Pelvic Pain
Pelvic pain can have many different causes. Two of the most common causes are normal menstrual cramps, called dysmenorrhea, and menstrual cramps associated with endometriosis. Pelvic pain can also be caused by ovarian cyst rupture, kidney stones, constipation, fibroids, ovarian torsion, and ectopic pregnancies. If the patient is older, the possible causes also include diverticulitis, irritable bowel syndrome, appendicitis, or muscle spasms.
During your initial visit for pelvic pain, we will evaluate for all of these conditions. There are many ways of diagnosing the cause including ultrasound, CT scans, MRIs, IVP, and barium enema.
Endometriosis and dysmenorrhea can be most easily differentiated on an MRI scan as well as pelvic exams. Endometriosis is a condition where cellular material from lining of the uterus is found outside the uterus, particularly with cyst formation on the ovaries. These cysts are called endometriomas or chocolate cysts. However, endometriosis can also involve the abdominal cavity lining, the fallopian tubes, bladder, uterus, or even rectum. Some patients with endometriosis have very few symptoms, but others can have debilitating pain.
The treatment for endometriosis depends on the extent of the disease and whether the patient is of childbearing years or not. The medications to treat endometriosis are hormonal. GNRH agonist is often used to temporarily stop the function of the ovaries. This type of medication can have side effects including hot flashes, headaches, vaginal dryness, because it temporarily induces menopause. Other hormonal manipulations include all progesterone birth control pills or an IUD with progesterone.
The diagnosis of painful periods, which is called dysmenorrhea, differs from endometriosis in that women will most likely outgrow the pain with age and will respond nicely to non-steroidal anti-inflammatories (Motrin, Aleve, or Advil). Birth control pills, as well as an IUD with progesterone will also help with the cramping associated with these. Other natural approaches to this condition include exercise, or a heating pad to the abdomen.
​