Pelvic pain is one of the most common reasons women seek gynecological care, and one of the hardest to pin down. It can be sharp or dull, constant or intermittent, mild or completely disabling. It can originate from a dozen different structures in the pelvis, which makes evaluation both important and nuanced.
If you have been living with pelvic pain and have not yet received a satisfying explanation, you are not alone. Research estimates that 30 to 50 percent of women will experience pelvic pain at some point in their lives.
Defining Pelvic Pain
Pelvic pain refers to any discomfort felt below the belly button and above the thighs. It can be acute, meaning sudden onset and relatively brief, or chronic, which is generally defined as pain lasting more than six months. Chronic pelvic pain is particularly complex because it may involve multiple overlapping conditions and can become a condition of its own, with changes in how the nervous system processes pain signals over time.
Gynecologic Causes
Reproductive causes are the most common in women of reproductive age. These include:
- Endometriosis: tissue similar to the uterine lining growing outside the uterus, causing inflammation, scarring, and pain that is often worse around menstruation
- Uterine fibroids: noncancerous growths that may cause pelvic pressure, heavy bleeding, and cramping, especially when large or positioned to press on surrounding organs
- Ovarian cysts: fluid-filled sacs on the ovaries that can cause dull or sharp pain, particularly when they rupture or cause an ovary to twist
- Adenomyosis: the uterine lining grows into the muscular wall of the uterus, causing severe, often debilitating menstrual pain and heavy bleeding
- Pelvic inflammatory disease (PID): bacterial infection of the uterus, fallopian tubes, and ovaries, usually resulting from untreated STIs
- Ovarian torsion: an ovary twists around its blood supply, causing sudden, severe pain and requiring emergency surgery
- Dysmenorrhea: painful menstrual cramps, which may be primary (without underlying disease) or secondary (caused by a condition such as endometriosis)
- Pelvic congestion syndrome: enlarged, varicose-like veins in the pelvis that cause a chronic, dull aching pain, often worse when standing
Non-Gynecologic Causes
The pelvis contains many structures beyond the reproductive organs. Pelvic pain can also originate from the bladder (interstitial cystitis, urinary tract infections, kidney stones that have passed into the lower urinary tract), the bowel (irritable bowel syndrome, inflammatory bowel disease, diverticulitis, constipation), or the musculoskeletal system (pelvic floor muscle dysfunction, fibromyalgia, nerve entrapment).
A history of physical or sexual trauma is also strongly associated with chronic pelvic pain, and screening for this is an important part of any comprehensive evaluation.
Pelvic Pain Related to the Menstrual Cycle
Pain that consistently follows your cycle, particularly pain in the days before or during menstruation, is strongly suggestive of a gynecologic cause. Many women dismiss this as “just bad cramps,” but pain that limits your ability to function, requires prescription medications, or has worsened over time should always be evaluated.
If you are experiencing menstrual or pelvic pain that is affecting your quality of life, the team at Ivana MD provides expert evaluation and treatment for women throughout Sugar Land, Missouri City, Stafford, Richmond, League City, Houston, and Fort Bend County. You do not have to simply endure it.
How Is Pelvic Pain Evaluated?
A thorough evaluation typically includes a detailed medical, surgical, and gynecologic history; a physical and pelvic exam; laboratory testing including a pregnancy test, complete blood count, and STI screening; and imaging such as transvaginal ultrasound. In some cases, diagnostic laparoscopy is needed to visualize the pelvic organs directly and confirm or rule out conditions such as endometriosis.
Because pelvic pain is so often multifactorial, finding the answer sometimes takes patience. But the right diagnosis is the foundation of the right treatment, and relief is possible.
