Pelvic pain and endometriosis

Persistent pelvic pain is exhausting, and it is often dismissed. Many women are told for years that severe period pain is normal, or that nothing can be found, and stop asking. Pain that affects your daily life deserves proper investigation and proper treatment.

Understanding the pain

Pelvic pain can be cyclical, arriving with periods, or constant. It may be felt during sex, when opening the bowels, or as a persistent ache. It can come from the reproductive organs, but also from the bowel, bladder, muscles or nerves — which is one reason it can be difficult to pin down.

Long-standing pain also changes how the nervous system processes signals, which means that treating pain effectively often involves more than treating a single structure.

What endometriosis is

Endometriosis is a condition where tissue similar to the lining of the womb grows outside it, most often in the pelvis. It responds to hormonal cycles, causing inflammation, pain and sometimes scarring.

It is common, affecting roughly one in ten women, and the delay to diagnosis is unacceptably long — frequently many years. The severity of pain does not necessarily match the amount of endometriosis found.

How it is assessed

Assessment starts with a detailed history of your pain — when it occurs, what makes it worse, how it affects you — followed by examination and usually an ultrasound scan.

Scans can identify some forms of endometriosis, particularly cysts on the ovaries, but they cannot rule it out. Where the diagnosis remains uncertain and symptoms are significant, a laparoscopy — keyhole surgery to look directly inside the pelvis — may be recommended.

Treatment approaches

There is no single treatment that suits everyone, and the right approach depends on your symptoms, your age and whether you hope to conceive:

• Pain-relieving medication used effectively and regularly
• Hormonal treatments to suppress the cycle, including the pill or hormonal coil
• Surgical treatment of endometriosis at laparoscopy
• Physiotherapy for pelvic floor muscle pain
• Pain management support for long-standing pain
• Fertility advice where relevant