3 Common Causes of Pelvic Pain You Should Be Aware Of
Did you know that one in seven women in the US will experience pelvic pain at some point in their lives? That being said, there is a high chance that you or someone close to you will experience this symptom. Becoming familiar with some common causes of pelvic pain may help you or your loved one understand when to seek medical attention.
Pelvic pain can stem from various conditions, including pelvic inflammatory disease (PID), endometriosis, adenomyosis, fibroids, and pelvic adhesions (scar tissue) from prior surgery or infection.
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1. Pelvic Inflammatory Disease (PID)
Pelvic inflammatory disease (PID) is an infection of the reproductive organs. If left untreated, it can damage the fallopian tubes, ovaries, and uterus. PID typically occurs when sexually transmitted bacteria spread from the vagina to the upper reproductive organs.
What Causes Pelvic Inflammatory Disease?
Several types of bacteria may cause PID. The most common are gonorrhea and chlamydia infections, which may result from unprotected sex.
Furthermore, bacteria leading to PID can also enter the reproductive organs whenever the function of the cervix barrier is disrupted. This can happen during menstruation, childbirth, abortion or a miscarriage. Bacteria causing PID may also enter the reproductive tract after an intrauterine device (IUD) is inserted, but this is rare.
What Does Pelvic Inflammatory Disease Feel Like?
Signs of pelvic inflammatory disease may be mild and go undetected. In addition, some women are asymptomatic, making it difficult to diagnose. When symptoms do occur, they may include:
- Mild to severe pelvic pain
- Vaginal discharge
- Painful urination
- Unusual bleeding during or after intercourse
Treatment Options for Pelvic Inflammatory Disease
If you think you may have PID, it is crucial to see a GYN specialist as soon as possible. If left untreated, PID can cause permanent damage to the reproductive organs and lead to infertility. Fortunately, if detected early enough, PID may be successfully treated with antibiotics.
This condition is caused when the endometrium tissue (the tissue that lines the uterus) grows outside the uterine area. When this occurs, the tissue thickens and sheds each month just as it would inside the uterus.
However, because this tissue has no way to exit the body, it becomes trapped. This can cause the tissue to grow and form lesions on the ovaries, fallopian tubes, outer surfaces of the uterus, and other surrounding areas. In addition, cysts on the ovaries called ovarian endometriomas might also develop.
What Causes Endometriosis?
Unfortunately, the root cause of endometriosis is still unknown. However, there are several theories as to what may play a role in its development. These include:
- Retrograde menstruation
- Hormone imbalances
- Immune system disorders
The following risk factors may also increase your chance of developing the condition. These include:
- Never giving birth
- Starting your period at a young age
- Short menstrual cycles (fewer than 27 days)
- Having high levels of estrogen
What Does Endometriosis Feel Like?
Pelvic pain and cramping are the most common symptoms of endometriosis. This pain is usually worse during menstruation and may increase over time. Other signs of endometriosis include:
- Pain during or after intercourse
- Painful bowel movements or urination
- Painful periods with excessive bleeding
What Are the Stages of Endometriosis?
There are four stages of endometriosis. To determine what stage you are in, your doctor will evaluate:
- How far the endometrial tissue has spread
- The extent and location of pelvic adhesions
- The size and number of endometriomas
- How much endometriosis is affecting other pelvic organs
The four stages can be classified as:
- Stage I: Minimal severity
- Stage II: Mild severity
- Stage III: Moderate severity
- Stage IV: Severe endometriosis
Treatment Options for Endometriosis
If you are experiencing symptoms of endometriosis, a laparoscopy should be performed to diagnose and remove the disease during surgery.
Unfortunately, OBGYNs often attempt to bypass surgery by making a diagnosis based on clinical assessments alone. Without a laparoscopy, it is difficult to make an official diagnosis and may further lead to the spread of the disease.
Conservative Surgical Options
Conservative surgery aims to preserve the uterus, fallopian tubes, and ovaries while removing the endometriosis. While this will decrease pain symptoms, it will not cure endometriosis.
Endometriosis excision is a conservative surgery that removes the endometriosis tissue and lesions. Removing each lesion decreases the risk of recurrence.
Endometriosis fulguration is done by burning endometriosis lesions. This surgical method is not as effective as excision because it is more likely to leave behind the abnormal endometrial tissue.
Ovarian endometriomas (cysts) should also be removed while still preserving the ovaries. A cyst that is not entirely removed may regrow.
Definitive Surgical Options
A hysterectomy with or without removal of the ovaries may be recommended in patients with adenomyosis and/or severe endometriosis. Many patients with endometriosis have adenomyosis (endometriosis in the muscle of the uterus) and removal of the uterus is the only effective treatment for this condition. Removal of the ovaries is sometimes necessary when the endometriosis has spread outside of the uterus and is involving the ovaries and other structures.
Using Medication and Alternative Medicine
Medication and alternative medicine are often used in conjunction with surgery. These methods can help control pain and symptoms associated with endometriosis.
- Pain medication
- Hormonal pills, IUD, implants, injections
- Hormone-blocking medications (Lupron, Orilissa)
- Pelvic floor physical therapy
- Nutritional counseling
Adenomyosis is a condition in which the endometrium grows into the myometrium (the cells that make up the uterine wall). This causes the uterus to enlarge with thickened tissue, which then breaks down and bleeds during menstruation, causing heavy bleeding and severe pain.
Adenomyosis is most common in women over 40 and usually disappears after menopause. However, some women may continue to experience symptoms even after menopause.
What Causes Adenomyosis?
The exact cause of adenomyosis is unknown. However, there are a number of theories as to what causes the condition, including:
- Childbirth-related uterine inflammation: Studies show that women who have experienced childbirth have higher rates of adenomyosis.
- Invasive tissue growth: Scar tissue may begin to migrate and invade the uterus wall after a uterine injury or surgery such as a cesarean section.
- Developmental origins: Adenomyosis may develop while the uterus is developing in a fetus.
- Stem cell origins: Adenomyosis may form when bone marrow stem cells invade the uterine muscle.
What Are the Risk Factors for Adenomyosis?
While the theories above may play a role in the development of adenomyosis, the following risk factors have also been linked to the condition:
- Short menstrual cycles
- Previous uterine surgeries
- Early age of first period
What Does Adenomyosis Feel Like?
Sometimes adenomyosis is asymptotic or only presents mild symptoms. In other cases, it may cause symptoms such as:
- Chronic pelvic pain
- Severe menstrual cramps
- Heavy bleeding
- Abdominal swelling
- Painful intercourse
- Clots in the legs and pelvis
Treatment Options for Adenomyosis
When treating adenomyosis, alternative treatments such as physical therapy and nutrition supplements may be attempted. However, these methods usually have low success rates.
The only true cure for adenomyosis is a hysterectomy (removal of the uterus). The ovaries can be preserved to avoid menopause. Women who are not finished childbearing may opt for more conservative treatment options such as hormonal suppression. While this option will not cure adenomyosis, it may help control the symptoms.
Other short-term treatment options include:
- Pain medication
- Pelvic floor physical therapy
- Using a heating pad
While these treatments may not be as effective as surgery, using them along with a healthy lifestyle may help temporarily improve symptoms.
GYN surgical specialists at The Center for Innovative GYN Care combine surgical skill with compassionate, personalized care. Learn more about the cause of your pelvic pain with one of our specailists.
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Get a Diagnosis for Your Pelvic Pain at The Center for Innovative GYN Care
The Center for Innovative GYN Care (CIGC) is devoted to providing women with the latest and most effective treatments for a wide range of complex GYN conditions. If you or a loved one are suffering from pelvic pain or another gynecological condition, schedule a consultation with one of CIGC’s GYN specialists today.
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CIGC is dedicated to helping women find relief from pelvic pain and other complex GYN conditions. The CIGC founders, minimally invasive GYN surgical specialists Paul MacKoul, MD, and Natalya Danilyants, MD, developed their advanced GYN surgical techniques using only two small incisions with patients’ well-being in mind.
Their personalized approach to care helps patients gain a better understanding of their condition and the recommended treatment so they can have confidence from the very start. Our surgeons have performed more than 25,000 GYN procedures and are constantly striving to improve outcomes for patients.