Managing Pelvic Pain

Revised 2008


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Managing Pelvic Pain.pngMany women have pain in their pelvis (lower part of the belly) from time to time, usually during their period. However, if you have daily pelvic pain, it could be a sign of a bigger problem with your bladder, bowels, reproductive organs, or pelvic muscles. Many conditions cause pelvic pain, including endometriosis, adhesions, chronic appendicitis, or hernias. Sometimes medication is necessary to treat the problem; other times surgery is needed. Your doctor will evaluate you to determine the problem and what kind of treatment may be of benefit.

Evaluation

Your doctor will ask you whether it is painful for you to go to the bathroom, walk, sit, climb stairs, or drive a car. If you have pain during these activities, your problems may be in your bladder, bowels, or the muscles of your pelvis, hips, or lower back. Your doctor will press on these muscle areas to determine exactly where the pain is orginating. Problems such as endometriosis can cause pain because there may be tissue from the endometriosis on different organs within and outside of the pelvic cavity, which includes the ovaries, bladder, behind the uterus, and bowel. Some doctors may suspect these problems during a pelvic exam.

Conservative treatment

Conservative treatment means treatment without performing surgery. Your doctor may first try to treat your pelvic pain with birth control pills and/or non narcotic pain medications. If these options do not work, you may be given medications that take away the estrogen in your body, therefore placing you in a short-term, menopause-like state. Decreasing the estrogen in your body will decrease the endometriosis implants and pain.

Diagnostic laparoscopy: Finding out what is wrong

Laparoscopy is a type of surgery that is performed with a telescope that is attached to a camera (laparoscope). The laparoscope is inserted into one to four small incisions in your belly. During a laparoscopic surgery, your doctor will be able to view your pelvic organs to see if they, or any other conditions, are contributing to your pain. Some of the conditions your doctor may find are endometriosis, adhesions (scar tissue), appendicitis (infection of the appendix), or a hernia. Sometimes, even finding out that everything is normal can be helpful in choosing further treatment. The two most common problems that can be treated with a laparoscopy are endometriosis and pelvic adhesions:

Endometriosis: Endometriosis can cause daily pelvic pain, painful periods, and pain during bowel movements or sex. Having endometriosis can also make it harder for you to get pregnant. At the time of your laparoscopy, your doctor will attempt to remove the endometrial tissue that is seen with an electric current or laser. Treatment will help to decrease or eliminate your symptoms and may make it easier for you to become pregnant.

Pelvic adhesions (scar tissue): Adhesions in and around the pelvic cavity may form if you have endometriosis, a pelvic infection, surgery on your pelvis, a cyst on an ovary, or have had surgery on your pelvis. Scar tissue causes organs that normally are separate from each other to become attached. For example, your ovary can be attached to your bowel, and your doctor will separate the adhesions with laparoscopic scissors to help relieve pain. This seems to work best when the adhesions are not too severe.

Fact Sheets/Booklets

View more fact sheets and booklets written by the ASRM Patient Education Committee.
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Resources For You

The American Society for Reproductive Medicine (ASRM) is committed to providing patients with the highest quality information about reproductive care.

Endometriosis

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Infertility: an Overview (booklet)

Infertility is typically defined as the inability to achieve pregnancy after one year of unprotected intercourse. View the booklet
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Endometriosis: Does It Cause Infertility?

When tissue like the tissue that normally lines the inside of the uterus (endometrium) is found outside the uterus, it is termed “endometriosis.” View the Fact Sheet
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What do I need to know about conceiving after tubal surgery?

Fallopian tubes connect the ovary (where the eggs are stored and grow) to the uterus (womb), where the fertilized egg develops into a baby (fetus). View the fact sheet
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Hydrosalpinx

The fallopian tubes are attached to the uterus (womb) on the left and right sides. View the Fact Sheet
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Endometriosis

Endometriosis is a condition in which endometrial tissue, which normally lines the uterus, develops outside of the uterine cavity in abnormal locations. Watch Video
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Causes of Female Infertility

Dr. Roger Lobo, of the American Society for Reproductive Medicine explains the causes of female infertility. Watch Video
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Endometriosis (booklet)

Women with endometriosis may experience infertility, pelvic pain, or both. This booklet will describe options for diagnosing and treating pain or infertility that may be attributed to endometriosis. View the Booklet
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Endometriosis and Infertility: Can Surgery Help?

Endometriosis is when tissue is found outside the uterus that appears similar to the lining of the uterus (endometrium). Endometriosis may grow on the outside of your uterus, ovaries, and tubes and even on your bladder or intestines. This tissue can irritate structures that it touches, causing pain and adhesions (scar tissue) on these organs. View the Fact Sheet
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Noncontraceptive Benefits of Birth Control Pills

Most women will use birth control pills at some time in their lives. View the fact sheet
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Managing Pelvic Pain

Many women have pain in their pelvis (lower part of the belly) from time to time, usually during their period. View the fact sheet
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Endometriosis Infographics

ASRM has prepared infographics to illustrate the subject of Endometriosis better. View the Infographics

Fibroids or Myomas or Leiomyomas

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SART Fertility Experts - Fibroids and Fertility

Fibroids and their impact on fertility are discussed in this episode featuring Dr. Elizabeth Stewart, interviewed by host Dr. Brooke Rossi.  Listen to the Episode
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Fibroid Tumors

An educational video that answers patient questions about the causes, symptoms, diagnosis and management of uterine fibroids. Watch Video
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Treatment of uterine fibroids

Do all fibroids require treatment? Not usually, because most patients with fibroids do not have symptoms. View the fact sheet
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Fibroids and Fertility

Uterine fibroids are benign (noncancerous) tumors of muscle tissue in the uterus. They are also called myomas or leiomyomas. View the Fact Sheet
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What are fibroids?

Uterine fibroids (also called myomas or leiomyomas) are benign (noncancerous) tumors of muscle tissue found in the uterus. View the fact sheet
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Causes of Female Infertility

Dr. Roger Lobo, of the American Society for Reproductive Medicine explains the causes of female infertility. Watch Video
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Fibroids or Myomas or Leiomyomas Infographics

ASRM has prepared infographics to illustrate the subject of Fibroids better. View the infographics

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