Chronic pelvic pain is a common disorder in women that can result in a significant disruption to daily life. Pain can be either intermittent or constant. Finding the cause of pelvic pain can be a long, often frustrating process, leading women to seek care from many different physicians in many specialties. Sometimes the exact source of pelvic pain cannot be completely determined; therefore treatment must be directed at alleviating symptoms. Non-gynecologic causes of pelvic pain include irritable bowel syndrome, colitis/diverticulitis (inflammation of the bowel), interstitial cystitis (inflammation of the bladder), abdominal muscle spasm, fibromyalgia, hernias, neurologic problems, and psychological disorders such as depression.
Endometriosis is one of the most common gynecologic causes of pelvic pain. Others include ovarian cysts, adenomyosis (endometrial tissue in the uterine muscle), adhesions (scar tissue from previous surgery), fibroids, ovulatory pain, and chronic pelvic infections. The exact cause of endometriosis is not completely understood, but most physicians believe that it is due to retrograde flow of endometrial tissue through the fallopian tubes into the pelvis. Each month the endometrium becomes thickened and sheds with your menstrual cycle. The endometrial tissue that spills from the tubes into the pelvis also becomes inflamed and painful, causing severe menstrual cramping, which is one of the most common symptoms of endometriosis.
Endometriosis is difficult to diagnose without performing surgery to look for implants in the pelvis. However, it can be strongly suspected based on history and physical findings on exam. Treatment with medications such as progesterone, birth control pills, and Lupron can be tried to see if symptoms improve. If the pain resolves or improves, then a diagnosis of endometriosis is very likely. If there is no significant improvement, then laparoscopic surgery can be performed to look for other causes of pelvic pain and/or remove the endometriosis. Hysterectomy may be considered when other treatments have failed and all other causes have been ruled out.
Even if an exact cause for the pain is not found, there are useful treatments for alleviating symptoms. Heat therapy, anti-inflammatories, muscle relaxants, nerve block injections, antidepressants, and relaxation exercises may all help to relieve pelvic pain.
