Pelvic Pain

Pelvic pain may occur during your periods or at the middle of your cycle, during ovulation. Crampy lower abdominal pain is caused when the uterus contracts to shed the lining of the womb each month. This type of pelvic pain is usually mild, only lasts 1-4 days and does not require strong pain killers.  Other symptoms that can be associated with normal menstruation include lower back pain, headaches, acne, and bloating. 

Ovulation pain occurs about 2 weeks before your period is due. This pain usually occurs on one side of the lower abdomen, and is caused when the ovary releases and egg each month. When an egg is released from the ovary, fluid and a small amount of blood may also be released, causing irritation of the pelvis and lower abdominal pain. This pain may last from a few hours to a few days, and is usually treatable with panadol or nurofen.

Endometriosis occurs in approximately 10-15% of women in the reproductive age range and can cause pain symptoms, infertility and decreased quality of life.  Endometriosis occurs when tissue from the womb is found in locations outside the uterus, usually in the lower abdomen. Endometriosis can grow on the ovaries, bowel, bladder, uterus, Fallopian tubes, and on the lining of the pelvis. 

Symptoms of endometriosis include severe period pain, painful sexual intercourse, diarrhea/ constipation, and nausea/vomiting.  Pain may also occur with bowel movements and urination in severe cases.   A basic pelvic ultrasound can identify ovarian cysts caused by endometriosis (called an endometrioma), however, a basic pelvic scan does not assess for deep endometriosis or pelvic adhesions. 

A more advanced pelvic ultrasound technique, called  Sonovaginography (SVG), can predict deep endometriosis nodules. SVG is recommended for women with symptoms of severe endometriosis, in order to detect or rule out deep endometriosis nodules and scar tissue in the pelvis. A SVG / deep endometriosis scan will also help your doctor to decide on the best treatment option for you.

Chronic pelvic pain (CPP) is defined when you experience pain in the area below your bellybutton and between your hips for three months or longer.  The pain can come from the digestive tract, the uterus or ovaries, the bladder, or from the bones, muscles or nerves in and around the pelvis.  It can be a symptom of another disease, or it can be a condition on it's own. The most common conditions associated with CPP are endometriosis, interstitial cystitis, pelvic inflammatory disease, irritable bowel syndrome, constipation and pelvic adhesions.  The reasons why some people develop chronic pain are not well understood.  The assessment of CPP  involves a gynaecological examination and investigations (blood tests, vaginal swabs, imaging studies). The treatment method for chronic pelvic pain depends on the underlying cause of the condition and most often consists of managing the symptoms. 

Adenomyosis occurs when the womb lining grows within the uterine muscle. Symptoms associated with adenomyosis include painful periods, heavy periods and painful intercourse. Features of adenomyosis can be seen during a pelvic ultrasound, and can assist your specialist in determining the optimal treatment. Medical treatment options for adenomyosis include anti-inflammatory medication (Nurofen) and the oral contraceptive pill or progestin only therapy (Mirena IUD).

Pelvic pain can be caused by an infection in the pelvis or "pelvic inflammatory disease" (PID). The most common organism causing PID is chlamydia Trachomatis.  A pelvic infection can spread to the Fallopian tubes, causing a swelling in the tubes known as a "hydrosalpinx".  The ovaries can also become infected, known as an ovarian abscess. Infection of the Fallopian tubes or ovaries can cause damage to these structures and affect your future fertility. Pelvic ultrasound can detect hydrosalpinx and tubo-ovarian abscess, allowing for early diagnosis and treatment with antibiotics.

Pelvic adhesions are caused by the formation of scar tissue between structures in the pelvis and can cause pelvic pain. This scar tissue may form as a result of a pelvic infection (i.e. PID), endometriosis, or previous surgery. Scar tissue may involve the ovaries, Fallopian tubes, uterus, bladder, and/or bowel. Pelvic ultrasound can detect these pelvic adhesions and assist your specialist, particularly with regard to surgical planning. 

Most ovarian cysts do not cause pain. However, if an ovarian cyst is very large, or ruptures, the pain can be immediate and severe. Large ovarian cysts have an increased risk of twisting (ovarian torsion) and stopping blood flow to the ovary; this is considered a medical emergency and requires emergency surgery to untwist the ovary (and remove the cyst). Pelvic ultrasound can be used to evaluate acute causes of pelvic pain caused by ovarian cysts, such as ovarian torsion and ovarian cyst rupture.