Introduction
Pelvic pain is a common problem for many women, and has a wide variety of features and causes.
Pelvic pain can occur as a normal part of the menstrual cycle, especially sharp pain in the middle of the cycle when the egg is released from the ovary called Mittelschmerz pain.
Some pain also occurs normally around the time of the period, due to chemical and hormonal changes in the uterus and irritation from the bleeding during the period called dysmenorrhoea.
Pelvic pain can be one side or the other, it can occur at similar times of the menstrual cycle, or can be independent of the menstrual cycle. Pelvic pain can be worsened by sexual intercourse, or can be closely related to bowel or bladder habits.
Pelvic pain can be due to abnormalities in the pelvis, and forming a correct diagnosis is important in managing pelvic pain correctly.
Causes
The uterus
Fibroids, dysmenorrhoea, adenomyosis.
The ovaries
Ovarian cysts and other masses.
The Fallopian tubes
Damage and swelling of the Fallopian tubes called hydrosalpinges. Infection in the Fallopian tubes called pyosalpinx.
The bladder
Infection, irritation, interstitial cystitis.
Abnormalities in the bowel
Irritable bowel, constipation, Inflammatory bowel disorders like Crohn’s disease.
Endometriosis
Endometriosis is a condition in which small deposits of the tissue that lines the uterus (endometrium) implant on the walls of the pelvis called the peritoneum. This causes inflammation and pain in this area. It is unknown why or how endometriosis starts, but removing it surgically usually leads to significant relief.
Investigations
The work up for pelvic pain is first and foremost to obtain an accurate diagnosis. History, examination, ultrasound, urine testing and potentially vaginal and cervical swabs are all useful in the initial stages to getting a diagnosis and ruling out some of the more common causes.
Frequently, a laparoscopy will need to be considered to examine the pelvis with detail, especially if endometriosis is suspected as this can only be diagnosed via laparoscopy. See lower on this website for information on laparoscopy.