Pelvic pain is a frequent concern for women presenting in primary care settings, and it can be caused by a wide range of conditions. As a healthcare professional, accurately diagnosing the source of pelvic pain is crucial, given that it can range from a mild inconvenience to a symptom of a serious underlying issue. Understanding the most common causes can help guide appropriate referrals, treatment options, and patient management.
- Endometriosis
Endometriosis is one of the leading causes of chronic pelvic pain in women. It occurs when endometrial tissue, which normally lines the inside of the uterus, grows outside it, often on the ovaries, fallopian tubes, or pelvic lining. The tissue behaves similarly to normal endometrial tissue, thickening, breaking down, and bleeding during each menstrual cycle. However, because this tissue has no way to exit the body, it becomes trapped, causing inflammation, pain, and potentially the formation of scar tissue or adhesions.
Symptoms of endometriosis include:
Severe menstrual pain (dysmenorrhea)
Pain during intercourse (dyspareunia)
Pelvic pain that worsens over time
Fatigue and heavy periods
Management often involves hormonal therapies, pain relief, and in more severe cases, surgical intervention.
For more information on this condition, healthcare professionals can access Endometriosis: What It Is, What Causes It, and How to Treat It.
- Pelvic Inflammatory Disease (PID)
Pelvic inflammatory disease (PID) is an infection of the female reproductive organs, typically caused by sexually transmitted infections (STIs) such as chlamydia or gonorrhoea. PID can lead to significant complications, including chronic pelvic pain, infertility, and ectopic pregnancies, making timely diagnosis and treatment essential.
Common symptoms include:
Lower abdominal or pelvic pain
Abnormal vaginal discharge
Pain during intercourse
Irregular menstrual bleeding
Fever
Treatment involves antibiotics to address the underlying infection, and early intervention is key to preventing long-term complications.
- Ovarian Cysts
Ovarian cysts are fluid-filled sacs that can develop on the ovaries, most commonly during ovulation. While many ovarian cysts are asymptomatic and resolve without treatment, some can cause pelvic pain, especially if they rupture or become large enough to exert pressure on surrounding organs.
Symptoms can include:
Dull or sharp pelvic pain
Bloating or abdominal fullness
Pain during bowel movements or intercourse
Large cysts or those that cause complications such as torsion (twisting of the ovary) may require surgical removal, but smaller, asymptomatic cysts are often monitored with regular ultrasounds.
- Irritable Bowel Syndrome (IBS)
Although IBS is primarily a gastrointestinal condition, it can cause significant pelvic pain in women, particularly when it coexists with gynaecological conditions such as endometriosis. IBS is characterized by abdominal discomfort or pain, changes in bowel habits, and bloating.
IBS-related pelvic pain often fluctuates in severity, with triggers including stress, certain foods, and hormonal changes. Treatment involves dietary modifications, stress management, and, in some cases, medications to manage symptoms like diarrhoea or constipation.
- Urinary Tract Infections (UTIs)
UTIs are another common cause of pelvic pain in women. A bladder infection (cystitis) can cause discomfort or pain in the lower abdomen, frequent urination, and a burning sensation during urination. If left untreated, the infection can spread to the kidneys, causing more severe pain and systemic symptoms like fever and chills.
Diagnosis is typically confirmed via a urine test, and treatment involves a course of antibiotics. Recurrent UTIs may warrant further investigation into underlying conditions.
- Fibroids
Uterine fibroids are non-cancerous growths of the uterus that can cause pelvic pain, particularly if they are large or exert pressure on other organs. Symptoms of fibroids include:
Heavy menstrual bleeding
Pelvic pain or pressure
Frequent urination or difficulty emptying the bladder
Constipation
Management of fibroids may involve hormonal treatments, non-invasive procedures, or surgery, depending on the size and location of the fibroids and the severity of symptoms.
Conclusion
Pelvic pain in women can stem from various causes, ranging from mild and self-limiting to chronic and debilitating. As a primary care healthcare professional, it is essential to take a thorough patient history and conduct appropriate examinations to identify the underlying cause. In cases where pelvic pain is severe, persistent, or accompanied by other concerning symptoms, early referral to a gynaecologist or specialist is advised to prevent long-term complications.
References:
- GOV.UK (2024) Pelvic pain: diagnosis and management. Available at: www.gov.uk [Accessed 2 October 2024].
- NHS England (2023) Pelvic pain in women. Available at: www.nhs.uk [Accessed 2 October 2024].
For further insight into one of the key causes of pelvic pain, endometriosis, visit our article: Endometriosis: What It Is, What Causes It, and How to Treat It. This resource offers detailed information on diagnosis and management, helping you stay informed on the latest treatment options for your patients.
