Chronic pelvic pain is a common problem affecting women of any age. The pain can occur on a regular cycle or may only occur at certain times ie before and after eating, while urinating, during the menstrual period. Chronic pelvic pain can often disrupt a woman’s work, movements, sexual relationships, sleep and family duties and lead to long-term problems in a woman’s menstrual and clinical health. If pelvic pain lasts for more than 6 months then it is advisable that you consult your doctor to identify an underlying cause.
The causes of pelvic pain are varied. Chronic pelvic pain can lead to conditions such as endometriosis or fibroids. It may also be secondary to bowel, urinary or musculo-skeletal problems. Because there are varied causes of pelvic pain the process of identifying the underlying problem may be complex and time consuming. Preliminary tests required would include an ultrasound scan and if underlying gynaecological problems were suspected a laparoscopy in order to view the pelvic organs and determine whether there is a gynaecological cause for the problem.
Treatment options vary between the conservative, medical and surgical options.
Conservative treatments consist of pain relief and chronic pain management strategies. Many women find treatments such as aromatherapy and acupuncture very useful.
Medical treatments all aim to suppress the menstrual cycle and stop ovulation. Therefore, while they are useful in the treatment of pelvic pain, medical options have no place in the management of the infertile patient with endometriosis. The common medical therapies consist of the combined oral contraceptive pill (COCP), progestogens or Gonadotrophin-releasing hormone antagonists. There are a numbers of newer drugs that look promising which are still being assessed. Most of the different drugs have similar success rates with the choice of treatment largely being governed by the side-effects of the hormones. There is a relatively high recurrence rate of symptoms after treatment is stopped.
Surgery is usually performed laparoscopically. The aim of treatment is to remove all endometriotic deposits either by cutting them out or by ablating them with diathermy or laser. Surgical treatment doubles a woman’s fertility and removes pain in 75-80% of cases, although the disease can recur in 20% of women 5 years after the operation. In severe cases, a woman may need a hysterectomy or possibly bowel surgery. The infertile woman with advanced endometriosis may need IVF to become pregnant.