Pelvic Pain

Endometriosis happens when tissue that normally grows inside your uterus, grows on the outside. While we still don't know the exact cause, we know its risk factors. These include:

• A family history of endometriosis (blood relative).
• Any condition that prevents normal menstrual flow.
• Going through menopause at an older age.
• Higher levels of estrogen in the body.
• Heavy periods that last longer than seven days.
• Low body mass index.
• Never giving birth.
• Reproductive tract problems.
• Short menstrual cycles (less than 27 days).
• Starting your period at an early age.

We've also been able to pinpoint common symptoms; the most telling seem to be chronic pelvic pain, painful intercourse or difficult periods.

Endometriosis is usually diagnosed after your doctor does a pelvic exam. You may also need to have an ultrasound or MRI. In some cases, your doctor may use minimally invasive surgery (laparoscopy) to check for signs of endometriosis.

Treatment for endometriosis can include pain medicine, hormone therapy or surgery. The type of treatment you receive will depend on your symptoms and whether you want to have children. Your doctor will work with you to decide on the best treatment for your needs.

Veins that are weak can cause blood to build up, and this pooling can lead to varicose veins. When varicose veins develop in your pelvis and cause chronic pelvic pain, we call it pelvic congestion syndrome.

This syndrome usually affects women of childbearing age, women who've had two or more pregnancies or women with a family history of vein problems.

The main symptom of pelvic congestion syndrome is chronic pelvic pain, but you also could have an urge to urinate more often, develop hemorrhoids or notice varicose veins on the outside of your genitals or on your inner thighs.

If your doctor thinks you have pelvic congestion syndrome, you'll have a physical exam. Then you may need to have an ultrasound or CT scan to confirm the diagnosis.

Treatment usually involves taking hormone medicines, and sometimes minimally invasive surgery.

Learn more about pelvic congestion syndrome.

The muscles, ligaments and nerves at the bottom of your pelvis make up what we call "your pelvic floor" You may have a pelvic floor disorder if you notice changes in your normal habits. These changes include trouble urinating, urine or feces that leak out or sudden pelvic fullness or pain.

If your doctor suspects you have a pelvic floor disorder, a physical exam alone can often confirm your diagnosis. But, if your doctor needs a clearer picture of your pelvic health, more imaging tests may be requested.

Treatment for pelvic floor disorders can vary based on your unique condition, but it will often include behavioral therapy, physical therapy or medicines. Surgery may also be recommended in some cases.

Learn more about pelvic floor disorders.

Uterine fibroids are noncancerous growths that form in the muscles of the uterus. They can be as small as a pea or as large as an orange or cantaloupe.

Fibroids are more likely to affect women with a family history of the condition. However, obese women, African American women and women who started puberty early are also at higher risk.

While many women have no symptoms, others may experience:

• Frequent urination.
• Heavy bleeding between or during periods that includes blood clots.
• Increased menstrual cramping.
• Menstruation that lasts longer than usual.
• Pain during intercourse.
• Pain in the pelvis or lower back.
• Pressure or fullness in the lower abdomen.
• Swelling in the abdomen.

Uterine fibroids are usually diagnosed with a pelvic exam. Your doctor may also want you to have imaging tests, such as an ultrasound or MRI. These tests can offer a clearer picture of your pelvic health and confirm your diagnosis.

Treatment for uterine fibroids may include hormone therapy, changes to your diet and in some cases, minimally invasive surgery.

If you're living with chronic pelvic pain, the usual reasons for that are endometriosis, pelvic floor disorders and uterine fibroids. However, other conditions can cause chronic pelvic pain, including:

• Abdominal myofascial pain happens when muscles in the abdominal wall, pelvic floor or lower back don't work properly. Sometimes, these muscles are too sensitive or contract too much. Women who have this condition often have small areas in the pelvis (trigger points) that feel tender.
• Cancers of the reproductive organs include cancer in the cervix, ovaries, uterus, vagina or vulva. If your doctor believes cancer is causing your pelvic pain, he or she will refer you to a gynecologist-oncologist.
• Interstitial cystitis happens when the bladder becomes inflamed, often causing urinary incontinence. If your doctor believes you have this condition, he or she will refer you to a urogynecologist or a urologist.
• Musculoskeletal problems affect your bones, joints and connective tissue, causing fibromyalgia, pelvic floor muscle tension, inflammation of the pubic joint and hernias.
• Psychological factors, such as depression, chronic stress and a history of abuse, can sometimes cause pelvic pain.