1. Pelvic pain

Pelvic pain is any pain you feel in the area between your lower belly and the top of your legs. This area contains your uterus (womb), ovaries, fallopian tubes, bladder, and part of the bowel, so there can be many causes of pelvic girdle pain.

Pelvic pain can be very distressing and interfere with your ability to study, work and do things you enjoy. If pain is severe or acute (comes on suddenly), it’s best to see your local doctor or visit the closest emergency department.

If you have pelvic pain, the first thing doctors do is check to see if you’re pregnant.

Causes of pelvic pain can include infection such as Pelvic Inflammatory Disease (PID), endometritis (infection of the womb), endometriosis, urinary tract infection, or gastroenteritis and bowel related pain.

Fortunately, we are able to help with most causes. A thorough history and examination is paramount to finding out the cause. You may then need further medical imaging and blood tests to determine the cause and urgency of care.

We can offer appropriate management and treatment depending on the cause of pelvic pain. Sometimes a laparoscopy may be needed to investigate and treat your pelvic pain if symptoms fail to improve with a more conservative approach.

2. Ovarian cysts

Ovarian cysts can sometimes cause pain. The majority of cysts in the pre-menopausal woman are benign and may resolve spontaneously. However, if they are persistent or if there are concerning features other than a simple cyst, or you are symptomatic, we can counsel you regarding further surgical treatment. This is usually done by key-hole minimally-invasive laparoscopic surgery which offers a quicker recovery. If you are postmenopausal and have a cyst with abnormal features, we would advise you to see a gynaecologist more urgently.

3. Polycystic Ovarian Syndrome

Polycystic Ovarian Syndrome is commonly referred to as PCOS. This is a condition that may cause menstrual disorders and infertility. Majority of women with PCOS also have hyperandrogenism, which is a manifestation of increased male hormones in a woman, causing increased hair growth, male pattern baldness and acne.

The diagnosis of PCOS relies on some of the following: 

• Abnormal cycles: Infrequent or absent period
• Hyperandrogenism: either physical symptoms or biochemical signs on blood tests (or both)
• Polycystic ovaries appearance on ultrasound (not diagnostic on its own)
• Exclusion of other conditions that may cause similar hyperandrogenism symptoms or signs such as Cushing’s disease

PCOS is associated with obesity, type II diabetes, high cholesterol levels, and increased risk of endometrial cancer.

4. Endometriosis

Endometriosis is defined as the presence of endometrial glands (ie those that line the uterus) implanted elsewhere in the body, most common in the pelvis region. Endometriosis is a common, benign, chronic, oestrogen-dependent disorder. It can cause pain that is either acute or chronic in nature depending on your stage of menstrual cycle, or where the lesions are located through local inflammation and irritation. 

It can be associated with many distressing and debilitating symptoms, such as chronic pelvic pain, severe dysmenorrhea (painful periods), dyspareunia (pain during intercourse) and infertility. Sometimes it may be asymptomatic, and incidentally discovered at laparoscopy. When endometriosis occurs on the ovaries, it has a tendency to form into ovarian cyst, which are known as endometriomas, or commonly referred to as chocolate cysts.

Endometriosis are usually diagnosed via a laparoscopy. Endometriosis lesions can be surgically removed and treated during the laparoscopy to improve your symptoms.

Sometimes a good quality ultrasound scan or MRI can pick up endometriosis lesion, if you wish for more conservative approach of investigation and subsequent medical management.

5. Abnormal uterine bleeding

Abnormal uterine bleeding (AUB) is a term which refers to menstrual disorder, which includes irregularity, abnormal quantity, or duration. It is a common gynaecological complaint, accounting for one-third of outpatient visits to a gynaecologist. In the first instance, you should go to your local doctor who will take your history and do a pelvic examination, perform a cervical screening if needed, and organise for further investigations. This is usually in the form of a blood test and medical imaging such as a pelvic ultrasound. A pregnancy test is also needed. Following that, your doctor may refer you to gynaecologist and we can look after you from here.

Heavy periods refer to an increase in the flow of your menstrual period and it is what you perceive as abnormal. Prolonged periods refer to an increase in the duration of the menstrual period.

Some women may experience persistent bleeding in-between your cycles or after intercourse. Both of these can be abnormal and require medical attention.

The most common cause of abnormal uterine bleeding is the shift between ovulatory cycles and anovulatory cycles; simply meaning that the ovaries may not be releasing eggs (ovulating) as regularly as they were.

There may be other causes for AUB, that need more investigation and management. This includes fibroids which are usually benign growths in your uterus; adenomyosis which is the presence of endometrial tissue within the muscle layer of the uterus; and endometrial polyps which may be benign or malignant, and worst case scenario a cancer. Fibroids and adenomyosis can also cause symptoms of pressure-like discomfort and pelvic pain.

If you are postmenopausal and if you have experienced any vaginal or uterine bleeding, we advise you to seek urgent medical care with your local doctor or to see a gynaecologist.

6. Abnormal CST - Cervical screening test (previously known as pap smear)

Abnormal CST can be a scary moment in a woman’s life. In the majority of cases, it does not mean you have cancer. CST is one of the most successful screening tools designed to identify a cervical abnormality before it becomes cervical cancer. Australia has one of the most successful screening programs in the world and this is reflected in having one of the lowest incidences of cervical cancer. All women who have ever been sexually active are encouraged to have routine cervical screening every 5 years, starting from age of 25.

If you have any abnormal vaginal bleeding, or persistent abnormal vaginal discharge, regardless of your age, you should see your local doctor to consider having a CST test.

Abnormal CST need more investigation in the form of colposcopy assessment and, if required, a cervical biopsy. This is carried out by a gynaecologist with colposcopy experience.

7. Pelvic Organ Prolapse (POP)

The organs within a woman’s pelvic consist of uterus and cervix, vagina, bladder and bowel. These organs are normally held in place by supporting muscle and ligaments. When these supporting tissues are weakened, it no longer holds these organs in the correct position, causing pelvic organs to prolapse.

Pelvic Organ Prolapse (POP) is a bulge or lump in the vagina, which may affect your quality of life.

Patients with prolapse may present with symptoms related specifically to the prolapsed structures. A bulge or symptoms of vaginal pressure are present, together with associated symptoms including recurrent UTIs (urinary tract infections), difficulties emptying the bladder or rectum or sexual dysfunction. Symptoms such as low back or pelvic pain can also be attributed to prolapse. Other causes of pain would need to be excluded and a pelvic scan would be warranted to most cases.

A medical history is important to elicit prolapse-associated symptoms, since treatment is generally indicated only for symptomatic prolapse. A prolapse is diagnosed on pelvic examination.

Treatment options range from conservative methods such as physiotherapy and pelvic floor exercises, pessary or surgery with the aim to correct the prolapse

Want to know more?

Visit the Sunnybank Private Hospital Gynaecology page to meet our doctors and specialists and find out what conditions they treat.

Visit the Gynaecology web page