole or intramuscular ceftriaxone, oral doxycycline, and oral metronidazole. In mild cases of PID, intrauterine contraceptive devices may be left in, but the evidence is limited, and removal of the IUD may be associated with better short-term clinical outcomes according to recent guidelines.

Complications of PID include perihepatitis (Fitz-Hugh Curtis Syndrome), which occurs in around 10% of cases and is characterized by right upper quadrant pain that may be confused with cholecystitis, infertility (with a risk as high as 10-20% after a single episode), chronic pelvic pain, and ectopic pregnancy.