Ovarian cysts. A cyst is anything filled with fluid. Most ovarian cysts are part of the normal functioning of the ovary. Other cysts are growths that need to be removed. Some ovarian cysts (endometriomas) are lined by the same type of tissue that lines the uterus. This can cause painful bleeding into the ovary.
Endometriosis. Endometriosis is a condition in which the type of tissue that lines the uterus implants in locations outside the uterus. This typically cause pelvic pain around the time of the menstrual period, but can cause pain at other times in the cycle.
Endometriosis can also grow into the wall of the uterus, causing a condition known as adenomyosis. This can cause severe pain with periods. The uterus can be extremely tender, and cause pain whenever it is bumped during intercourse.
Fibroids. Fibroids are benign growths in the muscle of the uterus. Fibroids are very common, and usually are not painful. Some fibroids can cause pelvic pressure and pain. Click here to learn more about fibroids.
Infection. Most pelvic infection is cause by Chlamydia and/or Gonorrhea. Infection can also be caused by other bacteria. Infection of the lining of the uterus (the endometrium) is called endometritis. Infection of the fallopian tubes is called salpingitis. Often pelvic infection is given the term Pelvic Inflammatory Disease, or PID. Sometimes pelvic infection can cause severe pelvic pain and a fever, but a chlamydia infection may not cause any pain at all. If pelvic infection is suspected, it is important to treat with antibiotics, since severe damage to the tubes and ovaries can result if treatment is delayed.
It is often difficult to tell for sure if pelvic infection is present. For that reason, if a woman has recurrent episodes of pelvic pain, laparoscopy may be necessary to accurately determine the cause of pain. (Laparoscopy is an examination usually done under anesthesia, which involves looking at the pelvic organs through a tiny telescoped inserted through the navel.)
Dysmenorrhea. This means pain with menstrual period. Some cramping with the menstrual period is normal, but it is not normal to have pain that interferes with a woman's normal activities. Prostaglandins are compounds in menstrual blood that cause the uterus to contract, and cause cramping. Common medicines used to treat dysmenorrhea, such as aspirin, ibuprofen, or naproxen sodium help by interfering with the production of prostaglandin. Birth control pills may also decrease cramping with periods.
Other conditions causing pain with periods are abnormal, and may require treatment.
Submucous myomas are fibroid tumors on the inside of the uterus. They can act as a foreign body, cause the uterus to contract to try to expel them. They can often be removed without major surgery using an instrument called a resectoscope.
Adenomyosis is common cause of severe menstrual pain, and is often confused with fibroids.
Pelvic adhesions. An adhesion is where two organs stick together. This is often caused by pelvic infection (PID), endometriosis, or previous surgery. Pelvic pain can occur when adhesions are stretched. For example, if an ovary is stuck to the intestine, ovulation may stretch these adhesions and cause pain. On the other hand, many adhesions cause no pain at all.
Unless adhesions cause the intestines to be blocked (a bowel obstruction) they usually cannot be diagnosed without doing laparoscopy and actually looking inside the abdomen. Most adhesions can be freed during laparoscopy, but they can reform. Freeing the adhesions may or may not relieve pain.
Pain from other organs
The colon sits next to the uterus and ovary. Pain from irritable bowel syndrome can seem like it is coming from the ovary. Usually this is a crampy pain. Constipation and inflammation of the intestine can also cause pelvic pain. As endometriosis can involve the intestines, evaluation of the intestinal tract and laparoscopy may necessary to determine whether the pain is coming from the intestine or from a gynecologic problem.
Bladder. Inflammation of the bladder is felt in the lower abdomen. A bladder infection usually also causes burning with urination and frequent urination. Interstitial cystitis is an inflammation of the bladder not caused by infection, but can cause severe symptoms. Kidney stones also can cause pelvic pain.
Abdominal wall pain. Nerves in the abdominal wall can be trapped, and cause severe pain. Often this is near a previous surgical incision. It is important to distinguish pain from the abdominal wall from problems inside the abdomen. Often this can be done by numbing areas of the abdominal wall with local anesthetics, which will eliminate pain coming from the wall, but not from internal organs.
