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Gynecological Pain – Minimally Invasive Surgery Options

April 26, 2012 1:59 PM with Dr. Frank Tu

Pelvic health concerns—including uterine fibroids, ovarian cysts, endometriosis, pelvic pain and abnormal bleeding—in women are not uncommon. As advancements in surgical procedures have become more readily available, hospital stays have been shortened, and recovery times and complications risks have been reduced. Join Frank Tu, MD as he answers your questions about diagnostic tests and minimally invasive surgical techniques. Your participation and early questions are welcomed.

Angela (Moderator) - 1:49 PM:
Welcome! Today’s chat: Gynecological Pain – Minimally Invasive Surgery Options will begin shortly. Please start submitting your questions and Frank Tu, MD will begin answering them as soon as we get started. While you are waiting for the chat to begin, feel free to visit the, Gynecological Pain & Minimally Invasive Surgery page on our website. We will do our best to answer all of your questions, but because this is such a popular chat, the physician may not be able to answer all of your questions in the time allowed. Your understanding is greatly appreciated.

  Anne Marie (Chicago) - 2:02 PM:
During a recent prenatal check-up, I was told that I have uterine fibroids. What are some of the risk factors? What treatment options are available, if necessary?
Dr. Frank Tu (NorthShore)
Hi Anne Marie. Fibroids can be found in up to 50-70% of women. Many are small and don't cause problems, but bigger ones (at least an inch or larger) can. Race is probably one of the biggest risk factors. They usually don't get treated in pregnancy, but in women who have bleeding or pain. They can often be treated with hormonal medications, or with a few different procedures if medications don't work. Here at NorthShore, we offer hysteroscopic (via the cervical opening), and laparoscopic (through little abdominal incisions) removal of fibroids which can allow women to recover in a few days to a couple of weeks. This preserves the chance of having children in the future. Other options include having a radiologist do a uterine artery embolization if you are not planning on having any more children.

  Jane (Waukegan, IL) - 2:08 PM:
How do you know the difference between severe menstrual cramps versus serious cramps related to other issues?
Dr. Frank Tu (NorthShore)
Hi Jane, it's a good question. If it's only during your time when you bleed, it's probably just menstrual cramps. There are ways to make those less painful, if they really are bad. Some women try to take anti-inflammatories like ibuprofen, others try to cut sugar out of their diet or add some magnesium or vitamin B during the period to make the uterus less irritable. Our research team is actually doing a study of menstrual cramps - you can find out more by calling 847.570.2622. Serious cramps would be often linked to a fever, or your belly being distended, or blood in your stool. Also if they last a long time, or don't get better with medications, menstrual cramps can also be a sign of uterine tissue growing into the pelvic cavity, which is known as endometriosis. Endometriosis can be linked to fertility problems and chronic pain in some women. Seeing a doctor who can examine you and decide if you need further testing can help.

  betty (chicago, il) - 2:15 PM:
Can ovarian cysts lead to cancer? I had one removed recently, but worry that I may be at a greater risk of developing cancer. Is there anything I can do prevent them?
Dr. Frank Tu (NorthShore)
Hi Betty. In general they aren't linked to a very high risk of developing ovarian cancer. They tend more to cause problems with pain. If you have symptoms like pain on one side of the abdomen that don't just go away, that might be a reason to have another evaluation with a gynecologist. If the cyst was a larger functional cyst (like what your body normally produces to release an egg) then you can try to block ovulation by taking the birth control pill. Endometriotic cysts, which are blood filled due to have uterine tissue inside them, also tend not to return if you take the pill. For the less common non-cancerous cysts, we don't have good ways to prevent them. Common sense says to eat a healthy diet with lots of produce and fruit, whole grains, grass-fed beef and fish, and limit intake of foods that might provoke inflammation, like saturated fats and simple carbohydrates.

  Kristy (Skokie, IL) - 2:21 PM:
For the past few months I’ve had a recurring pain in my crotch area. Sometimes it just a dull ache, but most times it is a more throbbing / burning pain. I had thought it would go away, but it hasn’t. I’m scheduled to visit by gynecologist next week, but wonder what this might be.
Dr. Frank Tu (NorthShore)
Hi Kristy. Pain in the crotch or "groin" can be from a few different causes. Infection (yeast, bacteria) is pretty common for a lot of young women. There are pretty easy tests for that you can have in the clinic. If it's related to sexual intercourse, muscle tightness in the pelvic floor is another. Sometimes you need to have your gyne refer you to a women's health physical therapist for that. Keeping the skin healthy down there is important. Making certain you don't apply any irritating cleansers to the groin is also a good idea. Some women will try to avoid wearing excessively tight underwear all the time. There are rare problems that are good to know about if this just keeps going on and on. We hear from a number of women that sitting for a long period, or occasionally doing too much riding on a bike can irritate some of the nerves in the groin, and these nerve entrapment syndromes get mistaken for infection all the time. They're pretty rare fortunately.

  Debbie - 2:26 PM:
My teenage daughter just started menstruating and has begun complaining of pelvic pain even when she doesn’t have her period. In doing some research it seems like she could have endometriosis. What testing can be done to diagnose her condition or it is common to have these pains?
Dr. Frank Tu (NorthShore)
Hi Debbie. Endometriosis gets a lot of attention when teenagers have pelvic pain. Our studies suggest about 5% of young Western women are diagnosed with it. Right now it's mainly diagnosed with a minor outpatient laparoscopy (using 1/4" incision in the belly button) to remove any uterine tissue growing inside the abdominal cavity. Not everyone needs surgery though. Some girls choose to try medical therapy like the pill for a few months to see if that helps. Along with making healthy diet choices that reduce overall inflammation, some cases, even if it is endometriosis, don't have to be operated on. Make sure she tries some ibuprofen a day or so before her period, which can reduce cramping. On the other hand not everyone has to be alarmed when they hear about this sort of pain. Sometimes it's just growing pains that we see go away as these young women go off to college. Is she into a lot of sports? Many doctors overlook the pelvic muscles and hip/thigh muscles.

  Beth (Skokie) - 2:35 PM:
I’ve heard that ovarian cysts usually go away on their own. How do you know when further action is needed? Can my gynecologist detect cysts during my annual exam?
Dr. Frank Tu (NorthShore)
Hi Beth. Most gynecologists will repeat a scan to show the cyst has gone away. If it looks worrisome (solid parts, very large, bizarre looking on scan), or if they are causing symptoms (pain) that's when surgeons often recommend removal. In some women, the cysts can be felt during an annual pelvic exam, but many of those will go away if they are just watched. In general, ovarian cysts are almost never cancers in young women. Ovarian cancer which affects about 1/70 women in their lifetime, unfortunately is hard to detect until it has become relatively advanced in its spread. Women with sudden, persistent abdominal distension and poor appetite should check with a doctor and have this rare cancer tested for. We're working on better tests in the meantime.

  Shelly (Chicago) - 2:41 PM:
Other than hysterectomy, what other treatment options exist for endometriosis? Are there any alternative treatments that help ease symptoms? I find it hard to battle with a condition that has no known cure, and am very interested to learn how to get back to feeling “normal.”
Dr. Frank Tu (NorthShore)
Hi Shelly, there are many treatments for pain related to endometriosis. 30-40% of cases actually disappear on their own, and many improve after pregnancy. A multi-disciplinary approach works best. For example: 1. Having complete laparoscopic surgical removal of all visible endometriosis, which our center does. Too many women are only treated with drugs because their doctors are uncomfortable doing surgical removal of the disease, but it can be done safely by expert surgeons. 2. Using a hormone suppressive medication such as the pill or a progestin-containing IUD. 3. Treating any muscular or nerve issues in the pelvis, with a good pelvic floor therapist 4. Using nerve drugs often used for conditions like chronic headaches. 5. Look for other pain problems like IC. 6. Follow a low-inflammation diet, focusing on healthy produce and fruit, legumes/beans, and whole grains. Practice yoga and stretch. If everything has failed, laparoscopic hysterectomy still can help.

Angela (Moderator) - 2:49 PM:
Thank you everyone for your great participation. The chat will be ending in approximately 10 minutes. Please submit your final questions.

  Suzanne (Evanston, IL) - 2:50 PM:
Is it most common to encounter pelvic issues, such as cysts, uterine fibroids, etc. during an annual exam? What are some warning signs I should be aware of that an issue may exist?
Dr. Frank Tu (NorthShore)
Hi Suzanne, the annual pelvic exam can be helpful in finding cysts and fibroids. But women come in with masses found when something else is being worked up, like blood in their urine or stool all the time! And not all of them need to be treated! Some warning signs that I tell my patients include not having a normal 3-7 day menstrual period (heavier, or in between spotting), persistent lower pelvic pain, pain during intercourse, or leakage of abnormal vaginal fluid. Having trouble getting pregnant, or maintaining an ongoing pregnancy is another sign of possible pelvic problems. Also, some women feel they need to go to the bathroom more often. That sometimes could be a sign of a fibroid pushing down on their bladder.

  Carrie (Lincolnwood) - 2:54 PM:
Most times I am able to relieve my pelvic pain with over-the-counter medications. I wanted to ask – are there certain exercises I can do to help ease the pain?
Dr. Frank Tu (NorthShore)
Hi Carrie, that's good to hear that the OTC meds work. There are yoga stretches that can help (pigeon prep comes to mind), but seeing a pelvic health therapist along with a well-trained gynecologist can help determine if learning other stretches (especially for the pelvic floor) or strengthening exercises, especially for your core, could be a good idea to prevent pain.

  Kara (Highland Park) - 2:57 PM:
I often have spotting in between my periods. It usually isn’t too much, but at times it can be rather heavy. Is this something I should be concerned about? When do you know is bleeding is abnormal?
Dr. Frank Tu (NorthShore)
Hi Kara, this sounds like something that you should see a gyne about at some point. Having an abnormal period would include longer periods (> 7 days), heavier periods - going through multiple pads or tampons/day, or bleeding in between periods. It might be something simple like a polyp or fibroid on your cervix, or in the uterus. Minor treatments in the office, including a hysteroscopic removal of some of these masses can often fix that. Are you on birth control pills - sometimes adjusting the dosing can also make a difference.

Angela (Moderator) - 3:01 PM:
Thank you for participating in our online chat today. An online transcript will be available shortly. To learn more about Gynecological Pain, visit our website.

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