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Managing Pelvic Pain

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Created 2008/Revised 2023


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Many females 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 or pain that inhibits your daily activities, 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 do your daily activities such as go to the bathroom, walk, sit, climb stairs, or have sexual intercourse. 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 originates. For example, endometriosis, a condition where the same tissue that lines the uterus is found in parts of the pelvis and abdomen, may be suspected during a pelvic exam by a doctor.

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, menopauselike state. Decreasing estrogen can help with conditions like endometriosis.

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 and inserted into the abdomen(laparoscope). One to 4 small incisions in your belly allow the introduction of operative instruments. During laparoscopic surgery, your doctor will be able to view your pelvic and abdominal organs to see if they 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 (organs pushing out through weakened abdominal wall). Sometimes, even finding that everything looks normal can be helpful in choosing further treatment.

The two most common problems that can be treated with laparoscopy are endometriosis and pelvic adhesions:

Endometriosis

Endometriosis can cause daily pelvic pain, painful periods, and/or 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, or a cyst on an ovary. 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.

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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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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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What do I need to know about conceiving after surgery on my Fallopian tubes?

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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SART Fertility Experts - Endometriosis

Endometriosis is a condition that can affect many facets of a person’s life, from pelvic pain to struggles with infertility.   Listen to the Episode
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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 (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

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 Infographics

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

Fibroids or Myomas or Leiomyomas

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Fibroids and Fertility

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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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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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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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