The relationship between gynecological health and whole blood C-reactive protein

Whole blood C-reactive protein (hereinafter referred to as CRP) is not a specific marker for gynecological diseases, but it can be used as an auxiliary indicator to help determine the activity of gynecological infectious diseases, recovery status after gynecological surgery, and the progress of some non-infectious gynecological diseases. Abnormal CRP values ​​alone cannot be used to diagnose any gynecological diseases, nor can CRP be used to rule out gynecological problems.。

Last week, I met a 29-year-old girl in the outpatient clinic. She came to cry with the physical examination report from her workplace. She said that her CRP was three times higher than the normal value. She checked online and found that there was inflammation or even cancer. She was so scared that she couldn't sleep for half the night. When I asked, she had stayed up all night to catch up on projects the day before the physical examination, and she was still having her first menstrual period that day. Her menstrual cramps were so painful that she took two ibuprofen pills, but she felt no discomfort except for a little backache. I asked her to come back for a follow-up check 3 days after her period was clear, and the result was that her CRP had completely dropped back to the normal range, which was a false alarm.

Of course, this does not mean that the increase in CRP is entirely unfounded. When we encounter patients who do have gynecological discomfort, this indicator can help us avoid many detours. I previously treated a girl who suffered from lower abdominal pain for 3 days. She had a low-grade fever of 37.8°C. The white blood cells were just stuck at the critical value, but the CRP soared to 48 mg/L. Combined with the obvious tenderness in the adnexal area during the gynecological examination, she was treated directly as acute pelvic inflammatory disease. After 3 days of medication, the CRP dropped to 15 mg/L, and the abdominal pain was significantly relieved. However, there are also differences in the use of this indicator in the industry. One group believes that CRP is more sensitive to pelvic infection than white blood cells. As long as the value exceeds 20mg/L combined with physical signs, anti-infective treatment can be initiated. ； The other group believes that it is necessary to make a comprehensive judgment with procalcitonin, leucorrhea routine results and other results to avoid misdiagnosing the increase in CRP caused by endometriosis rupture and ovulation bleeding to stimulate the peritoneum as infection, and instead use the wrong antibiotics.

In addition to infection, CRP changes after gynecological surgery are also an important reference for us to judge recovery. Not long ago, there was a patient who had laparoscopic uterine myomectomy. The CRP rose to 32mg/L on the second day after the operation. The young doctor who was in charge of the bed was afraid of infection and wanted to add high-level antibiotics. I stopped him - the patient's temperature was up to 37.5°C, there was no redness, swelling and exudation in the wound, and there was no abnormal vaginal bleeding. This increase is most likely due to postoperative absorption heat and normal stress response. No need to add medication. Sure enough, the review on the fourth day after the operation dropped to 8mg/L, and he was discharged successfully. I would also like to mention here that many patients panic when they see high CRP after surgery. In fact, as long as there are no other abnormalities, a slight increase in CRP within 3 days after surgery is mostly normal, and there is no need to be overly anxious.

There are also many non-infectious gynecological problems that can also cause CRP to rise, such as active endometriosis, adenomyosis, and acute abdominal diseases such as ovarian cyst torsion and corpus luteum rupture, which will cause CRP to rise slightly due to local tissue damage and aseptic inflammation. The rise at this time is not caused by bacterial infection, and antibiotics are completely useless. The primary disease must be treated.

Many people think that since CRP can reflect problems, then if my CRP is normal during a physical examination, does that mean there are no gynecological problems? Not really. Problems such as chronic cervicitis, non-degenerated uterine fibroids, early cervical precancerous lesions, and static ovarian cysts will basically not cause changes in CRP throughout the body. Even if you already have symptoms such as contact bleeding and abnormal leucorrhea, CRP may still be completely normal. There are also a lot of related debates: some grassroots institutions will include CRP in women’s routine gynecological examination packages, believing that inflammation can be diagnosed in advance ； However, more gynecological experts think it is unnecessary. On the contrary, it will only increase anxiety for many women with elevated physiological CRP, and will also miss gynecological lesions with normal CRP.

I always like to use an analogy when explaining to patients: CRP is like a property alarm at the door of your home. When it goes off, it may be because a burglar has entered the home, or it may be because the wind blew the window, the kitten touched the door, or even you accidentally pressed it when you went out. If you really want to judge whether there is a gynecological problem, you must also look at it together with "in-door examinations" such as gynecological physical examination, B-ultrasound, routine leucorrhea, and cervical cancer screening. Don't scare yourself just when you hear the alarm sound, or even buy anti-inflammatory drugs indiscriminately, which will delay things.