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While many women feel that they're alone in experiencing chronic pelvic pain during their lives, it can be a symptom of a number of related issues, including uterine fibroids, menstruation, endometriosis and post-pregnancy symptoms.
Dr. Frank Tu, Director of Gynecological Pain and Minimally Invasive Surgery, discussed these different topics in an online chat, and addresses more questions about pelvic pain and women's health from patients below:
I just got off my birth control after being on it for 10 years. Should I expect any problems?Usually no. Occasionally, a woman will not resume her regular menstrual cycle for a few months afterwards. If this continues for more than three months, it probably is not a bad idea to get seen by a gynecologist to make sure you haven’t developed a separate problem with cycle control.One of the doctor I just visited recommended an IUD, which I was considering before, however; now I’m not sure. I have started having excruciating pain during my cycle, and two or three pills of Ibuprofen don't help at all. The pain resides as soon as my cycle ends. This is only the third month experiencing this extreme pain. Is there any type of testing that I can have to figure out what’s going on?Before considering a hormone releasing IUD, a good exam can make sure there isn’t some obvious uterine mass like a fibroid, or deep endometriosis. A follow-up ultrasound or MRI might also be helpful after that exam. Your doctor suggested a hormone releasing IUD because this can be helpful f reducing local inflammation with your cycle. We also are doing a study called CRAMPP to study why some women get painful periods and how it may affect their future pain sensitivity. If you’re interested, take a look at the online screen. I've been suffering from pelvic pain for at least one year. I also have chronic hip pain and had 2 C-sections within the last 6 years, and have had IBS since I gave birth of my first child. I've been to 3 doctors who have 3 different opinions about this chronic pain. What might be the cause? What should my next steps be?Sorry to hear about all these post-pregnancy issues! Pelvic pain could be either post-pregnancy muscle and joint changes or post-surgery nerve function changes, and a good careful exam might help figure out where exactly the pain is from. When you mention you’ve had hip pain, that does make me think maybe your pelvic girdle might need some attention- strengthening or some connective tissue release by a skilled physical therapist. Separately, why IBS starts after a pregnancy is less clear – did you have any major dietary changes or get a lot of antibiotic exposure during the pregnancy? Regardless, it can be improved sometimes with diet, and mind-body approaches, and occasionally some women will try nerve-modulating medications to restore that mind-body balance. Seeing a primary physician or a GI doctor with good experience in treating functional health is an important step many of our patients take.I have had pelvic pain for years. Nothing helps to manage the pain. I have 1 fibroid. When I had an ultrasound in that area and a probe was inserted all the way back, whatever it hit what feels like a wall is what causes the pain every day in my pelvic area. Why is that? There is always pressure too!It is best to try to look at a careful pelvic exam to decide if the fibroid is causing the issue. Fibroids may cause local inflammation, or irritate local nerves to cause your symptoms. They certainly can cause pressure, but it would depend on how large the mass is. We are surprised that sometimes even small muscle masses can cause dramatic pain, and sometimes hormonal suppression, or removing them laparoscopically can be very effective. For the past 8 months, I have had consistent pain in my lower abdomen, hip and lower back. Lately, my periods have been very heavy and last between 8-10 days. Back in June, I was put on 90-day birth control so I should only have a period once every 3 months. Now I'm bleeding 30-40 days out of the 90. Are these symptoms of a pelvic issue?Sorry to hear about the abdominal pain issues, have you had these looked into as well? As for the bleeding on the continuous pill, about a third of women do have this challenge at least in the first year. This is likely more about how your body is adjusting to the pill, but overall body mass, and whether you are taking it consistently are important factors to consider also. Some women will take a break if needed for 3-5 days every 3 weeks until the bleeding starts to become more predictable. Sometimes, a monthly pill is also just a better choice if the 3 months isn’t being tolerated.I have had chronic pelvic pain on my left side. The pain can be moderate to severe. I have had multiple ultrasounds, and all they can find is cysts that come and go. I have been on birth control that has helped with the cysts, but not with the pain. I have been to a urologist who diagnosed me with over-active bladder. Even when the doctor pushes down, I am in pain. What else could this be - I feel like something is being missed?Left-sided chronic pain could be from several issues – the abdominal wall, the ovary, the peritoneum (endometriosis) or just general nerve sensitivity. Do you have any bladder pain as well? A laparoscopy could show if you have endometriosis as one suggestion. Other options would be to do a trial of low dose nerve drugs or physical therapy to address any potential muscle or nerve issues, like we see in chronic low back pain or migraine headaches. As I mentioned above, we’re doing a study of painful periods, and are also happy to look at women with daily pelvic pain if you want to consider the study.
I used to have really bad period pains when I was younger, but they've gotten much easier to deal with as I reached my 20s; is this normal? Is there a certain reason for this?There does seem to be less menstrual pain as women age, so yes that is fairly normal. We don’t exactly know why this happens, for some women, maybe a pregnancy changes how the uterus behaves; in others, maybe maturation of blood flow to the uterus finally brings adequate oxygen support for the muscles – but its not really well understood why this happens. It sounds like you’re in a better situation, thankfully!
My daughter, who is 14 years old now started her menses at 12. She feels severe stabbing and twitching pains in her rectal area, and her vaginal area hurts a lot during her days. Her stabbing and twitching bouts last 1-2 minutes in which she freezes and can't move. I had an ultrasound done in 2014, which was normal. What are other possible causes for such intense pain in that area? Anything she can take to relieve the pain?If she sees a gynecologist or her pediatrician, ruling out some basic vaginal infections might not be a bad idea. Also, some young women will develop a sensitive pelvic floor, and occasionally even teenagers will have this affect them – which could explain both rectal and vaginal symptoms. We don’t always find a cause, but excess athletic activity, or prolonged compression of the perineum are some causes we find that get better with reduction of the activity and treatment with a physical therapist. If she happens to cycle a lot or sit for long stretches, that activity could partly affect muscle health and blood flow. Physical therapy, muscle relaxants, or compounded topical nerve medications sometimes can help after a proper evaluation is done.