Pelvic pain or discomfort is a common occurrence in women. We’ve all experienced our share of cramps and aches, usually related to our menstrual cycle.
However, pain in the pelvic or lower abdomen area is actually a very general symptom that can be a sign of many conditions, not just premenstrual syndrome.
By recognising other characteristics and features that are present with pelvic pain, you can make it easier for your doctor to pinpoint the problem and help you to overcome it.
This article is the first of a two-part series on the different causes of pelvic pain in women.
Where is the pain?
When I say pelvic pain, I am referring to any sort of pain or discomfort in the abdomen below the belly button. This refers to a rather large area of the abdomen, so the pain could originate from several sources.
Causes of pelvic pain can include the following:
Premenstrual syndrome (PMS) and menstruation
The most common cause of pelvic pain in women is PMS. Before your monthly menstrual cycle begins, your hormones start to go through changes to prepare your body for ovulation and conception.
These hormonal fluctuations can cause a wide variety of PMS symptoms, starting from five to 11 days before menstruation. Abdominal cramps are one of the most common PMS symptoms during this time, along with low back pain, headaches, tender breasts, acne and mood swings.
When your menstrual period finally arrives, you may also experience cramps in your lower abdomen or back. These cramps occur because your uterus is contracting to push out the menstrual blood (the lining of the uterus wall).
Fortunately, these PMS and menstrual cramps do not last long. For some women, the cramps may cause a great deal of discomfort and pain. Putting a hot water bottle or warm heating pad on your lower abdomen will help to relax the muscles, as will having a warm soak in the bathtub.
You can also use over-the-counter painkiller medications to relieve the cramps, if they are really severe. Take these medications according to the instructions on the package.
Ovulation and appendicitis
Between your periods, your ovaries will release an egg, along with some fluid and blood. Believe it or not, you may actually feel something like a painful twinge in your abdomen when this happens, because the egg, fluid and blood may irritate the lining of the abdomen.
You may experience this pain midway through your menstrual cycle, and it may switch from your left to right side during different months (depending on which ovary releases the egg). The good news is, this pain will go away within a few hours.
What if you experience sudden pain in your lower abdomen, even though you are not getting your period? If it is a sharp pain in the lower right area of your stomach, accompanied by vomiting and fever, then it may be appendicitis.
When your appendix becomes infected and inflamed, it could potentially burst and cause complications or death. Go to the hospital emergency department immediately if you have this kind of pain.
Pelvic pain during pregnancy requires immediate attention because something could be wrong with the pregnancy.
Ectopic pregnancy is a life-threatening condition where the embryo implants outside of the uterus, usually in the fallopian tubes.
If you experience sharp pain in the lower abdomen or pelvic area, you should be aware that it could be a symptom of ectopic pregnancy. You may not even know that you are pregnant yet, as it could occur during the early stages of pregnancy.
You may also experience cramps on one side of your pelvis, abnormal vaginal bleeding, nausea and dizziness. See your doctor or gynaecologist immediately, even if you don’t think that you are pregnant.
STDs, PIDs, cysts and fibroids
Sexually transmitted diseases (STDs)
Pelvic pain can also be a warning sign for some STDs, especially chlamydia and gonorrhoea as these are the two most common STDs that affect women.
If you suffer from pelvic pain, painful urination, bleeding between periods and abnormal vaginal discharge, see your doctor about the possibility of STDs. Fortunately, they can be treated so that they won’t go on to cause further complications.
Pelvic inflammatory disease (PID)
STDs can go on to cause pelvic inflammatory disease (PID), which can also be a source of pelvic pain. Your doctor may consider the possibility of PID if you suffer from pelvic pain, together with fever, abnormal vaginal discharge, and pain during sex or urination.
PID is a serious consequence of untreated STDs and should not be taken lightly, as it can cause permanent damage to the uterus, ovaries and fallopian tubes, leading to infertility.
PID can be treated with antibiotics, so do not ignore the symptoms and make sure you see your doctor straightaway.
Constant pelvic pain could also be a sign of cysts in the ovaries. Ovarian cysts form during ovulation when the ovary doesn’t release the egg, or the follicle (the sac in the ovary) recloses after releasing the egg and swells with fluid.
If the cysts are big, they can cause pelvic pain, as well as weight gain and frequent urination. You may also have cysts that don’t cause any pain and resolve on their own.
Uterine fibroids are non-cancerous tumours or growths that grow on the wall of the uterus. Fibroids are very common and many women develop them during their childbearing years without suffering from any pain or symptoms.
However, fibroids may cause pelvic cramping, pain during menstruation, pressure in the lower abdomen, pain during sexual intercourse, lower back pain, and abnormal menstrual bleeding. If you experience these symptoms due to fibroids, ask your doctor about treatments to shrink or remove the fibroids.
In the next article for this column, I will continue to explain about other conditions that can cause lower abdomen or pelvic pain.
Datuk Dr Nor Ashikin Mokhtar is a consultant obstetrician & gynaecologist (FRCOG, UK). For further information, visit www.primanora.com.