What causes pelvic pain?

There are many causes of pelvic pain. This is a short list of various common causes.

• Premenstrual syndrome (PMS) is a combination of symptoms that many women in their 30s experience during the weeks before their period. Typical symptoms are breast tenderness, bloating, headaches, and irritability and mood changes. The cause is not known but changing hormone levels play a role. Treatments include hormonal birth control, antidepressants, diuretics, and anti-anxiety medications.
• Endometriosis is a condition where the endometrial tissue that lines the uterus, grows outside of the uterus. It is often found on the ovaries, fallopian tubes, bladder, intestines, and other internal organs. Endometrial tissues responds to hormone changes so that when you have your period, this tissue can cause significant pain and even form scar tissue contributing to infertility. Treatment may involve birth control pills, or surgery.
• Ovarian cysts occur when you ovulate, but the follicle doesn’t release the egg causing an ovarian cyst. Often a cyst will resolve without treatment but can cause significant pelvic pain, swelling and bloating. If it bursts, it can cause severe pain and require emergency treatment.
• Ectopic pregnancy (also called a tubal pregnancy) is where the embryo implants outside of the uterus. Most commonly, this occurs in the fallopian tube. When the embryo begins to grow, it causes sharp pelvic pain or cramps, bleeding, nausea and can cause the fallopian tube to burst. This is a life-threatening emergency. Ectopic pregnancy are THE leading cause of pregnancy-related deaths. Medication may be available if the fallopian tubes have not ruptured, otherwise the treatment is surgery.
• Polycystic ovary syndrome (PCOS) is a problem that affects one in ten women of childbearing age. It is caused by hormone imbalances and metabolic problems. The hormone imbalances affect development of the egg, and can cause facial hair growth, acne, thinning hair, weight gain, skin tags and more. Missed periods or severely irregular cycles are features of PCOS. It can also be associated with infertility, ovarian cysts, and diabetes and heart disease. There is no cure. Hormonal birth control, medications that block testosterone, and metformin may help. Dr. Patel will work with you to find a treatment plan that is based on your symptoms, plans for pregnancy, and lowering risk factors for diabetes and heart disease.
• Uterine Fibroids are benign tumors of the uterine walls. They are commonly found in women in their 30s and 40s. Symptoms can include pelvic pain, low back pain, heavy periods, painful sex, and difficulty getting pregnant. Treatment may involve medications to shrink the tumors or surgery to remove them.
• Sexually transmitted infections (STIs) Pelvic pain is a warning sign of STIs. The two most common STIs are chlamydia and gonorrhea. STIs cause painful urination, bleeding between periods and abnormal vaginal discharge. STIs are usually spread by having vaginal, oral, or anal sex. They can cause infertility, health problems for a fetus, organ damage, cancer, and death. Symptoms often mimic a urinary tract infection or a yeast infection. If you are sexually active, it is important to get tested for STIs. Treatment can include antibiotics and antiviral drugs. Hepatitis C, HIV and HPV are all sexually transmitted infections. Untreated STIs can lead to pelvic inflammatory disease (PID) which is the main preventable cause of infertility.
• Pelvic inflammatory disease (PID) is a serious infection of the female reproductive organs that leads to chronic pain and other serious health problems. It is usually caused by untreated chlamydia and gonorrhea. Symptoms include long, heavy periods, pelvic pain, fatigue, fever, chills, foul smelling vaginal discharge and painful sex. PID increases your risk of ectopic pregnancy, chronic pain, and infertility. It is treated with antibiotics.
• Urinary tract infection (UTI) is an infection in the urinary tract that includes the kidneys and ureters, but it mostly affects the bladder and urethra. Symptoms are painful urination and blood in the urine. Treatment is antibiotics.
• Painful ovulation (Mittelschmerz) When the egg develops in the ovary, it floats in follicular fluid and some blood. When ovulation occurs, the ovary releases an egg, fluid, and blood that can irritate the lining of the abdominal cavity (peritoneum) causing pain in the pelvis and lower abdomen. The main symptom is one-sided lower abdominal pain in the middle of the menstrual cycle. Usually the pain dissipates when the blood is absorbed by the body. OTC pain medications can relieve the pain. Women with especially painful ovulation may benefit from taking birth control pills. If the pain lasts longer than 24 hours, you should call Dr. Patel.
• Pelvic organ prolapse happens when the muscles and tissues that support the pelvic organs become weakened and the pelvic organs drop into the vagina. It is a pelvic floor disorder that affects one in five older women in the US. It can be caused by vaginal childbirth, giving birth to large babies, aging, hormone changes during menopause, genetics, or any combination of these. Symptoms include pelvic pain and pressure, leaking urine and problems with bowel movements. Treatments may involve the use of pessary, a removable device that is inserted into the vagina to support the pelvic organs; pelvic floor muscle therapy, and surgery to support the pelvic floor.
• Vulvodynia is pain in the vulva that is not caused by an infection or other medical problem and lasts more than 3 months. Symptoms include pain, burning, stinging, soreness, throbbing and swelling at the opening of the vagina. Symptoms may be constant or come and go. Often there is no single cause but can include inflammation, nerve irritation, food sensitivities, some genetic disorders, and problems with the muscles in the pelvic floor. Treatments may include anesthetic creams, physical therapy, trigger point therapy, nerve blocks, ultrasound, and electrical stimulation to ease pain. Cognitive behavior therapy or sexual therapy may help.

Pelvic pain can be a very debilitating and frustrating condition. If you are experiencing pelvic pain, it is important to see Dr. Patel so that the cause can be properly diagnosed and treated.

Dr. Dwaita Patel is a board-certified obstetrician and gynecologist at City OB+GYN in New York City, and a fellow of the American College of Obstetrics and Gynecology (FACOG). She specializes in women’s health, and the full scope gynecological services, including routine exams, contraceptive counseling, breast and ovarian cancer screenings, osteoporosis screening, premenstrual syndrome management and more.

Dr. Patel is smart and kind and finds great joy and fulfillment in her work. She offers the full scope of obstetrics including pre-pregnancy, prenatal, labor and delivery and postpartum care for low and high-risk patients. She also offers medical treatments and minimally invasive surgery for gynecologic conditions. All deliveries and major surgeries are performed at Tisch Hospital/NYU Langone Medical Center in Manhattan.