How can my doctor diagnose the cause of my pelvic pain?

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• Abortion
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• Prevalence
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• Dysmenorrhoea
• Diagnosis
• Laparoscopy
• Pelvic Adhesions
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• Mittelschmerz
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How can a doctor diagnose the cause of  pelvic pain?

A full history, examination and possibly some investigations will be required (Q4.4).

The story and examination findings may allow your doctor to make a diagnosis and initiate treatment.

Although pain related to the menstrual cycle suggests a gynaecological problem, it is not always the case (39).

Symptoms relating to the bladder or bowel may suggest that the problem is not gynaecological. Frequently, there may be a variety of symptoms and clinical skill is required to determine the more significant symptoms and prioritise investigations.

The more common conditions can often be diagnosed by your general practitioner. Specialist advice is usually sought when there is difficulty establishing a diagnosis, when there has been a poor response to initial treatment, if the pain is particularly severe or if specialist investigations such as laparoscopy (laparoscopy) may be required.

A difficult conundrum is that several conditions that may be associated with pelvic pain are common:

• IBS - irritable bowel syndrome 30%
• PID - pelvic inflammatory disease.
• endometriosis - perhaps 75% or more.⁰⁶⁰¹

Not surprisingly, these conditions may coexist.⁰⁸⁰¹

• Endometriosis and its coexistence with irritable bowel syndrome and pelvic inflammatory disease: findings from a national case-control study (2008-01)
• The prevalence of endometriosis in women with chronic pelvic pain.(2006-01)

Should every woman with pelvic pain be subjected to laparoscopy?

• Every case has to be evaluated carefully and management tailored accordingly. All operations, including laparoscopy, have an element of risk.
• It may be reasonable to treat medically for IBS or PID and evaluate response.
• Even if trials of medication for IBS or PID prove unsuccessful, it may still be reasonable to treat possible endometriosis medically before resorting to surgery.
• The Royal College of Obstetricians and Gynaecologists considers that whilst laparoscopy is the "gold standard" for the diagnosis of endometriosis, laparoscopy is not mandatory.

^"Empirical treatment for pain symptoms presumed to be caused by endometriosis without a definitive diagnosis includes counselling, adequate analgesia, progestogens or the combined oral contraceptive. It is unclear whether the combined oral contraceptives should be taken conventionally, continuously or in a tricycle regimen. A gonadotrophin-releasing hormone (GnRH) agonist may be taken but this class of drug is more expensive and associated with more adverse effects and concerns about bone density."

The question of when to investigate pelvic pain with laparoscopy is a subject of continued debate.

Some take the view that laparoscopy is overused to the extent that clinicians need a tool to determine whether women wish to seek a pathology-based explanation for chronic pelvic pain or whether they just want symptom relief. Such an approach might reduce the number of unnecessary laparoscopies without adversely affecting outcomes.⁰⁶⁰²

Others believe that laparoscopy is often unduly delayed.⁰⁶⁰¹

The Levonorgestrel IUS - Mirena may reduce dysmenorrhoea and chronic pelvic pain associated with endometriosis^{.9901, 0501, 0701} This device could therefore become the treatment of choice for chronic pelvic pain (CPP)-associated endometriosis in women who do not wish to conceive.⁰⁵⁰¹

The use of LNG-IUS is an alternative for the medical treatment of women suffering from endometriosis, adenomyosis, chronic pelvic pain or dysmenorrhea, but further long-term studies are required to reach definitive conclusions. However, for women who do not wish to become pregnant, this device offers the possibility of at least 5 years of treatment following one single intervention.⁰⁷⁰¹

Please click on the required question.

•  Pelvic Pain. Is this a common problem?
•  What are the common causes of pelvic pain in women?
•  What are the more common gynaecological causes of pelvic pain?
•  What are the more common non-gynaecological causes of pelvic pain?
•  What are primary and secondary dysmenorrhoea - painful periods?
•  What is retrograde menstruation?
•  How can dysmenorrhoea - painful periods be treated?
•  What are ovarian cysts?
•  How do ovarian cysts cause pain?
•  How are ovarian cysts diagnosed?
•  How are ovarian cysts treated?
•  I think I may be pregnant and I have some pelvic pain. What should I do?
•  What is pelvic inflammatory disease and how can it be treated?
• Mittelschmertz

FIBROIDS

• 14 What are fibroids?
• 15 I have fibroids. What difficulties might they cause for me?
• 16 How are fibroids diagnosed?
• 17 How could my fibroids be treated?

ENDOMETRIOSIS

• 18 What is endometriosis?
• 19 How prevalent is endometriosis?
• 20 What causes endometriosis?
• 21 How can my endometriosis be treated?
• 22 How can my doctor determine the cause of my pelvic pain?
• 23 What investigations might be recommended by my gynaecologist to investigate my pelvic pain?
• 24 What is laparoscopy?
• 25 What are pelvic adhesions?
• 26 I have chronic pelvic pain. Could this be related to adhesions?
• 27  What is uterine retroversion (retroverted uterus)
• 28  Does a retroverted uterus (backward tilted uterus) cause symptoms?
• 29 How is a retroverted uterus - backward tilted uterus - treated?
• 30 What is pelvic congestion?
• 31 What causes pain associated with sexual intercourse (dyspareunia)
• 32 How can painful sexual intercourse (dyspareunia) be treated?
• 33 What is a pelvic mass?

IRRITABLE BOWEL SYNDROME - IBS

• 34 What is irritable bowel syndrome?
• 35 How can we find out if I have irritable bowel syndrome?
• 36 Is irritable bowel syndrome (IBS) a common condition?
• 37 What causes IBS?
• 38 What is the pain associated with IBS like?
• 39 Can IBS be mistaken for gynaecological problems?
• 40 How can my IBS be treated?
• 41 What other treatments are available for IBS?
• 42 What can be done to reduce the amount of bowel gas(flatus)
• 43 What is constipation?
• 44 What causes constipation?
• 45  How can constipation be treated?
• 46 How could we summarise the treatments that are available for my pelvic pain?
• 47 Where can I obtain more information?
• 48 Pelvic Pain Support Groups.
• 49 Endometriosis Support Groups.
• 50 IBS Support Groups.

Thank you for choosing to visit us.

This is the personal website of David A Viniker MD FRCOG, Consultant Obstetrician and Gynaecologist at Whipps Cross University Hospital, London - Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.

I do hope that you find the answers to your women's health questions in the patient information and medical advice provided.