This topic focuses on pelvic pain that has lasted
longer than 6 months. If you have new, sudden pelvic pain, see your doctor as
soon as you can. To learn more about new pelvic pain, see the topic
Abdominal Pain, Age 12 and Older.
What is chronic female pelvic pain?
Female pelvic
pain is pain
below a woman's belly button. It is considered chronic, which means
long-lasting, if you have had it for at least 6 months. The type of pain varies
from woman to woman. In some women, it is a mild ache that comes and goes. In
others, the pain is so steady and severe that it's hard to sleep, work, or
enjoy life.
If your doctor can find what's causing the pain,
treating the cause may make the pain go away. If no cause is found, your doctor
can help you find ways to ease the pain and get your life back.
Diseases of
the urinary tract or bowel, such as
irritable bowel syndrome or chronic bladder
irritation.
Physical or sexual abuse. Experts are not sure why
this is so, but about half of women with chronic pelvic pain have a history of
abuse.1
Doctors don't really understand all the things that can
cause chronic pelvic pain. So sometimes, even with a lot of testing, the cause
remains a mystery. This doesn't mean that there isn't a cause or that your pain
isn't real.
Sometimes, after a disease has been treated or an
injury has healed, the affected nerves keep sending pain signals. This is
called neuropathic pain. It may help explain why it can
be so hard to find the cause of chronic pelvic pain.
What are the symptoms?
The type of pain can vary
widely. Chronic pelvic pain can include:
Pain that ranges from mild to severe.
Pain that ranges from dull to sharp.
Severe
cramping during periods.
Pain during sex.
Pain when
you urinate or have a bowel movement.
Chronic pain can lead to
depression. Depression can cause you to feel sad and
hopeless, eat and sleep poorly, and move slowly.
How is chronic female pelvic pain diagnosed?
At
your first visit, your doctor will do a complete
pelvic exam to look for problems with your
reproductive system. The doctor will also ask questions about your past and
present health and about your symptoms. You may have some tests, such
as:
Emotional issues can play a big role in chronic pain.
Your doctor may ask questions to find out if depression or stress is adding to
your problem. You may also be asked about any past or current sexual or
physical abuse. It can be hard to talk about these things, but it's important
to do it so you can get the right treatment.
If the first tests
don't find a cause, you may have other tests that show pictures of the organs
in your belly. These may include a
transvaginal ultrasound and an
MRI or
CT scan of the pelvis. You may also have a type of
minor surgery called
laparoscopy (say 'lap-uh-ROS-kuh-pee'). In this
surgery, the doctor puts a thin, lighted tube with a tiny camera through a
small cut in your belly. This lets the doctor look for problems like growths or
scar tissue inside your belly.
Finding the cause of pelvic pain
can be a long and frustrating process. You can help by keeping notes about the
type of pain you have, when it happens, and what seems to bring it on. Show
these notes to your doctor. They may give clues about what is causing the
problem or the best way to treat it.
How is it treated?
If your doctor found a problem
that could be causing your pelvic pain, you will be treated for that problem.
Some common treatments include:
Birth control pills or hormone treatment for
problems related to your periods.
Surgery to remove a growth,
cyst, or tumor.
Medicine to treat the problem, such as an
antibiotic for infection or medicine for irritable
bowel syndrome.
Chronic pain can become a medical problem in itself.
Whether or not a cause is found, your doctor can suggest treatments to help you
manage the pain. You may get the best results from a combination of treatments
such as:
Pain relievers called
NSAIDs, like ibuprofen (such as Advil or Motrin) or
naproxen (such as Aleve). You can buy these
over the counter, or your doctor may prescribe
stronger ones. These medicines work best if you take them on a regular
schedule, not just when you have pain. Your doctor can tell you how much to
take and how often.
Tricyclic antidepressant medicine, which can
help with pain as well as depression.
Counseling, to
give you emotional support and reduce stress.
You may need to try many treatments before you find the
ones that help you the most. If the things you're using aren't working well,
ask your doctor what else you can try. Taking an active role in your treatment
may help you feel more hopeful.
If you have pelvic pain, your health
professional will consider a broad range of possible causes.
Female pelvic pain is typically caused by a medical
condition involving the reproductive organs, muscles of the abdominal wall,
urinary tract, or lower gastrointestinal tract. Some causes are always
short-term (acute), and others can become long-lasting (chronic) unless
successfully treated.
Female pelvic pain can be a
difficult-to-solve medical mystery. Experts have yet to understand all possible
causes of pelvic pain, particularly when it has become chronic. For this
reason, some women have chronic female pelvic pain with no known cause, even
after a lot of testing. This does not mean, however, that there isn't a cause
behind the pain nor that there is no possible treatment.1
Chronic pain with no diagnosable cause can occur in any part of the body. Long after a disease or injury
has healed, nerves can continue firing pain signals (neuropathic pain). This is thought to be caused by an
overloading of the
nervous system by extreme or long-lasting pain. It
also helps explain why it's fairly common for chronic pelvic pain to have no
obvious cause.
Conditions that can cause acute pelvic pain include:
Normal
ovulation, which can cause brief ovary pain, or
"mittelschmerz." This pain is cyclic, meaning that it happens once during each
normal menstrual cycle.
Conditions that can cause chronic pelvic pain include:
Endometriosis,
the growth of uterine lining (endometrial) tissue outside of the uterus, which
often causes cyclic pain and bleeding. For more information, see the topic
Endometriosis.
Adenomyosis, the
growth of endometrial tissue into the uterine muscle, which can cause cyclic
pain and bleeding.
Noncancerous (benign) tumors of the uterus, such
as:
Scar tissue (adhesions) in
the abdomen and pelvis, typically caused by pelvic inflammatory disease,
radiation treatment of the pelvis, or pelvic or abdominal surgery. For more
information, see the topic
Pelvic Inflammatory Disease.
Physical or
sexual abuse in the recent or distant past. (Though poorly understood, combined
emotional and physical trauma are thought to cause chronic pain or make it
worse.1) For more information, see the topics
Domestic Violence and
Child Abuse and Neglect.
Urinary tract problems, such as bladder inflammation (chronic
interstitial cystitis).
Low
backache 1 or 2 days before the start of the menstrual period (or earlier),
subsiding during the period.
Pain during sexual intercourse
(dyspareunia).
Painful urination.
Rectal
pain.
Pain during bowel movements.
Symptoms that can accompany pelvic pain, depending on the
cause, include:
Blood in the urine or
stool.
Vaginal bleeding after intercourse.
Heavy or
irregular vaginal bleeding.
Depression symptoms are commonly linked
to chronic pain. Signs of depression include sleep problems, appetite changes,
feelings of emptiness and sadness, and slowed body movements and reactions. If
you have depression symptoms, see your health professional. For the best chance
of recovery from pain, depression must be treated along with any known physical
cause(s) of pain.
What Happens
Experts have yet to understand
all possible causes of
female pelvic pain, particularly when it has become
chronic. For this reason, the cause of pelvic pain sometimes remains unknown,
even after a lot of testing. This does not mean that there is no cause behind
the pain.1 Fortunately, even without knowing the
cause, there is available treatment for relieving the pain.
Because female pelvic pain can be caused by one or more conditions, its
course can have just as many variations.
When a cause is readily diagnosed and treated,
such as an
ovarian cyst, pain is most likely to be
reversed.
For pain that is difficult to diagnose, your health
professional can do a number of tests to rule out various medical conditions.
Your health professional may also try certain treatments to see whether they
work, which can also help with diagnosis.
When a diagnosed cause is
difficult to treat, such as
endometriosis, your pain may have an unpredictable
course.
For pain that is undiagnosed after a lot of testing, you
and your health professional can consider several types of pain relief options
that are known to help relieve chronic pain.
Chronic pain
In some cases, pain that lasts 4 to 6
months can become chronic pain, which is a medical condition in itself.2 Even after the cause of pain has been treated, the affected
nerves don't stop transmitting pain signals. This is called neuropathic pain, a
type of chronic pain. When chronic pain has set in, it's possible that
treatment will manage the pain yet not cure it.2
Experts continue to research the causes and best treatments for chronic pelvic
pain.
About half of women with chronic pelvic pain report a
history of sexual or physical abuse.1 Although it is
not well understood, past or current abuse is strongly linked to chronic pelvic
pain. If you have a history of abuse, counseling is recommended as part of your
pain treatment plan.
What Increases Your Risk
Factors that increase a
woman's risk of developing
female pelvic pain that becomes chronic
include:
Pregnancy and childbirth that have stressed
the back and pelvis, including delivery of a large baby, a difficult delivery,
or a forceps or vacuum delivery.
A history of childhood or adult
physical or sexual abuse. About half of women with chronic female pelvic pain
report abuse in their past.1
If you have
chronic female pelvic pain that has not yet been
evaluated, call your health professional for an appointment.
If
you have chronic pelvic pain that has already been evaluated, call a health professional for immediate care if sudden,
severe pelvic pain occurs with or without vaginal bleeding.
Call a
health professional if:
Your periods have changed from relatively
pain-free to painful.
Pain interferes with your daily
activities.
You begin to have pain during
intercourse.
You have painful urination, blood in your urine, or an
inability to control the flow of urine.
You have blood in the stool
or a significant, unexplained change in your bowel movements.
Even if you have existing pain or other symptoms, call your
health professional if you notice new pelvic symptoms.
Watchful Waiting
Watchful waiting is a period of time during
which you and your health professional observe your pelvic pain symptoms
without using additional medical treatment. During this period, you can keep a
daily record of your symptoms, menstrual cycle, and any other life events that
you consider important. A watchful waiting period may vary from a few days to
weeks or possibly months.
Who To See
The following primary health professionals can
generally evaluate and help you manage the symptoms of female pelvic
pain:
If chronic
pelvic pain is to be formally diagnosed or treated with advanced methods,
consult with a
gynecologist or a urologist who specializes in female
pelvic disorders.
Experts have noted a link between abuse and
chronic pelvic pain.1 If you have ever been physically
or sexually abused, the physical and psychological trauma you have suffered may
be playing a part in your pain. For this reason, it's important that you have a
health professional with whom you are comfortable discussing any past or
current abuse, as well as your current symptoms.
If you have had
long-lasting (chronic) pelvic pain that hasn't responded to treatment or seems
to have no physical cause, you may have developed neuropathic pain, which means
your nerves continue to fire pain signals long after an original injury or
disease has healed. If your health professional suspects that you have
neuropathic pain, he or she may refer you to a
pain management clinic for evaluation and treatment.
There are many possible causes of
female pelvic pain, so it is important to see your
health professional for a thorough evaluation. Although your condition may be
easily diagnosed during your first exam, expect that you might have a series of
medical appointments and tests. For many women with pelvic pain, diagnosing the
cause is a process of elimination that takes a while to complete.
Initial exam for a cause of female pelvic pain
If
possible, bring with you a calendar or diary of your symptoms, menstrual cycle,
sexual activity, physical exertion, and any other factors that you consider
important, such as stressful events or illnesses. To begin narrowing down the
list of possible causes of your pain, your health professional will review your
symptom diary and:
Ask about
your health history, including the history of your menstrual cycle as well as
any pelvic surgery, radiation treatment, sexually transmitted disease,
pregnancy, or childbirth.
Perform a
pelvic exam to look for signs of abnormalities in your
reproductive tract. You may also have a
digital rectal exam. Your health professional may
conduct this exam in a slower, more thorough manner than a routine pelvic exam,
carefully checking for tender areas.
You may also have additional tests, depending on whether
you've recently had a Pap test or are sexually active. These may include:
Experts have noted a link between abuse and chronic
pelvic pain.1 If you have ever been physically or
sexually abused, your pelvic pain may be made worse by physical and
psychological trauma. For this reason, it's important that you choose a health
professional with whom you are comfortable discussing any past or current abuse
as well as your current symptoms.
Further testing for a cause of female pelvic pain
If your initial exam hasn't detected a cause of your pain, or if your
results suggest a specific condition, your health professional will recommend
further testing. Commonly used tests for further diagnosis of pelvic pain
include:
Abdominal ultrasound and/or
transvaginal ultrasound of the pelvic area using a
small ultrasound device (transducer) inserted into the vagina. Ultrasound plays
a major role in looking for causes of pelvic pain. It is useful for detecting
endometrial hyperplasia;
pelvic inflammatory disease; and cancerous or
noncancerous (benign) growths such as fibroids, cysts, and tumors on the
ovaries, uterus, cervix, or fallopian tubes.
Intravenous pyelogram (IVP), which uses an injected
dye combined with X-rays to create pictures of the kidneys, bladder, ureters,
and urethra.
Laparoscopy, a surgical procedure that
uses a thin, lighted viewing instrument (laparoscope) inserted through a small
abdominal incision. This allows a doctor to look inside the pelvis for causes
of pain, including scar tissue (adhesions),
abnormal growths, cysts, tumors, and pelvic inflammatory disease. Laparoscopy
is the only way to confirm the presence of
endometriosis. If needed, a growth or adhesion can
also be removed during the procedure.
Magnetic resonance imaging (MRI) of the
pelvis, which uses a magnetic field and pulses of radio wave energy to create
pictures of organs and bones.
Cystoscopy, which uses a viewing
instrument inserted through the urethra into the bladder. This allows a doctor
to see signs of inflammation, growths, or kidney stones in the
bladder.
Urodynamic studies, which test bladder function and
whether bladder spasms are causing pelvic pain.
Evaluation of
abdominal wall for 'trigger points."
Chronic pain testing
Chronic pain can have a
wearing effect on the mind and emotions, which can in turn make pain management
more difficult. Your health professional may recommend a
mental health assessment. You will be asked questions
to determine whether such conditions as
depression,
insomnia, or stress are contributing to or being
caused by your chronic pain. For the best chance of recovering from pain, these
conditions must be treated along with any known physical cause(s) of pain.
What to think about
A laparoscopy or other test
that reveals no apparent problems (negative test result) does not necessarily
mean that no physical cause is present. Exams and tests for causes of female
pelvic pain are not yet able to detect all causes.2
Treatment Overview
Treatment for
chronic female pelvic pain can be approached in two
ways: treating a known, specific cause of the pain or treating the pain itself
as a medical condition. If possible, your health professional will combine the
two approaches.2
Treatment of a known or suspected cause of pelvic pain
Based on your history, pelvic exam, and testing results, your health
professional may find one or more conditions that could be causing your pelvic
pain or making it worse, such as
endometriosis,
irritable bowel syndrome, or
uterine fibroids. Depending on the cause, your
treatment may include:
Medication to control or stop the
ovulation cycle, if cyclic hormonal changes seem to
make your symptoms worse.
Surgery to remove painful
growths, cysts, or tumors. (However, studies have shown that surgery to remove
scar tissue, or
adhesions, does not relieve pain unless the adhesions
are severe, referred to as stage IV adhesions.2)
Healthy lifestyle choices, such as regular
exercise to manage stress and improve strength, mood, and general health, along
with dietary changes, such as those recommended to manage irritable bowel
syndrome.
Pain treatment
For both new (acute) and chronic pelvic pain, nonsteroidal anti-inflammatory drugs
(NSAIDs) are the first-choice treatment for relieving pain and inflammation.
NSAIDs are also highly effective for relieving menstrual pain because they
block production of
prostaglandin, which is responsible for cramping pain.
Your health professional may recommend a
nonprescription NSAID, such as ibuprofen, taken on a
regular schedule. Different types of NSAIDs work for some people but not
others. If your first trial doesn't work, your health professional will
recommend a different type, possibly a
prescription NSAID.
For cyclic pain that seems to be caused or made worse by menstruation,
stopping ovulation and controlling hormone levels is commonly recommended and
sometimes effective.
Birth control pills (oral contraceptives) or
high-dose progestin are commonly prescribed to reduce
painful menstruation. Oral contraceptives are often prescribed for
endometriosis-related pain, though there is little research that shows them to
be effective.1 However, when the risk of using an oral
contraceptive is low, it is typically worth trying for several months.
Gonadotropin-releasing hormone agonists (GnRH-As) can
relieve endometriosis-related pain by stopping production of the hormones that
make endometriosis worse. GnRH-A treatment may also relieve cyclic pelvic pain
not related to endometriosis, as well as pelvic pain related to
irritable bowel syndrome.1
However, this short-term treatment induces
menopause for as long as you take it, with side
effects such as
hot flashes and loss of bone density. For more
information, see the topic
Endometriosis.
For chronic pelvic pain, combining
medical and psychological treatment increases your chances of treatment
success. Medications that may help manage your chronic
pelvic pain include:
Nonsteroidal anti-inflammatory drugs (NSAIDs), taken on a regular schedule to relieve pain caused by
inflammation or menstruation. If one type doesn't work for you, your health
professional may recommend trying another before discontinuing NSAID therapy.
Talk to your health professional about whether NSAID
therapy is safe for you, how much to take, and what type of schedule to
follow.
Tricyclic antidepressant medications (TCAs), which are
used to treat chronic pain in other areas of the body as well. Limited research
suggests that TCA therapy decreases chronic pelvic pain intensity for some
women.1
Narcotic pain medication, which is only recommended as a last-resort, short-term
treatment for severe pelvic pain because of the risk of addiction.
Counseling and mental skills training help you learn the mental and emotional tools for managing
chronic pain and the stress that makes it worse. Commonly recommended
approaches include:
Cognitive-behavioral therapy focused on
changing both the way you think about pain and your ability to mentally
influence how pain affects you.
Biofeedback, which
is the conscious control of body function that is normally unconsciously
controlled.
Interpersonal counseling focused on best managing your life events, stressors, and
relationships.
Alternative pain treatments such
as acupuncture,
transcutaneous nerve stimulation (TENS),
hypnosis,
guided imagery,
aromatherapy,
meditation, and
yoga are low-risk pain treatments that many people use
to manage pain. Acupuncture and TENS have shown some success in relieving
painful menstrual periods. Acupuncture has also been used as a treatment for
nonmenstrual chronic pelvic pain but has not been well studied.1
Surgical treatment for
chronic pelvic pain should be limited to the treatment of surgically
correctable problems. Surgery is most useful for treatment of a specific cause
of pelvic pain, such as
fibroids or
endometriosis.
There is no evidence that
surgical removal of the reproductive organs relieves chronic pelvic pain when
the cause of pain cannot be found.3 When surgery is
done for pain with no known cause (hysterectomy or
cutting of specific pelvic-area nerves), there is a risk of persistent or
worsened pain after surgery as well as surgery-related side effects.
What To Think About
After 4 to 6 months of pain, some
people develop
chronic pain, which is a medical disorder that is
separate from the original pain-causing condition. Because chronic pain and
female pelvic pain have yet to be fully understood, treatment can be a
trial-and-error process. It is common for women with chronic female pelvic pain
to try many treatments before finding one or more that are helpful.
Decisions are complicated when considering treatment for chronic pelvic
pain. Evaluate the following:
Are the symptoms bothersome enough to require
treatment?
Do you want to have a child or more
children?
Has a specific cause of the pain been discovered, or is
the cause unclear?
Is menopause, which may stop symptoms, going to
occur soon?
Would an opinion from another health professional be
helpful?
Would an opinion from a physician who specializes in
chronic pain be valuable?
Have you tried cognitive-behavioral
therapy?
Prevention
Early diagnosis and treatment of pelvic pain
may help prevent
chronic female pelvic pain from developing.
One cause
of chronic pelvic pain is
pelvic inflammatory disease (PID). You can greatly
reduce your risk of PID by protecting yourself from sexually transmitted
diseases (STDs).
Practice safe sex or abstinence
Preventing an STD
is easier than treating an infection after it occurs.
Talk with your partner about STDs before
beginning a sexual relationship. Find out whether he or she is at risk for an
STD. Remember that it is quite possible to be infected with an STD without
knowing it. Some STDs, such as
HIV, can take up to 6 months before they can be
detected in the blood.
Be responsible.
Avoid sexual contact if you have symptoms
of an STD or are being treated for an STD.
Avoid all sexual contact
with anyone who has symptoms of an STD or who may have been exposed to an
STD.
Don't have more than one sex partner at a time. Your risk for
an STD increases if you have several sex partners at the same time.
Condom use reduces the risk of becoming infected with an
STD, especially gonorrhea, chlamydia, and HIV. Condoms must be in place before
beginning any sexual contact. Use condoms with a new partner every time you
have sex, until you know from test results that he or she does not have an
STD.
Abstaining from sexual contact is the only certain way to
avoid exposure to STDs.
Home Treatment
Home treatment may help ease
female pelvic pain and can be used along with your
medical treatment plan.
To relieve your pain:
Try
nonprescription medicine, such as ibuprofen (for
example, Advil or Motrin) or acetaminophen (for example, Tylenol).
Start taking the recommended dose of pain
medicine as soon as you feel uncomfortable. If you have painful periods, start
taking the medicine one day before your menstrual period is scheduled to
start.
Take the medicine in regularly scheduled doses to keep the
pain under control. Pain medicine works better if you take it at regularly
scheduled times.
Before you take any nonprescription medicine for
the first time, be sure to carefully read the information on the package. It is
important to understand how much of the medicine you should take and when you
should take it as well as reasons not to take the medicine.
Do not
take more than the recommended dose.
Do not take aspirin if you are younger than 20 unless your doctor
tells you to.
If you are or could be pregnant, call your doctor
before using any medicine.
Apply a heating pad, hot water bottle, or warm
compress to your lower belly, or take a warm bath. Heat improves blood flow and
may relieve pain.
To relieve back pain, lie down and elevate your
legs by placing a pillow under your knees. When lying on your side, bring your
knees up to your chest.
Exercise
regularly. It improves blood flow, increases pain-relieving endorphins
naturally made by the body, and reduces pain.
Try sexual activity,
which may relieve pelvic cramping and backache. If your pain is related to
endometriosis, however, sex may make it worse.
Medications
Treatment with medication does not cure
female pelvic pain. However, controlling pain can help
prevent it from getting worse or becoming chronic.
Medication Choices
The following may help relieve symptoms:
Prescription nonsteroidal anti-inflammatory drugs (NSAIDs), taken on a regular schedule, help relieve pain caused by
inflammation or menstruation. If one type doesn't work for you, your health
professional may recommend that you try at least one other before stopping
NSAID therapy.
Birth control pills (oral contraceptives) are commonly prescribed to reduce
painful menstruation. Oral contraceptives are often prescribed for
endometriosis-related pain, though there is little research that shows them to
be effective.1
High-dose progestin
is sometimes prescribed to relieve pain related to endometriosis.1
Gonadotropin-releasing hormone agonists (GnRH-As) can relieve endometriosis-related pain by stopping production
of the hormones that make endometriosis worse. GnRH-A treatment may also
relieve cyclic pelvic pain not related to endometriosis, as well as pelvic pain
related to
irritable bowel syndrome.1
However, this short-term treatment induces
menopause, with side effects such as
hot flashes and loss of bone density, for as long as
you take it. For more information, see the topic
Endometriosis.
Tricyclic antidepressant medications (TCAs) are sometimes used to treat chronic pain in other
areas of the body. Limited research suggests that TCA therapy decreases chronic
pelvic pain intensity for some women.1
Narcotic pain medication is only
recommended as a last-resort treatment for severe pelvic pain because of the
risk of addiction.
What To Think About
No single medication successfully
treats chronic pelvic pain in all women.
Treating chronic pelvic
pain with medication is usually preferable to using a surgical option. Surgery
is only recommended when a correctable cause of pain is clearly known. Even in
these cases, there are no guarantees that surgery will relieve pain or that it
will not cause further problems.
Chronic pelvic pain symptoms
sometimes stop naturally when menopause occurs. If you are close to menopausal
age (usually around age 50) and your symptoms are likely related to hormones,
your best option may be home treatment and medication until menopause
occurs.
Surgery
Surgery may be used in the diagnosis or
treatment of
chronic pelvic pain. It is most likely to be effective
when it is performed for a specific condition, such as
fibroids or
endometriosis.
There is no evidence
that surgical removal of the reproductive organs relieves chronic pelvic
pain.3 When surgery, such as
hysterectomy or cutting of specific pelvic-area
nerves, is done for pain with no known cause, there is a risk of persistent
pain or pain that is worse after surgery as well as surgery-related side
effects.
Surgery Choices
Either
laparoscopic surgery through a small incision or
laparotomy through a larger abdominal incision can be
used for procedures to treat pelvic pain.
Hysterectomy, the surgical removal of
the uterus, is sometimes used as a last-resort treatment for chronic, severe
pelvic pain. Depending on the cause, hysterectomy may relieve pain for some
women.
Studies have shown that surgery to remove scar tissue
adhesions from previous surgery or from
pelvic inflammatory disease does not relieve pain
unless the adhesions are severe (referred to as stage IV adhesions).2
What To Think About
Laparoscopy to diagnose chronic pelvic pain may be done before treatment with
medications (other than birth control pills) or surgery. Sites of endometriosis
(implants) or scar tissue (adhesions) may be removed or destroyed during the
laparoscopy.4
Hysterectomy is only a good
treatment choice for chronic pelvic pain when a documented disease or
surgically correctable condition of the pelvic organs is present. When
hysterectomy is performed solely for relief of pelvic pain, the results may be
disappointing.
Surgery may lead to complications that cause added
pain, discomfort, or other problems such as infection or scar tissue.
Symptoms caused by chronic pelvic pain often go away without treatment
when
menopause occurs and hormone fluctuations settle down.
Controlling symptoms with home treatment or medications until menopause may be
an option. Symptoms of chronic pelvic pain may return if you decide to use
hormone replacement therapy for
perimenopausal symptoms. Discuss your options with
your health professional if you are nearing menopause.
Other Treatment
Female pelvic pain treatment can be enhanced with counseling, mental skills training,
relaxation, and physical therapy treatment.
Other Treatment Choices
Counseling and mental skills training help you learn the mental and emotional tools for managing
chronic pain and the stress that makes it worse. Commonly recommended
approaches include:
Cognitive-behavioral therapy focused on changing the
way you think about and mentally manage pain. See a psychologist, licensed
counselor, or clinical social worker who specializes in pain management
skills.
Biofeedback, which is the conscious control of body
function that is normally unconsciously controlled.
Interpersonal counseling, focused on best managing
your life events, stressors, and relationships.
Physical therapy can help
you learn specific exercises to stretch and strengthen certain muscle groups.
Physical therapy helps you to improve posture, gait,
and muscle tone.
Alternative pain treatments for chronic female pelvic pain are not well studied but are
considered helpful for managing stress and building mental mastery over pain.
Acupuncture and
transcutaneous nerve stimulation (TENS) have shown
some success in relieving painful menstrual periods. Acupuncture has also been
used as a treatment for nonmenstrual chronic pelvic pain but is not yet well
studied.1
Other low-risk alternative pain
treatments that many people use to help manage pain include:
Chronic pelvic pain takes time to
develop and can take a long time to treat. Take charge of how you cope with
pain by using one or more of the treatment choices above. Combine your
treatment with the practices you prefer for keeping a positive state of mind.
For more information, see the topic
Stress Management.
Other Places To Get Help
Organizations
International Pelvic Pain Society
1111 North Plaza Drive
Suite 550
Schaumburg, IL 60173-4950
Phone:
(847) 517-8712
E-mail:
info@pelvicpain.org
Web Address:
www.pelvicpain.org
Chronic pelvic pain affects millions of women. However, new
surgical and medical therapies are available that may offer hope for women
suffering from chronic pelvic pain. The International Pelvic Pain Society
brings physicians, psychologists, physical therapists, and basic scientists
together to coordinate, collect, and apply this growing body of information,
and the organization serves as a forum for professional and public education.
National Women's Health Information
Center
8270 Willow Oaks Corporate Drive
Fairfax, VA 22031
Phone:
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American College of Obstetricians and Gynecologists
(2004, reaffirmed 2008). Chronic pelvic pain. ACOG Practice Bulletin No. 51.
Obstetrics and Gynecology, 103(3): 589-605.
Howard FM (2003). Chronic pelvic pain. Obstetrics and Gynecology, 101(3): 594-611.
Lentz GM (2007). Pelvic Pain section of Differential
diagnosis of major gynecologic problems by age groups. In VL Katz, et al.,
eds., Comprehensive Gynecology, 5th ed., pp. 158-164.
Philadelphia: Mosby Elsevier.
Lobo RA (2007). Endometriosis. In VL Katz, et al.,
eds., Comprehensive Gynecology, 5th ed., pp. 473-499.
Philadelphia: Mosby Elsevier.
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American College of Obstetricians and Gynecologists
(2004, reaffirmed 2008). Chronic pelvic pain. ACOG Practice Bulletin No. 51.
Obstetrics and Gynecology, 103(3): 589-605.
Howard FM (2003). Chronic pelvic pain. Obstetrics and Gynecology, 101(3): 594-611.
Lentz GM (2007). Pelvic Pain section of Differential
diagnosis of major gynecologic problems by age groups. In VL Katz, et al.,
eds., Comprehensive Gynecology, 5th ed., pp. 158-164.
Philadelphia: Mosby Elsevier.
Lobo RA (2007). Endometriosis. In VL Katz, et al.,
eds., Comprehensive Gynecology, 5th ed., pp. 473-499.
Philadelphia: Mosby Elsevier.
