Improvement of Severe Chronic Pelvic Pain and Dysmenorrhea Following Treatment with Cabergoline

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There are various methods of treating pelvic pain. Laparoscopic laser vaporization or excision may be effective but frequently the relief is short lived. Furthermore, surgery may lead to decreased egg reserve which already may be diminished secondary to the pelvic inflammation associated with endometriosis. Standard medical treatments aimed to block or decrease estrogen are frequently ineffective, may produce significant side effects and, have not been found to improve subsequent fecundity. They preclude pregnancy while they are employed. One theory as to the etiology of pelvic pain is that this excessive cellular permeability of the pelvic tissues leading to an exaggeration of infiltration of irritants into pelvic tissue, which in a more moderate form, may be part of the mechanism used by the female body to induce post-ovulatory inflammation with an increase in natural killer cells in the fetal microenvironment to help create spiral arteries. The theory contends that progesterone blocks dopamine, and dopamine acts to decrease cellular permeability. Whether the hypothesized mechanism is correct or not there has been considerable anecdotal experience demonstrating marked amelioration of active pain by purposely prescribing a drug known to release dopamine from sympathetic nerve fibers, i.e., dextroamphetamine sulfate. Unfortunately, for unknown reasons, amphetamines have been placed in the same category of drugs as potent opiates. This precludes their easy use by treating physicians. A pilot case with severe pelvic pain was chosen as a model case to determine if another drug that releases dopamine from sympathetic nerve fibers, cabergoline, could also prove effective in relieving pelvic pain. Indeed, in this one case there was marked reduction in pain. Thus, this case encourages the initiation of a larger study to determine if cabergoline can be a less controversial option for treating pelvic pain, while not precluding pregnancy.