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Pelvic pain: Causes and cures

How doctors evaluate pelvic pain

A doctor can tell a lot about what might be causing pelvic pain when a patient describes what the pain feels like, when it occurs and where it’s located. After taking a medical history, the doctor will do a pelvic exam and, perhaps, a pregnancy test. If he or she suspects an infection may be causing the pain, blood tests will be done.

The doctor may want to do a diagnostic laparoscopy. In this procedure, a tiny viewing instrument is inserted through the navel. Often, seeing the pelvic organs enables the doctor to determine exactly what’s causing the pain.

When to see your doctor

Seek emergency medical help if you experience sudden, severe, abdominal pain. The pain may or may not be accompanied by fever, vomiting, vaginal bleeding or signs of shock.

Make an appointment with your doctor if you have pelvic pain that comes and goes, occurs during intercourse or is accompanied by a foul-smelling discharge, fever or other symptoms.

Pain in the pelvic region (below the navel and above the thighs) is an alarm bell that signals a variety of health problems. Fortunately, the nature of the pain and the symptoms that accompany it can help doctors determine the cause.

If you ever experience sudden, severe abdominal pain, either on its own or accompanied by fever, vomiting, vaginal bleeding or signs of shock, get emergency medical help.

More common is recurrent pelvic pain. It may come and go with your period, for example, or be associated with intercourse. Learn about possible causes and treatment options by reading the descriptions below. Then, if you’re bothered by pelvic pain, make an appointment with your doctor.

  • Premenstrual syndrome (PMS). For some women, pelvic pain is just one more sign that they’re about to start their periods. They experience pain in the lower abdomen along with other symptoms of PMS, such as headache, fatigue and tender breasts. The use of drugs to treat PMS has met with limited success. However, many women find that exercise and certain dietary changes—such as avoiding salt and caffeine and increasing calcium intake—provide some relief.
  • Infection. Vaginal infections such as gonorrhea and chlamydia sometimes cause pelvic pain. If a sexually transmitted disease goes untreated, the bacteria that caused it may spread up the reproductive tract. The resulting infection, called pelvic inflammatory disease (PID), can also cause pelvic pain.
    Pain caused by an infection often begins right after a menstrual period and may become worse during intercourse. Other symptoms might include vaginal bleeding, vaginal discharge, fever and chills. Gonorrhea, chlamydia and PID are treated with antibiotics.
  • Ovarian cysts. These fluid-filled sacs can cause abdominal pain (either sharp or dull), irregular and painful periods and pain during intercourse. For women younger than 40, hormone therapy may be prescribed. Surgical removal of the cyst is usually recommended for women older than 40.
  • Endometriosis. In this condition, tissue from the uterine lining (the endometrium) attaches itself to body tissues outside the uterus, such as the ovaries, the fallopian tubes and the outside of the uterus itself. The tissue continues to function as it would in the uterus, building up to prepare for a fertilized egg, and shedding when none arrives. However, since it’s not in the uterus, the debris has no exit. It builds up in the affected tissue, causing irritation and swelling.
    Pain that’s associated with endometriosis may be constant or occur around each menstrual period. Other signs include heavy, irregular menstrual flow and pain in the lower back. Treatment options include laparoscopic surgery, medication or a combination of the two.
  • Adenomyosis. When endometrial tissue grows into the uterine wall, the condition is called adenomyosis. Although some women have no symptoms, others bleed heavily and suffer severe menstrual cramps and longer-than-normal periods. If you’re nearing menopause, painkillers may be adequate treatment since the condition usually resolves itself when menstruation ends. If, on the other hand, menopause is years away, hysterectomy may be an option.
  • Fibroids. Although usually symptomless, fibroids (benign tumors of the uterus) can cause abdominal pain. Medication can sometimes shrink fibroids. If the pain is severe, surgery may be necessary. The fibroids can be removed individually (myomectomy) or the uterus itself can be removed (hysterectomy).
  • Cervical, ovarian and uterine cancers. Pain in the pelvic area, legs and back may signal advanced cervical cancer. Other signs include pain while urinating, blood in the urine and bleeding between periods or after intercourse. Mild or acute abdominal pain can also be a sign of ovarian or uterine cancer. Treatment for cancer of the reproductive organs includes surgery, radiation, chemotherapy or a combination of those methods.


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