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Pelvic Pain: It’s Real

Pelvic pain is a common gynecological condition that affects women of all ages. The pain occurs in the pelvis (area between the hip and bladder), and has typically been present daily for more than three to six months. Pelvic pain is often more severe during menstruation, but unlike “menstrual cramps,” which are cyclical, pelvic pain is ongoing, and can be dull, aching, or sharp, and become severe enough to warrant a doctor’s visit. Pelvic pain typically responds well to over the counter pain medications, especially Ibuprofen. However, Ibuprofen effectiveness may diminish over time as the disease progresses.

The most common cause of chronic pelvic pain is endometriosis, a benign gynecologic condition where the uterine lining (endometrium) is present within the abdomen and pelvis. As the endometrium grows over time it creates severe inflammation, pain and scarring. It is unclear why the endometrium migrates into the pelvis. One theory is retrograde menstruation during which the endometrium spills into the pelvis via the fallopian tubes as pressure builds within the uterus. According to researchers, genetics and the immune system’s response also play a significant role in the condition.

The effect of endometriosis on women can be physically and psychologically debilitating, particularly if left undiagnosed. Patients may be led to believe the pain isn’t real, and only “in their head.” Frequent doctor visits secondary to pain might be misinterpreted as pain medication seeking behavior. Another effect of endometriosis is infertility due to scarring of reproductive organs or the presence of a microscopically hostile environment preventing development of the embryo.

Fortunately, endometriosis can be treated with medications such as oral contraceptives, high dose Ibuprofen, and hormonal therapy. Surgery is generally offered when the patient has not responded to medications, or when the pain is severe. Surgery can also be helpful as a means of investigating the cause of pain or infertility. If endometriosis is discovered, it should be cauterized (burned) or removed. Normal anatomy should be restored and pain-causing scar tissue should be removed. There have been tremendous technological advances in treating endometriosis with minimally invasive surgery. Small incisions result in minimal tissue destruction, faster recovery and less post-operative pain. Depending on the surgeon’s skill and experience, both laparoscopic and robotic methods are highly effective. Robotic surgery allows for superior vision of the surgical field with unmatched precision of instrumentation. Advocates of robotic surgery believe it provides a more complete surgical removal of endometriosis than does laparoscopy. There is no scientific evidence to support this belief, and as in any procedure, the surgeon’s experience and expertise ultimately dictates the outcome.

Most patients with chronic endometriosis do well with a combination of surgery and medical management, and go on to lead active, pain-free productive lives. Most infertile couples are able to conceive after endometriosis treatment, either spontaneously or with medical assistance. Diagnosis of endometriosis should not foster self-pity or helplessness. It is very important for the endometriosis patient to assume an active role in her treatment and seek the services of a health professional who will listen to her concerns and guide her through treatment options.

Published in Buffalo Healthy Living Magazine, June 2014