Untreated Chronic Pelvic Pain May Be Common Among Young Women

Source: Human Reproduction – August 2015

Roughly one-third of women reported that they have experienced chronic pelvic pain that has gone untreated for 6 months or longer, according to researchers from the National Institutes of Health and the University of Utah School of Medicine in Salt Lake City.

The researchers polled 473 women between the ages of 18 and 44 at 14 different surgical centers in Salt Lake City and San Francisco before and after exploratory laparoscopic surgery. They asked the women whether they had experienced 17 different types of pain during activities such as sexual intercourse, menstruation, urination, and bowel movements as well as if they had experienced muscle pain, joint pain, and headaches. Women were asked to record the location and severity of their pain on a diagram.

More than 30% of women reported they have experienced chronic pain and/or cyclical pain that lasted 6 months or longer, regardless of their post-surgical diagnosis. When compared with women with a normal pelvis, women with endometriosis were more likely to experience chronic pelvic pain. Women with an endometriosis diagnosis were also more likely to experience pain during intercourse, pain during menstrual cramping, and pain during bowel movements; they also reported higher rates of vaginal pain and pelvic-abdominal pain.

Regarding surgical diagnosis, 40% of women were diagnosed with endometriosis; 31% were diagnosed with a combination of conditions such as uterine fibroids, ovarian cysts, and tumors, and 29% had not been diagnosed with any pelvic health condition. Notably, 3% of women polled reported having none of the 17 types of pain, while 60% reported having six or more different types of pain.

In our experience at RADfertility, women with chronic pelvic pain most likely have endometriosis. What I wish this study had addressed is a confirmation of endometriosis through tissue biopsy, rather than laparoscopic visualization.

We at RADfertility know that, a lot of the time, endometriosis is not necessarily visually seen with laparoscopy. I believe this study did not address the atypical endometriosis we see in our chronic pelvic pain patients that can be easily missed. To the non-trained eye, the peritoneum looks normal but can actually be abnormal. For example, some types of endometriosis have lesions that are easy to pass by unless a surgeon has a great laparoscope and is looking very close. Another type of atypical endometriosis has a mucus-like appearance, with a thick coating along the peritoneum.

Every patient is an individual: endometriosis is an individual disease with individualized symptoms, and one symptom doesn’t fit all. It is essential for a specialist to ask the right questions before going into the operating room. Endometriosis excision surgery should be performed while looking for the specific areas that are causing the symptoms our patients identify.

That is why the first thing we ask our chronic pelvic pain patients at RADfertility is about their history. We want to know their past and present history, what happened when they started their cycles, and the regularity and symptoms of their cycles. After we take a full history, patients undergo a physical exam and an ultrasound. The ultrasound is key for many patients because it is a unique opportunity to connect their pain with what they view on screen. When our clinicians explore the trouble spots patients identify in their history and it hurts, patients are able to identify their pain. I consider the ultrasound for us to be as similar as a stethoscope is for a cardiologist.

Women need to find someone who will listen to them, but we recognize there are obstacles to care, sometimes even at home. If their mother or another family member had experienced chronic pelvic pain, they may not connect their problems to their daughters’ symptoms. Even more unfortunate is that these young women may not seek out care because other people convince them their symptoms are normal.

But it’s important to define what normal really is. Normal is starting your cycle and needing 1-2 Tylenol or Motrin. Normal is bleeding that stops within 3-4 days. If women require Midol, Pamprin, hot water bottles, sitting on cold tile floors, staying home from school or work, and/or balled up in a fetal position to find relief, there is nothing normal about any of these things. Women experiencing these symptoms should see a women’s health specialist as soon as possible.