Chronic Pelvic Pain

Pelvic pain is pain felt in the lower abdomen or pelvis. Pain is described as ‘chronic’ if it occurs all or some of the time for more than 6 months. Chronic pelvic pain affects 1 in 6 women on average. It can disrupt work, social and sexual activity.

There are so many reasons for chronic pelvic pain including:

  • Endometriosis (tissue similar to the lining of the womb is found outside the womb).
  • Ovarian cysts.
  • Chronic pelvic inflammatory disease (PID) secondary to a previous pelvic infection.
  • Pelvic scar tissue secondary to endometriosis, surgery or infection.
  • Nerve related pain.
  • Chronic painful bladder syndrome.
  • Irritable bowel syndrome (IBS).
  • Musculoskeletal pain.
  • Previous traumatic physical or sexual experience.

It would be very useful to keep a diary of the pattern, duration and severity of the pain. It is also important to observe whether the pain gets worse before/during periods and during/after intercourse or not.

Taking detailed medical history, clinical examination and a transvaginal ultrasound scan are expected to help tailoring any further investigations and/or treatment. Diagnostic laparoscopy (telescope down the abdomen and pelvis) may have to be done to diagnose any gynaecological cause. The advantage of laparoscopy is that treatment of endometriosis and pelvic scar tissue can be done at the same time.

If pain is related to periods, it may be appropriate to offer you to take a course of the combined oral contraceptive pills or try Mirena coil provided pelvic examination and scan are normal.

Menstrual Disorders

Menstrual problem can be either heavy, prolonged or irregular bleeding. The average menstrual blood loss is less than 35ml. The average length of the menstrual cycle is 24-34 days. Period bleeding lasts for average 3-7 days. The average being 5 days. When the menstrual blood loss is more than 80ml, women start to have anaemia (low haemoglobin). 1 in 20 women consult their GP every year about this problem. Period disorders can disrupt women’s work, social and sexual activity.

There are different causes for menstrual disorders such as:

  • Abnormal balance of the hormones coming from the ovaries.
  • Fibroids
  • Endometrial polyp.
  • Endometriosis.
  • Pelvic inflammatory disease.
  • Polycystic ovaries.
  • Endometrial (lining of the womb) cancer.

It is important to keep a record of your menstrual calendar. Taking detailed history, pelvic examination and a transvaginal ultrasound scan will help making decision about further management. Doing hysteroscopy (telescope to check the cavity of the womb) and endometrial biopsy may have to be done. Hysteroscopy is done to diagnose and treat endometrial polyps and fibroid distorting the cavity of the womb. Laparoscopy may have to be done during hysteroscopy especially if the woman has chronic pain as well as menstrual disorder. Laparoscopy is done to diagnose and treat underlying causes such as endometriosis, pelvic scar tissue or ovarian cyst.

Medical treatment is normally offered if examination and ultrasound scan are normal. Medical treatment includes:

  • Tranexamic acid and/or mefenamic acid oral tablets. Bothe of them are taken during period bleeding to reduce the amount of period bleeding.
  • Combined oral contraceptive pills.
  • Oral progesterone tablets.
  • Contraceptive injections.
  • Mirena coil.
  • Esmya oral tablets for women who have fibroids. Esmya is given to shrink the fibroids.

Surgical treatment is normally offered for treatment of fibroids and/or endometrial polyps. It is also indicated if medical treatment failed to provide symptom relief.

  • Hysteroscopy and removal of fibroids and endometrial polyps.
  • Endometrial ablation for women who completed their family.
  • Myomectomy (removal of fibroids) in women who have not completed their family.
  • Hysterectomy (removal of the womb) which can be done through key-hole surgery, open surgery or vaginally.