Pelvic inflammatory disease
Pelvic inflammatory disease (PID) is an infection of any of a woman's pelvic organs, including the uterus, ovaries, or fallopian tubes, or the peritoneum, the membrane covering the abdominal cavity. One million women are diagnosed with PID annually in the United States, usually resulting from a sexually transmitted infection such as chlamydia or gonorrhea. Acute PID comes on suddenly and tends to be more severe, whereas chronic PID is a low-grade infection that may cause only mild pain and sometimes backache. If not treated promptly, PID can result in infertility and, in rare cases, death.
Signs and Symptoms
Acute PID is accompanied by the following signs and symptoms:
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Severe pain and tenderness in lower abdomen
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Vaginal discharge
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Fever
Chronic PID is accompanied by the following signs and symptoms:
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Mild, recurrent pain in the lower abdomen
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Backache
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Irregular menstrual periods
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Pain during intercourse
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Infertility
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Heavy, unpleasant-smelling vaginal discharge
What Causes It?
PID occurs when bacteria from the vagina or cervix infiltrate the normally sterile pelvic organs.
Who's Most At Risk?
People with the following conditions or characteristics are at risk for developing PID:
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Frequent sexual encounters, many partners
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History of sexually transmitted diseases or previous history of PID
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Young age (14 - 25 years old), particularly early age at first intercourse
What to Expect at Your Provider's Office
If you are experiencing symptoms associated with PID, you should see your health care provider. A combination of a physical exam, lab tests, imaging, and other procedures are used to make a diagnosis.
Treatment Options
Prevention
Barrier methods of birth control (condoms, diaphragms, vaginal spermicides) reduce the risk of PID. Rapid diagnosis and effective treatment of lower urinary tract infections can help prevent PID from developing. Experts recommend routine screening for infections in high-risk individuals.
Treatment Plan
Your health care provider may recommend hospitalization or outpatient treatment with follow-up. Outpatient therapy consists of rest and medications.
Drug Therapies
Your provider may prescribe the following antibiotics or combination of drugs:
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Doxycycline combined with metronidazole (do not drink alcoholic beverages with this medication)
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Ofloxacin combined with metronidazole (do not drink alcoholic beverages with this medication)
Surgical and Other Procedures
Some conditions, such as an abscess in the ovary or fallopian tube, may make surgery necessary.
Complementary and Alternative Therapies
A comprehensive treatment plan for PID may include a range of complementary and alternative therapies. PID can lead to serious complications. Complimentary therapies should be used only in conjunction with conventional medical interventions. Keep all of your prescribing doctors informed about any supplements or therapies you may be using.
Nutrition and Supplements
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Eliminate potential food allergens, including dairy, wheat (gluten), corn, soy, preservatives, and food additives. Your health care provider may want to test for food sensitivities.
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Eat calcium-rich foods, including beans, almonds, and dark green leafy vegetables (such as spinach and kale).
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Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes) and vegetables (such as squash and bell pepper).
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Avoid refined foods, such as white breads, pastas, and sugar.
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Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy) or beans for protein.
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Use healthy cooking oils, such as olive oil or vegetable oil.
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Reduce or eliminate trans-fatty acids, found in such commercially baked goods as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
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Avoid coffee and other stimulants, alcohol, and tobacco.
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Drink 6 - 8 glasses of filtered water daily.
You may address nutritional deficiencies with the following supplements:
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A multivitamin daily, containing the antioxidant vitamins A, C, E, the B-complex vitamins and trace minerals such as magnesium, calcium, zinc, and selenium.
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Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 tbsp. of oil one to two times daily, to help decrease inflammation. Cold-water fish, such as salmon or halibut, are good sources.
-
Probiotic supplement (containing
Lactobacillus acidophilus)
, 5-10 billion CFUs (colony forming units) a day, for maintenance of gastrointestinal and immune health. You should refrigerate your acidophilus products.
-
Grapefruit seed extract (
Citrus paradisi
), 100 mg capsule or 5 - 10 drops (in favorite beverage) three times daily, for antibacterial or antifungal activity and immunity.
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Methylsulfonylmethane (MSM), 3,000 mg twice a day, to help decrease inflammation.
Herbs
Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.
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Green tea (
Camellia sinensis
) standardized extract, 250 - 500 mg daily, for antioxidant effects. You may also prepare teas from the leaf of this herb.
-
Cat's claw (
Uncaria tomentosa
) standardized extract, 20 mg three times a day, for inflammation and antibacterial or antifungal activity.
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Bromelain (
Ananus comosus
) standardized, 40 mg three times daily, for pain and inflammation.
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Reishi mushroom (
Ganoderma lucidum
), 150 - 300 mg two to three times daily, for inflammation and for immunity. You may also take a tincture of this mushroom extract, 30 - 60 drops two to three times a day.
-
Olive leaf (
Olea europaea
) standardized extract, 250 - 500 mg one to three times daily, for antibacterial or antifungal activity and immunity. You may also prepare teas from the leaf of this herb.
Castor Oil Packs
Dampen a cloth with castor oil, and apply to the abdomen. Cover with saran wrap, then apply a heating pad over this pack. Used for 1 - 3 hours, castor oil packs can reduce cramping and pain in some patients.
Acupuncture
Acupuncture may help enhance immune function and reduce pain and inflammation, especially with chronic PID. Acupuncturists often will gear their protocols at draining what they call “Damp Heat” from the area. This is done using both acupuncture and Chinese herbal preparations.
Prognosis and Possible Complications
In 85% of cases, the initial treatment succeeds. In 75% of cases, patients do not experience a recurrence of the infection. However, when there is a recurrence, the likelihood of infertility increases with each episode of PID. Potential complications from PID include:
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A tubo-ovarian abscess
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Fallopian tube obstruction, which can result in ectopic pregnancy or infertility
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Chronic pelvic pain
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Sexual dysfunction
Following Up
Your health care provider will schedule a follow-up visit 48 - 72 hours after treatment is started. If you are diagnosed with PID, you should inform any sexual partners so that they can be examined and treated if the infection has been transmitted.
Supporting Research
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Office Practice of Medicine
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Carr BR, Blackwell RE.
Textbook of Reproductive Medicine
. Norwalk, CT: Appleton & Lange; 1993: 88-90.
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Acta Pharm
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Review Date:
8/5/2006
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Reviewed By: Ernest B. Hawkins, MS, BSPharm, RPh, Health Education Resources; and Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.
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