9 Causes of Pelvic Pain—That Aren’t Your Period
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9 Causes of Pelvic Pain—That Aren’t Your Period

Awful cramping or discomfort could signal a serious condition, like fibroids or endometriosis.

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By Olivia DeLong

Pelvic pain is caused by a variety of different conditions, and sometimes a combination of multiple conditions. But what is pelvic pain and where is it located, exactly?

In general, pelvic pain is discomfort that occurs below the belly button, down below your hip bone. If you’re looking at your pelvis, and feel just above the belt line and your bones that protrude out, it’s underneath that imaginary line.

The pain may come from any of the organs in that part of your body, including the uterus, ovaries, fallopian tubes, bowel and bladder, says OBGYN Alex Letham, DO, of LewisGale Hospital Montgomery in Blacksburg, Virginia. But, due to the nerve supply to the area, it can be hard to pinpoint the exact source. Also, that’s why pain can spread to the back or thighs, he adds.

Depending on the cause, the pain can present itself in different ways and on different sides of the pelvis. Here are some of the reasons you may experience pelvic pain, plus the most common ways to treat it.

Endometriosis

2 / 11 Endometriosis

Pelvic pain and pressure are the most common symptoms of endometriosis. It’s a condition in which the endometrium forms outside of the uterus in places like the ovaries, fallopian tubes, intestines or bladder. Endometriosis is pretty common—about 1 in every 10 women of reproductive age have it.

Because the tissue is the same type of tissue that’s in your uterus, as estrogen fluctuates, the growths can mature and bleed, which may cause the surrounding area to become inflamed or swollen, and could even result in scarring. All of this irritation can trigger pain in the pelvic region, especially before and during menstruation.

Nonsteroidal inflammatory drugs (NSAIDs), oral contraceptive pills or a combination of both are the preferred treatment options for endometriosis. If these methods are unsuccessful, others, like progestin treatments and gonadotropin releasing hormone (GnRH) agonists are usually suggested. And sometimes, surgery may be needed.

Uterine adenomyosis

3 / 11 Uterine adenomyosis

Adenomyosis is a condition similar to endometriosis, since it involves the tissue that usually lines the uterus. But with adenomyosis, the tissue instead grows into the muscular wall of the uterus.

“The intense pelvic pain associated with adenomyosis typically follows trends with the menstrual cycle,” says Letham. That’s because your uterus swells and expands during that time. You’re likely to have heavy bleeding and even a feeling of heaviness or tenderness in your abdomen. Some women don’t have any symptoms at all, though.

Adenomyosis usually goes away on its own after menopause. But if it doesn’t, a hysterectomy is the most recommended treatment.

If you have symptoms during your childbearing years and wish to have children or don’t want a hysterectomy, anti-inflammatory medications may help reduce the pain. And like endometriosis, progestin therapy may also be used to treat heavy bleeding and discomfort.

Ovarian cysts

4 / 11 Ovarian cysts

Ovarian cysts, or sacs consisting of fluid and tissue, can also cause pain during the reproductive years, or even after menopause. “Pain associated with ruptured cysts can be random and sporadic and can cause some brief, yet intense pain that resolves over the course of a few days,” says Letham. Cysts are almost always non-cancerous.

The good news is that ovarian cysts may never cause you any pain. But if they do, it may be because they have ruptured. Pain associated with cysts can feel dull or sharp. And if they rupture, you’re likely to feel a sudden, sharp pain in your abdomen—sometimes just on one side. Treatment for ovarian cysts depends on a few things, like:

  • Its size
  • Your age
  • Whether or not you want to have children
  • Whether or not you’re having symptoms
  • Your history of ovarian or breast cancer

Many women may not need any treatment, since most cysts go away on their own after a couple of menstrual cycles. If cysts don’t disappear by themselves, your gynecologist may want to monitor them through ultrasounds, watching for any changes. If she thinks they may be cancerous, or if the cysts are causing major pain or other severe symptoms, a cystectomy (surgery to remove the cyst) or an oophorectomy (surgery to remove the ovary) may be needed.

Oral contraceptives are often suggested to prevent new cysts from forming.

Uterine fibroids

5 / 11 Uterine fibroids

Fibroids, also known as leiomyomas or myomas, are non-cancerous growths that develop from uterine muscle tissue. “A fibroid is uterine muscle tissue that slowly enlarges to a very firm ball-like mass of muscle,” says Letham. They can develop on the inside or outside of the uterus, inside the uterine wall itself, or be attached to it by a stem-like structure. Fibroids can get bigger over time, but may remain small forever.

Some women with fibroids don’t have any symptoms, but some will. “Because they are disrupting the muscle around the uterus, they can cause pain, heavy periods, and can get large enough and impact the bladder or rectum.” Pelvic pain, or lower back pain that’s achy—and even sharp—may accompany fibroids. Pain during sex is common, too.

If you’re not having symptoms, you probably won’t need any treatment. But if the pain is interfering with your regular daily activities, talk to your gynecologist. Like with endometriosis and adenomyosis, she may prescribe birth control pills, gonadotropin releasing hormone (GnRH) agonists and progestin-releasing intrauterine devices, which may help reduce heavy bleeding and pain.

If your symptoms are severe, your gynecologist may recommend certain procedures, like uterine artery embolization or a myomectomy, to remove the fibroids. Myomectomies are usually recommended for those women who want to have children. New fibroids can form after this surgery, though. If your fibroids are extremely large or other treatments haven’t worked, a hysterectomy may be needed.

Pregnancy and miscarriage

6 / 11 Pregnancy and miscarriage

Up to 80 percent of pregnant women experience some sort of pelvic pain during pregnancy, normally in the third trimester because of the pressure on the pelvic area. Down the road, about two to four weeks before delivery, you may notice some pelvic heaviness that reaches around to your back, since the fetus drops lower into the pelvis.

There are more serious conditions that cause intense pain, such as:

  • Ovarian torsion, or twisted ovary 
  • Ectopic pregnancy, when the fertilized egg implants in another place besides the inside of the uterus, such as the fallopian tube
  • Miscarriage, loss of pregnancy within the first 13 weeks

If you have a sharp pain on one side that makes it hard for you to walk, breathe or talk, or is accompanied by other symptoms like vomiting or bleeding, see your OBGYN immediately or head to the emergency room.

Regardless of how far along you are, it’s best to talk with your OBGYN if you’re having any type of pain. And if your doctor has explained that your pain is normal, you can try stretching, breathing techniques and walking for some relief.

Ovulation

7 / 11 Ovulation

“Some women will have pain for a few short days during ovulation, which is usually sometime between day 11 and day 15 of their menstrual cycle,” says Letham. “This type of pain is technically called mittelschmerz, which is German for the words ‘middle’ and ‘pain.’”

It occurs because the ovary is releasing an egg.

If you’re having pain, the easiest way to connect it to ovulation is to start taking a closer look at your menstrual cycle. “Keeping a pain diary and tracking your cycle can be very helpful for the doctor when you come in for evaluation,” says Letham. Use a regular notepad or one of the many phone apps available, like Flo, Day After or My Cycles, to record the day of your first period, how long your period lasts and any symptoms you’re experiencing.

Ovulation pain isn’t something you usually need to worry about, unless it lasts for more than a couple of days or is accompanied by burning urination and irregular bleeding. Over-the-counter anti-inflammatory medications like ibuprofen can give you some relief in the moment.

Urinary tract infections

8 / 11 Urinary tract infections

In addition to gynecological issues, other health conditions can cause discomfort in the pelvic region. A urinary tract infection (UTI) most often occurs when bacteria get into the urinary tract and start to multiply in the bladder. When a UTI is severe, says Letham, it may result in lower abdominal soreness and pelvic pressure, in addition to traditional symptoms like frequent or burning urination.

Antibiotics, such as nitrofurantoin, fosfomycin and trimethoprim-sulfamethoxazole are almost always the recommended treatment option for UTIs.

Irritable bowel syndrome

9 / 11 Irritable bowel syndrome

Pelvic pain can also be caused by irritable bowel syndrome (IBS), a condition that often triggers pain in the abdominal and pelvic areas, bloating, and bowel problems like constipation and diarrhea.

Many of the treatment options involve lifestyle changes, including:

  • Avoiding trigger foods
  • Gradually adding more fiber to your diet
  • Steering clear of big meals

Fiber supplements, antidepressants, anti-diarrheal and other IBS-specific medication can relieve symptoms. Sometimes, stress relief techniques can help, too.

Pelvic inflammatory disease

10 / 11 Pelvic inflammatory disease

Untreated sexually transmitted infections like chlamydia and gonorrhea can lead to pelvic inflammatory disease (PID), an infection of a woman’s reproductive organs. Other things like douching can also increase your risk.

PID symptoms include pain in your lower abdomen area in addition to a fever, irregular discharge, painful sex, painful urination and bleeding between periods. Some women with PID may not have symptoms at all.

PID is curable with antibiotics if it’s caught early. The earlier you begin treatment, the lower your risk of reproductive damage caused by PID.

Don’t be afraid to see your gynecologist

11 / 11 Don’t be afraid to see your gynecologist

When it comes to pelvic pain, Letham says the biggest thing to remember is a diagnosis is needed for pain that worsens, pain that no longer responds to medications or pain that keeps you from regular daily activities. A physical exam can help your gynecologist determine what’s going on, and even refer you to a gastroenterologist or other specialist if need be.

Gynecology

Gynecology

There are many key areas in the field of female reproductive system health, including menstruation, pregnancy, fertility, and menopause. As a woman, you may be concerned about other issues related to your sexual health, including ...

genital problems and sexually transmitted diseases. If you are a female that is sexually active, or over the age of 18, it is important to begin seeing a womans' health specialist in order to make sure that your reproductive system stays healthy. Before that, any concerns with menstruation should be addressed with a physician. As you get older, most women become concerned with issues pertaining to avoiding or achieving pregnancy, until menopause begins around age 50.
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