Should you worry about pelvic pain in pregnancy?
Pelvic pain is an extremely common condition - affecting a huge 1 in 6 women in their lifetime, according to Dr Hemlata Thackare, consultant gynaecologist and IVF specialist at the London Women’s Clinic Group.
It's not only uncomfortable, but it can affect your quality of life. "Pelvic pain is pain that you feel in your lower abdomen or pelvis. You may get a dull, constant ache, which can sometimes be distressing enough to affect a woman's quality of life," says Dr Hemlata.
We take a look at some of the most common causes of pelvic pain in women.
Common causes of pelvic pain
As you might imagine, periods are the number one cause of pelvic pain in women. Most women get pelvic pain in the first couple of days of their period - so-called menstrual cramps or simply period pain. Some women also get pelvic pain around the middle of their cycle when they ovulate. These pains vary hugely in severity, but if they're lasting more than a few days, starting before your period, associated with other symptoms or having a significant impact on your life, they need checking out.
One of the first things you should look at is if pelvic pain is related to your cycle and if is severe and affecting your quality of life, explains Dr Karen Morton, consultant gynaecologist and founder of medical helpline Dr Morton's. If it is, endometriosis could be the problem.
Endometriosis, where cells similar to those found in the womb lining are found outside the uterus, is a fairly common condition affecting more than a million women in the UK, and it can cause severe debilitating period pain. It can also cause pain between periods, painful sex, bleeding between periods and problems getting pregnant. And getting diagnosed may take some time as symptoms can be similar to other common conditions.
"On average, endometriosis takes seven and a half years, or 11 visits to the GP, to diagnose," says Mr Pandelis Athanasias, consultant gynaecologist at the London Women's Centre.
He also highlights another condition called adenomyosis - where the endometrial tissue (the lining of the womb) migrates inside the muscle of the womb - which often goes undiagnosed. This can also cause prolonged menstrual cramps, heavy bleeding and pain during sex.
Pelvic inflammatory disease
If your pain isn't related to your cycle and if it's the first time you've had this type of pain, Dr Morton says that it could be an infection, such as pelvic inflammatory disease (PID). PID is an infection of a woman's reproductive organs affecting the womb, Fallopian tubes and ovaries. "Chronic pelvic pain may be accompanied by a discharge as well as a fever," she says.
If you are (or could be) pregnant, you should be aware of the following causes of pelvic pain: ectopic pregnancy (acute pelvic pain possibly accompanied by vaginal bleeding), miscarriage, rupture of the corpeus luteum and premature labour. See our Pelvic Pain in Women leaflet for more details.
One of the issues with pelvic pain is that it can be multifactorial - meaning it's not only one condition causing the symptoms, says Mr Athanasias. "Usually pain can be coming from the urinary tract, the gynaecological tract, the gastrointestinal tract or it could also be a musculoskeletal cause - so you have to look at everything."
Other causes of pelvic pain include ovarian cysts, fibroids, irritable bowel syndrome, pelvic congestion syndrome, urinary tract infections, appendicitis and inflammatory bowel diseases, such as Crohn's and ulcerative colitis.
The emotional factor
Experiencing pelvic pain can also be triggered by emotions - such as stress, anxiety and depression. People who have suffered with post-traumatic stress disorder are often at a higher risk of developing chronic pain. This is of course much harder to diagnose as well as treat.
Dr Morton says that she often performs a laparoscopy, a procedure to look inside the abdomen with a camera, in young women because of pelvic pain. She warns them beforehand that they need to prepare themselves to the fact that nothing might be found. "We probably find nothing more often than we find something," says Dr Morton. "There are a number of women who come to the hospital recurrently with pelvic pain and it worries me terribly that there's an underlying cry for help in this."
"Indeed, there's quite a lot of research that shows issues such as sexual abuse can lead to women developing pelvic pain - and it isn't that it's not real for them, but that there's no identifiable underlying pathology. These women need a pain strategy, as well as psychological support," explains Dr Morton.
What should you do about pelvic pain?
Firstly, women should seek an appointment with their GP for an initial evaluation and assessment of their condition, especially if the pain has been present for three to six months and has become chronic, or if it is affecting her ability to carry out normal daily activities, says Dr Hemlata.
Judy Birch, co-founder of the Pelvic Pain Support Network, says that it's difficult to cope with any recurring pain. "Treatments vary and will be individual, based on the condition and severity. It may involve medication, surgery, physiotherapy, nerve blocks, psychology, self-management, coping strategies and combinations of any of these at various points in time."
She suggests keeping a simple visual diary of when the pain occurs, how long it occurs for and what relieves it, if anything. "Take this with you when you see a doctor if you're having difficulty getting a diagnosis or managing and coping with the pain. And ask about investigations, such as an ultrasound, and even to be referred to a specialist," she explains.