Accurate diagnosis key in treating this troublesome condition
For many women, "that time of the month" is an uncomfortable time. Along with fatigue and irritability, they experience cramps, backaches and bloating before or during menstruation that commonly resolve during the course of their cycle. While occasional pelvic pain - particularly during menstruation - is a frequent complaint among women, pain that occurs at other times or persists for six months or longer may require closer evaluation. Although all pelvic pain may not be related to your reproductive organs, your gynecologist's office is a logical place to start looking for answers. "Studies have shown that 25 to 33 percent of women will experience chronic pelvic pain sometime during their lives, particularly during their reproductive years," noted Eugene Scioscia Jr., M.D., System Vice Chair, WPAHS Department of Obstetrics and Gynecology. "For some women, that pain is associated with their period, others have pain only mid-cycle, and still others experience distressing pain during intercourse." When should you seek medical attention? Whenever you become concerned that the pain is interfering with your day-to-day routine or normal functioning, he said.
A difficult diagnosis
Because pelvic pain differs in each patient in terms of site as well as severity, it can be very difficult to diagnosis. A systematic evaluation that includes your own perception of the pain is necessary to sort through all the possible causes .
A complete medical history is an essential first step. Your doctor should ask about reproductive history - has there been pain during periods or intercourse, problems with fertility or pregnancies, a family history or past diagnosis of endometriosis? He should also look at your surgical history - any abdominal surgery, including C-sections, that may have caused scarring? Past urological problems, such as bladder or kidney infections, urinary frequency or incontinence, and recurrent diarrhea or constipation may also provide insight into the cause of pelvic pain.
A thorough physical examination, including a pelvic examination, routinely follows the history-taking. In addition to evaluating the vagina, vulva, perineum, uterus, fallopian tubes and ovaries, the doctor may examine other organ systems, said Dr. Scioscia.
"Pain that you feel in your pelvic region may actually be caused by a musculoskeletal problem such as a slipped disc or a neurological problem. If this appears to be the case, your gynecologist may refer you to the appropriate specialist," he said.
Finding the cause
If your doctor determines that your pain is gynecological in nature, additional testing often is necessary to establish a clear-cut diagnosis. Common tests that can be performed in the physician's office include blood and urine analysis, vaginal cultures and sonograms. If more extensive information about the uterus, ovaries and fallopian tubes is needed, your doctor may recommend laparoscopy. During this surgical procedure, the doctor inserts a small telescope-like instrument called a laparoscope through a small incision near your navel to view your reproductive organs directly.
Treating the problem
Treatment options for the management of pelvic pain depend on the diagnosis, and range from over-the-counter pain relievers to hormonal management to surgery. According to Dr. Scioscia, in the majority of cases, pelvic pain has no serious pathology. The following conditions, however, are among the possible gynecological causes of pelvic pain that require further evaluation and, in most cases, treatment:
- Endometriosis: a disorder of the reproductive system in which tissue that normally lines the uterus grows somewhere else in the body
- Fibroids: noncancerous growths in the uterus that develop from cells that make up the muscle of the uterus
- Pelvic adhesive disease: a condition that develops from scar-tissue formation from previous abdominal surgeries
- Ovarian cysts or tumors: Cysts are noncancerous, blister-like growths that can result from a hormonal imbalance of estrogen and progesterone; cancerous ovarian tumors are rare in premenopausal women.
- Sexually transmitted diseases (STDs): Gonorrhea and chlamydia are diseases that are spread through sexual activity. STDs are caused by germs that can infect the cervix, urinary tract, uterus and fallopian tubes.
"The important thing to remember is that chronic pain of any type is much too complicated to diagnose and manage on your own," Dr. Scioscia said. "Pain that interferes with daily living should be evaluated and managed by a medical professional."
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Last Updated: September 27, 2009