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

The core relationship between gynecological health and whole blood C-reactive protein (hereinafter referred to as CRP) can be explained in one sentence: CRP is not a specific indicator of gynecological diseases, but as a sensitive marker reflecting systemic acute inflammation and tissue damage, it can assist in judging the progress of gynecological infectious diseases and recovery status after gynecological surgery. It is also related to the activity of some benign and malignant gynecological lesions. It is impossible to diagnose any gynecological disease by relying solely on elevated CRP.

Last Wednesday, I met a 27-year-old girl in the outpatient clinic. She suddenly had pain in her lower abdomen and broke out in a cold sweat while at work. A colleague helped her over. The tenderness and rebound pain in her lower body were obvious during the examination, and her leucorrhea was so yellow that it turned green. After an urgent full blood test, her CRP was 47. mg/L, the white blood cells were only a little high, so I treated it as acute pelvic inflammatory disease. After two days of targeted antibiotics, most of the pain was gone. When I checked again, the CRP had dropped to 6 mg/L, which was much faster than the white blood cell count.

In fact, there have been different voices in the industry regarding the application of CRP in gynecological inflammation: when I participated in the academic forum on gynecological infections two years ago, some scholars from the Department of Infectious Diseases believed that using CRP ≥ 20 mg/L as an auxiliary diagnostic threshold for pelvic inflammatory disease has a sensitivity of 92%, which is much more reliable than conventional white blood cell examination.； However, many front-line gynecologists do not agree with this statement - many patients with chronic pelvic inflammatory disease usually have distended lower abdomens and have hydrops in their fallopian tubes, but CRP has always been within the normal range. If they rely solely on indicator cards, it is easy to miss the diagnosis. After all, many inflammations in the reproductive tract are local and may not trigger acute phase reactions throughout the body. This is the core reason why CRP can only be used as an auxiliary and not as a basis for diagnosis.

In addition to inflammation, it is almost routine in our department to check CRP before and after gynecological surgery. Whether it is hysteroscopy to remove polyps or laparoscopic removal of ovarian cysts, CRP will rise transiently 24 hours after surgery. It is generally the body's normal response to surgical trauma and will drop in 2-3 days. Last year, I managed a 42-year-old patient who underwent uterine myomectomy. The CRP was 32 mg/L on the second day after the operation. I thought it was a normal postoperative reaction. However, the recheck on the third day went straight to 89. The patient also said she had a slight fever. I quickly opened the vagina to look at the stump. Sure enough, there was a small hematoma combined with infection. After cleaning the hematoma and changing antibiotics, the CRP fell off the next day, which was earlier than the reaction of body temperature and white blood cells.

But what many people don’t know is that elevated CRP does not mean that there is a gynecological problem. Last month, a girl came with a physical examination report and said that her CRP was 18mg/L. The medical examination agency said that she had pelvic inflammatory disease and needed lavage treatment. I asked around and found that she had neither abdominal pain nor abnormal leucorrhea, and the physical examination was fine. I asked again and found that she had just had her wisdom teeth extracted the day before the physical examination, and her face was still swollen. The high CRP was purely caused by the tooth extraction and had nothing to do with the gynecological half-cent. Some girls have severe menstrual cramps during pregnancy, or a small amount of corpus luteum bleeding during ovulation, and their CRP will rise slightly, so there is no need to be overly nervous at all.

There are also some non-infectious gynecological problems that may also be linked to elevated CRP. For example, in active stages of endometriosis and adenomyosis, because repeated bleeding from the lesions stimulates the surrounding tissue to produce an inflammatory reaction, many patients' CRP will remain in the mildly elevated range of 10-20mg/L all year round. ； In the advanced stages of gynecological malignant tumors such as ovarian cancer and cervical cancer, tumor tissue necrosis can also trigger an increase in CRP. Previous studies have used CRP and CA125 as a prognostic evaluation indicator for ovarian cancer. However, many gynecological oncologists have reservations - after all, when many benign ovarian cysts are infected, CRP will also rise very high. It is too hasty to rely on this alone to judge benign or malignant or prognosis.

In fact, I have been sitting in the clinic for so long, and I feel that CRP is like an "alarm light" that is not very accurate. When it comes on, it only means that there is inflammation or damage somewhere in your body. Whether it is a gynecological problem, or a cold, toothache, or gastroenteritis, you have to look at it in combination with symptoms, specialist physical examination, and other examinations. Don't scare yourself with an abnormal report, and don't believe in the lies that high CRP alone can diagnose gynecological inflammation. If you really have discomforts such as abnormal leucorrhea, lower abdominal pain, and abnormal bleeding, it is much more reliable to see a gynecological specialist directly than to guess based on indicators.