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

Whole blood C-reactive protein (hereinafter referred to as CRP) is a non-specific marker that reflects acute inflammation in the body. Its core connection with gynecological health is that it can assist in determining acute gynecological infection, postoperative recovery status, and the activity of some chronic gynecological diseases. However, it cannot be used alone as a basis for diagnosis of any gynecological disease. The CRP change patterns corresponding to different gynecological problems are very different.

To put it bluntly, CRP is like a fire alarm in your home. When it goes off, it only means "there is an abnormality related to fire in the surroundings." But it cannot tell whether it is the burnt dishes in your kitchen or the smoke coming up from the neighbor's fire downstairs. Last week, I met a 28-year-old girl in the clinic. She had pain in her lower abdomen for 3 days. Her leucorrhea was green and had a fishy odor. She had pain when she pressed the appendix area during a gynecological examination. Her white blood cells were just stuck at the critical value during the blood test. Only her CRP soared to 42mg/L (normal reference value is generally <10mg/L). She was given symptomatic anti-inflammatory drugs as acute pelvic inflammatory disease. After 3 days of follow-up visit, she said the pain was basically gone. But if you use "increased CRP" to directly determine that it is gynecological inflammation, you will be in a trap.

There are actually two different tendencies in the current clinical use of this indicator: many doctors in primary hospitals see lower abdominal pain + high CRP and give antibiotics as pelvic inflammatory disease first. After all, if the infection is missed and later develops into pelvic abscess and fallopian tube adhesion, it is more troublesome; but in higher-level hospitals, doctors Most doctors will be more cautious and will definitely check for other system problems first - after all, acute appendicitis, urinary tract infection, or even if you just had your wisdom teeth pulled out the day before, and you have gastroenteritis after eating three spicy hot pot meals, it may cause CRP to rise. There is really no need to throw the blame to the gynecologist at the first sign. Last week I met a girl who came crying with a physical examination report, saying that her CRP was 35 mg/L. Baidu said it might be ovarian cancer, but in the end it was found that she had a perianal abscess, which has nothing to do with gynecology. She couldn't laugh or cry.

After talking about inflammation, let’s talk about CRP abnormalities that people often ask after gynecological surgery. Whether it is abortion, liposuction, uterine fibroid removal, or hysteroscopic polypectomy, it is normal for CRP to rise slightly in 2-3 days after surgery. After all, the body has wounds, and stress-induced inflammatory reactions are normal. Generally, it will slowly fall back to the normal range in about 7 days. If CRP rises higher and higher after surgery, accompanied by fever, wound exudation, and smelly lochia, you need to be alert to the possibility of infection. Last month, a patient who had a hysteroscopy had a low-grade fever of 37.8°C on the fourth day after surgery, and her CRP rose to 58. We first checked the gynecological B-ultrasound and leucorrhea, and there were no problems. Finally, a routine urine test revealed that it was a urinary tract infection. She drank more water and took antibiotics for three days, and it was no big deal.

Many people are also concerned about "whether high CRP is a gynecological cancer." To be honest, when late-stage cervical cancer and ovarian cancer are combined with tumor necrosis or infection, CRP may indeed continue to rise, but early gynecological malignant tumors will rarely cause significant fluctuations in CRP, and it cannot be used as an indicator for gynecological cancer screening. There are also some cutting-edge studies suggesting that mildly elevated CRP (between 10-20mg/L) lasting for more than 3 months may be related to the activity of endometriosis and the chronic low-inflammatory state of polycystic ovary syndrome. However, this conclusion has not been included in clinical guidelines and can only be used as a reference at best. If a doctor diagnoses endometriosis based solely on high CRP, you should be more careful. Oh, by the way, many people still ask me about the ultra-sensitive CRP used in physical examinations. It measures cardiovascular risk. The measurement range is different from the whole blood CRP commonly used in our gynecology department. Don’t confuse them.

I have been practicing gynecology for almost 10 years, and the most common situation I have encountered is that the little girl took the physical examination report and said that the CRP was 2mg/L higher than the reference value, and she might have pelvic inflammatory disease. In fact, in many cases, this slight increase may occur if you stayed up late the night before the blood draw, happened to be in your menstrual period, or just ran 5 kilometers the day before. There is no need to be nervous at all.

To put it bluntly, CRP is a "sentinel" that reminds doctors, not a "judge" that makes the final decision. If you don’t feel any discomfort, you don’t need to refer to gynecological problems for a simple slight increase in CRP. If you really have symptoms such as lower abdominal pain, abnormal leucorrhea, and non-menstrual bleeding, don’t just focus on the CRP value. Bring the report to the gynecologist, and make a judgment based on the results of physical examination, B-ultrasound, and routine leucorrhea. It is much more reliable than scaring yourself on Baidu.