Consultant Gynaecologist Ora Jesner shares the potentially serious problems that your pelvic pain may indicate
Pelvic pain is very common. Unfortunately many women will experience pelvic pain at different points in their lives. Whether it be period cramps, ovulation pain, pain during pregnancy or pain after childbirth. For any persistent pelvic pain, seeing a gynaecologist is recommended. However, there are times when pelvic pain could be a sign that something more serious is going on.
Ms Ora Jesner is a Consultant Gynaecologist at London Gynaecology. She is an expert gynaecologist with expertise in pelvic pain
She explains that knowing when pain is ‘normal’ and when it isn’t, can make all the difference.
“Acute pelvic pain is defined as pain in the lower abdomen or pelvis that is sudden and severe. It typically lasts for less than three months, as opposed to chronic pelvic pain which lasts for six months or more,” says Ms Jesner.
“Acute pelvic pain can be caused by a number of different conditions, so the cause of the pain can be hard to diagnose”.
Ms Jesner adds: “When I see a patient who has acute pelvic pain, I’ll assess the type of pain, whether it’s localised or radiates to other areas and ascertain if there are any other accompanying symptoms, such as fevers, vomiting or diarrhoea. Where they are in the menstrual cycle is important, if there’s any chance of pregnancy, as well as any previous history of surgery. This can help me form a diagnosis.”
Here, Ms Jesner shares some of the possible reasons behind your pelvic pain and when to seek urgent help. If you need advice from a gynaecologist with expertise in pelvic pain, don’t hesitate to contact one for guidance.
1. Ectopic Pregnancy
An ectopic pregnancy occurs when a fertilised egg implants outside the uterus, usually in the fallopian tube. These are the tubes connecting the ovaries to the womb.
“The pain is typically one-sided, sharp or stabbing, and it can be accompanied by vaginal bleeding, shoulder tip pain, dizziness or fainting,” says Ms Jesner.
But some women will experience minimal symptoms.
“In women of reproductive age with acute pain, I will always ask them to take a pregnancy test, as ectopic pregnancy could be the cause. Ectopic pregnancies tend to be diagnosed in early pregnancy, around six to eight weeks, so some women, especially those with irregular periods, may not even know that they are pregnant.”
Ms Jesner adds: “If undiagnosed, an ectopic pregnancy can be life threatening; this is because as the pregnancy grows, the tube can stretch and rupture, causing internal bleeding. Sadly, ectopic rupture is the leading cause for maternal mortality in the first trimester. This is why raising awareness about ectopic pregnancy is so important.”
With this in mind, it’s vital to seek urgent medical attention if you experience pelvic pain, especially if you have a positive pregnancy test or could be pregnant. Moreover, a pelvic pain gynaecologist will be able to assess your symptoms and recommend further tests if needed.
2. Functional Ovarian Cysts
Functional ovarian cysts are common, affecting pretty much all women with a menstrual cycle at some point in their life. These fluid-filled sacs, which the ovaries, often cause no symptoms and usually resolve on their own.
But, as Ms Jesner explains, some cysts can become large and cause pelvic pain.
Pain can be sharp, sudden and severe and it’s usually continuous pain, localised to one side.
“These cysts rarely require surgical or hormonal interventions, but if you are experiencing pain that is increasing, it’s worth getting medical help, to rule out any complications.”
A Haemorrhagic ovarian cyst is a type of functional cyst that has bled into itself and can also cause sudden, sharp pain.
Ms Jesner adds: “A transvaginal scan is the main way of diagnosing cysts and checking if there are any complications from the cysts. Often these cysts resolve on their own, and a repeat scan is usually recommended after several weeks to check this.”
3. Adnexal Torsion (Ovarian Torsion)
Although rare, accounting for up to 7% of all gynaecological emergencies, adnexal torsion is serious.
It occurs when an ovary (and sometimes the fallopian tube) twists on itself, cutting off its blood supply. Often, this is due to the presence of a large ovarian cyst.
“Pain is usually sudden and severe, usually one sided and it may radiate to the loin or thigh. This pain is often accompanied by nausea and vomiting,” says Ms Jesner.
“The risk of adnexal torsion is increased slightly in pregnant women, and in the post-partum period, because this is when the uterus is changing size and shifting position most rapidly, which increases the risk of twisting,” adds Ms Jesner.
An internal scan and blood tests can help to diagnose adnexal torsion. In terms of treatment, a laparoscopy, or keyhole surgery, is the most common approach; this allows your surgeon to untwist the ovary.
4. Endometriosis
Endometriosis affects 10% of women of reproductive age. Unfortunately however, diagnosis is often delayed and some women wait up to seven to 10 years for a diagnosis.
Explaining endometriosis, Ms Jesner says: “This is a condition where tissue similar to the lining of the uterus is found outside the uterus. During a period, this tissue can swell and bleed, and this can lead to inflammation and scar tissue formation, causing severe pain for many women.”
As well as pelvic pain, you may experience heavy periods or pain with sex. Some women with endometriosis have endometriomas, which are ovarian cysts caused by endometriosis.
“These tend to be more asymptomatic but rarely, they can rupture, tort or become infected. Endometriotic nodules, also caused by endometriosis, can form in other areas in the pelvis such as the bowel, bladder, pelvic walls or behind the uterus,” says Ms Jesner.
Sometimes, surgery is recommended to remove the endometriomas or endometriotic nodules.
5. Adenomyosis
In adenomyosis, the lining of the womb (uterus) starts growing into the muscle in the wall of the womb. According to Ms Jesner, it can affect up to 20% of women.
“As well as acute pelvic pain, it can cause severe period pains and heavy or prolonged periods.”
Hormonal treatment may be recommended to help treat adenomyosis (such as pills or a hormonal coil) and in more severe cases, uterine artery embolisation or surgery is advised. But, at London Gynaecology, all these options will be discussed, to ensure you make the right choice for you.
6. Pelvic Inflammatory Disease (PID)
Pelvic inflammatory disease, which affects around one in 50 sexually active women every year in the UK, is an infection of the female reproductive organs. It’s usually caused by bacteria travelling into the uterus from the cervix and spreading into reproductive organs, such as the womb, the fallopian tubes or the ovaries.
“It can cause lower abdominal or pelvic pain, fever, abnormal discharge, bleeding between periods and/or pain during sex,” says Ms Jesner.
Patients with PID may have similar symptoms to those with appendicitis, which is an infection of the appendix.
“Both cause pelvic pain, however PID pain is more constant and may also come with abnormal vaginal discharge. Appendicitis pain tends to migrate from the belly button to the lower right side” explains Ms Jesner.
Diagnosis of PID requires blood tests, swabs and an internal ultrasound to detect any fluid or abscesses (pus-filled, painful pockets that form in or around tissue) or inflamed fallopian tubes.
“Antibiotics are the usual treatment for PID, but sometimes the infected fluid needs to be drained surgically,” adds Ms Jesner.
7. IUD Issues
Typically known as the coil, intrauterine devices (IUDs) are a form of contraception which most of the time, are completely safe. But, occasionally they can cause problems.
“Pelvic pain can occur if the IUD moves out of position, lodges into the uterine wall or partially or completely comes out of the uterus. Expulsion is more common in the first few months after an IUD is inserted,” says Ms Jesner. In fact, within the first year of having an IUD inserted, one in 20 women will experience it falling out.
You might feel a cramp-like, sharp pain, accompanied by abnormal bleeding or painful sex.
Very rarely, IUDs can cause a pelvic infection, so if you’re experiencing any pain, abnormal discharge or fever, it’s vital you seek help.
Antibiotics can help treat infections and the IUD will likely need to be removed.
Acute pelvic pain isn’t something to ignore; it can sometimes indicate a serious problem, so it’s best to seek help, just to be on the safe side.
At London Gynaecology, we offer urgent and same-day appointments, so you can get the help you need, fast. Additionally, a gynaecologist with expertise in pelvic pain can help you understand the underlying causes and support your recovery.
Don’t ignore pelvic pain. See a specialist today: Book Here
