- 7 Period Symptoms No Woman Should Ignore
- 1. Skipped periods
- 2. Heavy bleeding
- 3. Abnormally short or long periods
- 4. Intense cramps
- 5. Bleeding between periods
- 6. Breast pain
- 7. Diarrhea or vomiting
- Heavy periods and pelvic pain aren’t ‘normal’ – uterine fibroids might be to blame
- When Uterine Fibroids Become Problematic
- Ask the doctor: Heavy bleeding, fibroids, and polyps
- Abnormal Menstruation (Periods): Management and Treatment
- What does ovulation pain mean?
- Fibroids with pain/bloating before/during ovulation – Anyone??
- What to do about fibroids
- Treatment approaches
- Uterine artery embolization
- Magnetic resonance–guided ultrasound
- What causes pelvic pain in women?
- 1. Menstrual pain and cramps
- 2. Ovulation
- 3. Interstitial cystitis
- 4. Cystitis or urinary tract infections
- 5. Sexually transmitted infections
- 6. Pelvic inflammatory disease
- 7. Endometriosis
- 8. Irritable bowel syndrome
- 9. Appendicitis
- 10. Urinary stones
- 11. Ectopic pregnancy
- 12. Pelvic adhesions
- 13. Ovarian cysts
- 14. Uterine fibroids
- 15. Tumor
- Related posts:
7 Period Symptoms No Woman Should Ignore
Every woman’s period is different. Some women bleed for two days, while others may bleed for a full week. Your flow might be light and barely noticeable, or heavy enough to make you uncomfortable. You may or may not get cramps, and if you do, they could be mild or intensely painful.
As long as your periods stay consistent, there’s probably no reason to worry about them. But you should stay alert in case you experience any changes to your monthly menstrual cycle.
Here are seven symptoms that are worth reporting to your doctor.
1. Skipped periods
Some women have more regular periods than others, but most get a period about once every 28 days. If your periods suddenly stop, there could be a few reasons for it. One possibility is pregnancy, and a pregnancy test can quickly and easily determine the answer to that.
If pregnancy isn’t the case, something else may be the cause of your skipped period, such as:
- Intense exercise or significant weight loss. Overexercising can affect levels of hormones that control your menstrual cycle. When you lose too much body fat through diet or exercise, your periods can stop altogether. You need some body fat to manufacture hormones.
- Weight gain. Gaining a lot of weight also can throw off your hormone balance and disrupt your menstrual cycle.
- Continuous birth control pills. Certain birth control pills that provide a continuous dose of hormones means you’ll get fewer periods, and in some cases, they can stop your periods altogether.
- Polycystic ovary syndrome (PCOS). With this condition, a hormone imbalance leads to irregular periods and the growth of cysts in the ovaries.
- Extreme stress. Being under stress can throw off even the most regular menstrual cycle.
- Perimenopause. If you’re in your late 40s or early 50s, you might be in perimenopause. This is the period of time leading up to menopause when estrogen levels decline. You’re officially in menopause once your periods have stopped for 12 consecutive months, but your periods can fluctuate a lot in the years leading up to menopause.
2. Heavy bleeding
Period blood volume varies from woman to woman. Generally, if you soak through one or more pads or tampons an hour, you have menorrhagia — an abnormally heavy menstrual flow. Along with the heavy bleeding, you might have signs of anemia, such as fatigue or shortness of breath.
A heavy menstrual flow is common. About one-third of women will eventually see their doctor about it.
Causes of heavy menstrual bleeding include:
- A hormone imbalance. Conditions like PCOS and an underactive thyroid gland (hypothyroidism) can affect your hormone production. Hormonal changes can make your uterine lining thicken more than usual, leading to heavier periods.
- Fibroids or polyps. These noncancerous growths in the uterus can cause bleeding that’s heavier than normal.
- Endometriosis. This condition is caused by tissue that normally lines your uterus growing in other parts of your pelvis. In your uterus, that tissue swells up each month and then is shed during your period. When it’s in other organs — like your ovaries or fallopian tubes — the tissue has nowhere to go.
- Adenomyosis. Similar to endometriosis, adenomyosis is a condition that happens when tissue that normally lines the uterus grows into the uterine wall. Here, it has nowhere to go, so it builds up and causes pain.
- Intrauterine device (IUD). This birth control method can cause heavy bleeding as a side effect, especially during the first year after you start using it.
- Bleeding disorders. Inherited conditions like Von Willebrand disease affect blood clotting. These disorders can also cause abnormally heavy menstrual bleeding.
- Pregnancy complications. An unusually heavy flow could be a sign of a miscarriage or ectopic pregnancy. It can happen so early that you may not realize you were pregnant.
- Cancer. Uterine or cervical cancer can cause heavy bleeding — but these cancers are often diagnosed after menopause.
3. Abnormally short or long periods
Normal periods can last anywhere from two to seven days. Short periods may be nothing to worry about, especially if they’re typical for you. Using hormonal birth control can also shorten your cycle. Going into menopause can disrupt your normal cycles as well. But if your periods suddenly get much shorter, check in with your doctor.
Some of the same factors that cause heavy bleeding can make your periods longer than usual. These include a hormone imbalance, fibroids, or polyps.
4. Intense cramps
Cramps are a normal part of periods. They’re caused by uterine contractions that push out your uterine lining. Cramps typically start a day or two before your flow begins, and last for two to four days.
For some women, cramps are mild and not bothersome. Others have more severe cramps, called dysmenorrhea.
Other possible causes of painful cramps include:
- an IUD
- pelvic inflammatory disease (PID)
- sexually transmitted diseases (STDs)
5. Bleeding between periods
There are a few reasons why you might notice spotting or bleeding in between periods. Some causes — like a change in birth control — aren’t serious. Others require a trip to your doctor.
Causes of bleeding between periods include:
- skipping or changing birth control pills
- STDs like chlamydia or gonorrhea
- an injury to the vagina (such as during sex)
- uterine polyps or fibroids
- ectopic pregnancy or miscarriage
- cervical, ovarian, or uterine cancer
6. Breast pain
Your breasts might feel a little tender during your periods. The cause of the discomfort is likely fluctuating hormone levels. Sometimes there is pain right up into your armpit where there is some breast tissue called the Tail of Spence.
But if your breasts hurt or the pain doesn’t coincide with your monthly cycle, get checked out. Although breast pain isn’t usually due to cancer, it can be a symptom of it in rare cares.
7. Diarrhea or vomiting
Some women normally get an upset stomach during menstruation. In one study, 73 percent of women reported having abdominal pain, diarrhea, or both around the time of their period.
If these symptoms aren’t normal for you, they could indicate PID or another medical condition. Because excessive diarrhea or vomiting can cause dehydration, report this symptom to your doctor.
Heavy periods and pelvic pain aren’t ‘normal’ – uterine fibroids might be to blame
Fibroids will begin to shrink right away; the goal is to reduce their volume by up to 50% over a few months. Recovery typically takes one to two weeks. Gynecologic surgeons at UT Southwestern now offer the Acessa procedure, which is approved by the U.S. Food and Drug Administration and typically only requires day surgery (outpatient) and a short recovery.
3. Uterine fibroid embolization
Another minimally invasive procedure, uterine fibroid embolization essentially starves fibroids of blood so they shrink over time. An interventional radiologist inserts a thin, flexible tube called a catheter into a patient’s artery and guides it to the uterus. Then, tiny particles are passed through the catheter to the blood vessels in the uterus.
The particles wedge into the blood vessels, blocking blood flow to the fibroids so they can no longer thrive. Over a few months, the growths should shrink by 40% to 60%.
This more permanent procedure removes the uterus and, in some cases, the fallopian tubes and ovaries. For uterine fibroid treatment, we typically recommend hysterectomy only for women who do not want to become pregnant in the future. Our surgeons can perform three types of minimally invasive hysterectomy – through the vagina, laparoscopic, or robot-assisted approaches – as well as traditional open hysterectomy when appropriate.
5. Medical management
Some women can manage their uterine fibroid symptoms with prescription medications or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. Women with iron-deficiency anemia from heavy periods also might benefit from iron supplements. A gynecologist can recommend medications based on specific symptoms. If symptoms are not well controlled with NSAIDs, we frequently offer hormonal medications, such as birth control pills or other hormonal treatments that can help with symptom management Additionally, for patients whose main issue is bleeding, an oral medication called Lysteda (tranexamic acid) can be taken during menses to reduce menstrual blood loss.
Fibroids are non-cancerous little balls of muscle that start in the uterus’s muscle wall and grow in response higher levels of estrogen. Most women after about age 30 are growing fibroids; however, most of us will never have any problems related to them. Very rarely fibroids can interfere with pregnancy, or grow so big that they cause urine or bowel blockage, bladder symptoms or pain. Fibroids shrink when women become menopausal.
Most women first learn that they have fibroids when they develop heavy flow (often in perimenopause). Because there is the wrong understanding that fibroids cause heavy flow, many family doctors will then order a uterine ultrasound. Very commonly this ultrasound shows fibroids. However that doesn’t mean that the fibroids are causing the heavy flow. Higher estrogen levels cause both heavy flow and fibroid growth.
Fibroids tend to grow in three directions—within the muscle (the most common situation), pushing outside of the uterus (called subserosal or, if on a stalk, pedunculated) and into the endometrium (called submucosal). Submucosal fibroids are the only one of these three kinds of fibroids that could potentially cause abnormal vaginal bleeding—they make up less than 1 of every 10 fibroids. Instead, heavy bleeding is caused by the higher estrogen and lower progesterone levels of perimenopause and these hormonal changes make fibroids grow. Remember that fibroids are common and usually cause no problems.
When Uterine Fibroids Become Problematic
Uterine fibroids are very common — 20 percent to 80 percent of women will develop them during their childbearing years, many without even knowing it. And while uterine fibroids are not cancerous, they can sometimes cause uncomfortable symptoms and problems getting pregnant. But they can be treated.
What Are Uterine Fibroids?
Uterine fibroids are benign growths that develop in the muscular wall of the uterus. They range in size from smaller than a pea to as large as a grapefruit.
Uterine fibroids are controlled by the hormones you produce most readily during your childbearing years, progesterone and estrogen. This is why your fibroids may stop growing and even shrink once you go through menopause.
In some women, uterine fibroids do not cause any symptoms. But depending on the size, shape, and number of your uterine fibroids, you may experience one or more of the following:
- Long menstrual periods
- Frequent periods
- Heavy periods
- Menstrual cramping
- Bleeding between periods
- Pain or aching in the abdomen or lower back
- Pain during sex
- Abdominal pressure
- Problems urinating
- Frequent urination
- Rectal pain
- Problems getting pregnant
Because uterine fibroids and premenstrual syndrome (PMS) share certain symptoms (abdominal pain, bloating, constipation), some women may assume their symptoms are simply a part of PMS. But uterine fibroids can be more serious than PMS, so it is important to talk with your doctor if you have possible symptoms of fibroids.
Non-Surgical Fibroids Treatment Options
Uterine fibroids are most often found during a pelvic exam. You may need to have an ultrasounds or a procedure like a laparoscopy to give your doctor a clearer picture of your fibroids. During laparoscopy, your doctor will use a thin tube with a camera attached to the end of it, which is inserted into the body near the navel so that the doctor can get a clear view of your uterus.
Uterine fibroids that are not causing any symptoms or problems may not need to be treated.
If your symptoms are mild, your doctor may recommend over-the-counter pain medications such as Advil or Motrin (ibuprofen) or Tylenol (acetaminophen) to help reduce your pain. Ask your doctor if you should take an iron supplement to prevent or treat anemia related to your fibroids.
But if your uterine fibroids are causing severe pain or other problems, fibroids treatment options include:
- Medications. Hormonal therapy, like birth control pills, can help manage heavy bleeding and menstrual pain, but it can cause fibroids to grow. Gonadotropin-releasing hormone (GnRH) agonists are sometimes temporarily used to halt the menstrual cycle, shrink fibroids, and help control bleeding.
- Intrauterine device. If your fibroids are not changing the shape of the inside of your uterus, your doctor may recommend an intrauterine device that releases progesterone into your uterus to reduce heavy bleeding and menstrual pain.
Types of Fibroids Surgery
Sometimes, surgery is needed to shrink or remove uterine fibroids. There are several types of fibroids surgery:
Myomectomy. In myomectomy, your fibroids will be surgically removed through an incision or with a laser beam, leaving the rest of your uterus intact. If your fibroids are making it difficult for you to become pregnant, myomectomy may help.
Endometrial ablation. Endometrial ablation destroys the uterine lining with heat or microwaves. This procedure, which helps to manage heavy menstrual flow or remove small fibroids, is typically used only after a woman has stopped having children, since most women cannot get pregnant after endometrial ablation.
Magnetic resonance imaging-guided ultrasound surgery. Using MRI for guidance, a doctor directs ultrasound waves at fibroids to shrink or destroy them. This method seems to give good results for up to one year; longer term results are unknown, but they are being studied.
Hysterectomy. In severe cases of uterine fibroids, a hysterectomy, a surgery in which the uterus is removed, may be necessary to completely eliminate uterine fibroids. You cannot have children after a hysterectomy.
Uterine artery embolization (UAE). UAE blocks the blood supply that feeds the fibroids, enabling them to grow. For this procedure, your doctor will pass a thin tube into a small incision in your groin area, through a large artery, until it reaches the small arteries that supply blood to your uterus. There, your doctor will inject tiny particles into the arteries to cut off blood flow. UAE is usually recommended as an alternative to hysterectomy for women with severe symptoms who do not want any more children.
Uterine fibroids are common and not usually associated with serious problems. But talk with your doctor if you have symptoms of fibroids, since early treatment can reduce your risk of complications.
Ask the doctor: Heavy bleeding, fibroids, and polyps
Updated: May 14, 2019Published: May, 2011
Q.I am 53. I’ve had fibroids for some time but have experienced heavy menstrual bleeding lately. A recent ultrasound showed fibroids and polyps. What are my options?
A. As you know, you’re almost certainly in perimenopause, the four to eight years leading up to menopause and the complete cessation of menstruation. Every woman’s script for the transition to menopause is a little bit different, but it’s very common for the menstrual cycle to be irregular and the amount of blood flow to vary. Erratic ovulation — the release of eggs from the ovaries — may result in hormonal changes that cause the lining of the uterus (the endometrium) to become thicker than usual, so when it sloughs off, the menstrual bleeding is heavier and more prolonged than women are used to.
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Abnormal Menstruation (Periods): Management and Treatment
How is abnormal menstruation (periods) treated?
The treatment of abnormal menstruation depends on the underlying cause:
- Regulation of the menstrual cycle: Hormones such as estrogen or progestin might be prescribed to help control heavy bleeding.
- Pain control: Mild to moderate pain or cramps might be lessened by taking an over-the-counter pain reliever, such as ibuprofen or acetaminophen. Aspirin is not recommended because it might cause heavier bleeding. Taking a warm bath or shower or using a heating pad might help to relieve cramps.
- Uterine fibroids: These can be treated medically and/or surgically. Initially, most fibroids that are causing mild symptoms can be treated with over-the-counter pain relievers. If you experience heavy bleeding, an iron supplement might be helpful in preventing or treating anemia. Low-dose birth control pills or progestin injections (Depo-Provera®) may help to control heavy bleeding caused by fibroids. Drugs called gonadotropin-releasing hormone agonists may be used to shrink the size of the fibroids and control heavy bleeding. These drugs reduce the body’s production of estrogen and stop menstruation for a while. If fibroids do not respond to medication, there are a variety of surgical options that can remove them or lessen their size and symptoms. The type of procedure will depend on the size, type and location of the fibroids. A myomectomy is the simple removal of a fibroid. In severe cases where the fibroids are large or cause heavy bleeding or pain, a hysterectomy might be necessary. During a hysterectomy, the fibroids are removed along with the uterus. Other options include uterine artery embolization, which cuts off the blood supply to the active fibroid tissue.
- Endometriosis: Although there is no cure for endometriosis, over-the-counter or prescription pain relievers may help to lessen the discomfort. Hormone treatments such as birth control pills may help prevent overgrowth of uterine tissue and reduce the amount of blood loss during periods. In more severe cases, a gonadotropin-releasing hormone agonist or progestin may be used to temporarily stop menstrual periods. In severe cases, surgery may be necessary to remove excess endometrial tissue growing in the pelvis or abdomen. A hysterectomy might be required as a last resort if the uterus has been severely damaged.
There are other procedural options which can help heavy menstrual bleeding. A five-year contraceptive intrauterine device (IUD), called Mirena®, has been approved to help lessen bleeding, and can be as effective as surgical procedures such as endometrial ablation. This is inserted in the doctor’s office with minimal discomfort, and also offers contraception. Endometrial ablation is another option. It uses heat or electrocautery to destroy the lining of the uterus. It is usually only used when other therapies have been tried and failed. This is because scars from the procedure can make monitoring the uterus more difficult if bleeding persists in the future.
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What does ovulation pain mean?
Many other conditions can cause pelvic pain, including pelvic pain around the time ovulation. Some of the most common causes include:
Pelvic relaxation syndromes
Pelvic relaxation syndromes, which are common in those who have given birth and in older women, happen when muscles in the pelvis weaken. They cause chronic pain that may also result in back or stomach pain.
A urinary tract infection can affect the urethra, bladder, or kidneys. It can make urination very painful, cause blood in the urine, and also cause fevers and back pain.
Pain in the lower stomach, especially if the pain occurs with urinary pain, may mean there is a urinary tract infection.
Endometriosis is a condition that causes the tissue that lines the uterus to occur in other areas of the body. It causes chronic pelvic pain at the place where the endometrial tissue has developed.
Many people with endometriosis experience intense menstrual cramps or very heavy periods. Others have pain throughout their cycle or very irregular periods.
Cramping right before or during a period is not ovulation pain.
Many women experience menstrual cramps. If the pain is mild and does not interfere with daily tasks, there is probably no need for concern and treatment is not usually necessary.
However, intense pain or pain that has gotten steadily worse with each period requires the attention of a doctor.
Constipation can cause a range of painful or unusual sensations in the stomach or pelvis.
A person who has not had a bowel movement in several days, or who has strained to have a bowel movement, may have constipation.
Chronic constipation may also be a sign of an underlying medical condition.
Appendicitis occurs when the appendix becomes infected. It can be very dangerous without treatment. The pain usually starts in the middle of the stomach and may come and go. Typically, the pain travels to the lower right side of the abdomen over several hours and becomes very intense.
Anyone who suspects they may have appendicitis should see a doctor immediately.
An ectopic pregnancy occurs when a fertilized egg implants somewhere other than the uterus.
An ectopic pregnancy cannot continue. If a doctor does not remove the fertilized egg, the fallopian tube could rupture, which may have a severe impact on fertility or even be fatal.
Pain on one side of the body late in the cycle, especially if a period is late, could be a sign of an ectopic pregnancy. If the pain gets worse over several days or fever develops, see a doctor immediately.
Ruptured ovarian cyst or ovarian torsion
Most ovarian cysts go away on their own. Sometimes, however, they rupture or damage the ovary.
An ovarian torsion happens when the ovary twists around the fallopian tube. It can cause dangerous bleeding and possibly cause the ovary to die.
A ruptured ovarian cyst or ovarian torsion is a medical emergency. The pain is intense and unrelenting and can happen at any time during the menstrual cycle.
Share on PinterestGastrointestinal problems or urinary tract infections can cause stomach pains.
Sometimes, it can be difficult to tell the difference between stomach and pelvic pain.
Many stomach and intestinal problems can cause pain, including pain on one side of the body. Problems with the pancreas or liver often cause pain in the upper right stomach.
Other gastrointestinal problems, such as diverticulitis, an infection, or another serious problem with the intestines, can also cause stomach pain.
Many people also develop other symptoms alongside pain, such as:
- changes in the color of the stool
Fibroids with pain/bloating before/during ovulation – Anyone??
I am a long-time fibroids sufferer. I had a 14 cm pedunculate fibroid removed in 2011 when it’s blood supply was cut off and it started to necrotize. It was extremely traumatic! Now, my other smaller fibroids have started getting larger. I have several, two of which are 7+ cm. For about a year I’ve been getting pelvic pain and bloating from the day my period ends until on or just after I ovulate. My doctors (I recently switched gynecologists) do not believe me when I say the timing is always the same and it must have to do with my cycle!
A few months ago the pain got worse and I could suddenly feel a mass in my lower abdomen. I went to the doctor who also felt it. I had an ultrasound and then MRI to confirm the fibroids and their size AND it turned out that they’d gotten so big that they’d made my uterus flip from tilting backwards to tilting forwards, which is why I can now feel them in my abdomen.
The nice thing is that a lot of my previous symptoms have subsided – I don’t get the rectal pain and bladder pressure I was having before when the fibroids must have been pressing on my bowels (which my doctor didn’t believe!!) I also have a small umbilical hernia that no longer bothers me at all (also my doctor told me it wasn’t being caused or irritated by the fibroids). But, I still get the pain and bloating at the same part of my cycle.
For much of my cycle I can’t feel the fibroids and they cause me no issues. But, like clock work, as soon as menstrual bleeding stops, there comes the pain and pressure and I can feel the fibroids pressing into my pelvic area and the whole area is tender. It lasts for a few days and then subsides after ovulation.
I feel like I’m losing my mind because no one believes me that this could be hormonal or in any way related to my cycle. Because of that I have no idea what to do about it! Has anyone else experienced this? It’s the only time the fibroids are symptomatic. I would really like to avoid surgery and I’m trying desperately to wait it out until menopause for these suckers to shrink, but I’m only 36 and don’t want to deal with this for the next 10-15 years.
I’m not on any birth control because I’m afraid it would make them grow, but I do wonder if it might actually help with this pain.
Any tips?? (Sorry for the novel!)
0 likes, 5 replies
What to do about fibroids
Published: July, 2008
New options for managing troublesome fibroids continue to appear. Here’s help in finding what’s best for you.
Every year in the United States, hundreds of thousands of women undergo treatments and procedures (including as many as 200,000 hysterectomies) because of fibroids. About 25% to 30% of reproductive-age women have symptoms caused by these rubbery noncancerous growths that form in the walls of the uterus, usually between the ages of 35 and 50. Many more women have fibroids but no symptoms. African American women are three times more likely to develop symptomatic fibroids than women of other ethnic groups, and typically do so at an earlier age.
Fibroids can drastically alter a woman’s quality of life. For example, a very large fibroid can expand the uterus to the size of a second-trimester pregnancy and press against the bowel or bladder, causing constipation or frequent urination. Fibroids are also occasionally associated with infertility, miscarriage, and premature labor. But the most common complaint is heavy, often clot-studded menstrual bleeding, called menorrhagia (if a pad or tampon is soaked through every hour) or hypermenorrhagia (if two or more tampons or pads are soaked through every hour), which can make a woman a virtual prisoner in her home during her periods. Such heavy bleeding can also cause iron-deficiency anemia.
No one knows exactly what causes fibroids. Genes that accelerate the growth of uterine muscle cells may play a role. Abnormalities in uterine blood vessels may also be involved. The presence of estrogen and possibly progesterone seems to be important in some way: fibroids seldom occur before the first menstrual period, pregnancy can spur their growth, and they usually shrink after menopause.
Until the late 1990s, hysterectomy was often among the first treatments considered. Since then, less-invasive therapies have become more available, and more is known about the options for managing different types of fibroids. Women now have more choices for their treatment, and clinicians can better individualize care.
Types of fibroids
Fibroids are classified by location. They are generally multiple, and you can have more than one type. The most common type, intramural fibroids, grow within the uterine wall and sometimes cause heavy menstrual flow, a frequent urge to urinate, and, in some cases, back and pelvic pain. Submucosal fibroids, the least common type, start under the uterine lining (endometrium) and may protrude into the uterine cavity. They can cause heavy bleeding and are most closely linked to fertility problems. Some fibroids are pedunculated, meaning that they grow on a stalk. Subserosal fibroids grow on the outer surface of the uterus, sometimes on a stalk. They usually don’t cause bleeding but may cause pressure. Rarely, they can twist or degenerate and will be painful.
Fibroids are often found during a routine pelvic exam or imaging procedures performed for other reasons. If they don’t cause symptoms — heavy bleeding, pressure, or pain — and aren’t implicated in infertility, fibroids usually don’t require treatment. When there are symptoms, they can be managed with medications (the usual first approach) or with surgery, using minimally invasive techniques where possible.
The first step in determining your options is a thorough evaluation, starting with your gynecologist. She or he can often feel fibroids on a pelvic exam but may use imaging techniques to get more precise information, which is critical for planning treatment. For example, transvaginal ultrasound can help assess the size of fibroids that extend into the uterine cavity (intracavitary fibroids); the addition of 3-D imaging can determine their location precisely. This is important because intracavitary fibroids can cause infertility. Other potentially useful imaging techniques include magnetic resonance imaging (MRI) and sonohysterogram (ultrasound with a saline infusion into the uterine cavity). Your clinician may also examine the uterine cavity with a small optical device (hysteroscope) inserted through the cervix.
If you’re relatively young and symptoms aren’t severe, you may simply wait out your fibroids, since they’re likely to shrink after menopause. As you “watch and wait,” your clinician will monitor them at regular intervals. Development and growth of fibroids isn’t unusual in premenopausal women, but in postmenopausal women, a new or enlarging mass may indicate a malignancy and should be followed up.
If your symptoms preclude waiting until menopause, there are other options, surgical and pharmaceutical. For mild pain, your clinician may suggest over-the-counter analgesics, including acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs, such as ibuprofen (Motrin, Advil). For anemia caused by heavy bleeding, you may be advised to increase your iron intake through diet, supplements, or both.
No medication can prevent fibroids or guarantee that they won’t return. But there are prescription drugs that shrink fibroids and reduce bleeding. The most important classes of prescription drugs are the following:
GnRH agonists. Gonadotropin-releasing hormone (GnRH) agonists such as leuprolide (Lupron) suppress ovarian estrogen production and produce a temporary false menopause that reduces blood flow to fibroids and shrinks them. Fibroids usually grow back once the drug is stopped. These medications are rarely used for more than six months, because they can bring on menopausal symptoms, including hot flashes and vaginal dryness — as well as depression, joint pain, bone loss, and sleep problems. The best candidates for GnRH treatment are women who need only a short-term “bridge” to menopause, when fibroids tend to recede, or respite from periods to build up their blood count. A GnRH agonist may also be prescribed before surgery to shrink fibroids.
Hormonal agents. Birth control pills, the androgen drug danazol (Danocrine), or medroxyprogesterone acetate (Depo-Provera) may be prescribed to help control bleeding. Mifepristone (RU-486) blocks progesterone, shrinking fibroids and reducing bleeding. (Researchers are developing other drugs in this class, called selective progesterone receptor modulators, or SPRMs.) Early studies suggested that RU-486 might cause overgrowth of uterine cells, but lowering the dose appears to solve that problem. Raloxifene (Evista) helps shrink fibroids but is prescribed only for postmenopausal women. Some women get relief from heavy bleeding by using a progestin-releasing intrauterine device (Mirena).
For more severe symptoms, you may want to consider surgery. Your decision will depend largely on whether you’ve completed childbearing and, if you have, whether you are willing to wait for menopause. The two most common surgeries are these:
Myomectomy. This operation removes only the fibroid (or fibroids). It preserves the uterus, so it’s the best option for women who may want to have children (although they may be advised to deliver by cesarean section).
Depending on the type, size, and location of the fibroid(s), myomectomy may be performed through a standard abdominal incision or — less invasively — via laparoscopy, where small incisions and video-aided instruments are used. The surgeon may also employ a technique called hysteroscopy. In this procedure, a hysteroscope equipped with instruments for removing the fibroids is introduced into the uterus through the vagina and may be used for fibroids that protrude into the uterine cavity. Surgeons must be specially trained to perform this operation. Recovery time is shorter in hysteroscopic and laparoscopic procedures than in abdominal myomectomy, and fertility rates are excellent.
One disadvantage of myomectomy is that adhesions may form. (Adhesions are a type of scar tissue that forms on pelvic organs and binds them to each other.) Another is that fibroids may recur, since the uterus isn’t removed. Among women undergoing myomectomy, 10% to 33% require a second surgery within five years.
Hysterectomy. The uterus is removed through an incision in the lower abdomen, through the vagina, or laparoscopically. This completely eliminates fibroids and their symptoms.
Hysterectomy is safe and effective and has a low complication rate. Nevertheless, it’s major surgery that requires anesthesia and — depending on the particular procedure — two to six weeks of recovery time. Women who have had a hysterectomy are at greater risk for urinary incontinence and reach menopause an average of two years earlier.
Studies suggest that most women are satisfied with their decision to have the procedure. But hysterectomy ends periods and childbearing, so you need to consider psychological as well as medical ramifications.
Uterine artery embolization
Uterine artery embolization (UAE) — also known as uterine fibroid embolization — is a minimally invasive procedure that shrinks fibroids by cutting off their blood supply. UAE has been around since the early 1980s as a treatment for postpartum and other traumatic pelvic bleeding. Since 1995, it’s been used to treat fibroids and has become increasingly popular.
Before the procedure, the pelvic area is imaged (preferably with MRI) to rule out other causes of symptoms, such as an ovarian tumor. This also helps ascertain the size, location, and types of fibroids involved. During the procedure, an interventional radiologist inserts a catheter through a small nick in the skin (at the groin) into the femoral artery. Using contrast dye x-ray imaging, the catheter is guided into one of the two arteries that supply the uterus (the uterine arteries). Sand-sized particles made of a synthetic material are then injected into the uterine artery. The particles concentrate in the blood vessels feeding the fibroid (see illustration), cutting off its blood supply and eventually shrinking it. Both uterine arteries can usually be treated during the same catheterization.
Uterine artery embolization
During the procedure, an interventional radiologist threads a catheter into the uterine artery by way of the groin, using real-time x-ray imaging, and releases tiny particles into the artery on one side of the uterus. The particles accumulate in the blood vessels feeding the fibroid, cutting off its blood supply. Then the procedure is repeated on the other side.
UAE is performed under local anesthesia and takes less than an hour. It can be performed on an outpatient basis but usually requires a one-night hospital stay to monitor for post-embolization syndrome (pelvic pain and cramping, nausea, vomiting, fever, and general discomfort). Serious cramping during the first 12 to 24 hours after UAE is common and treated with oral or intravenous painkillers. Some women experience a bloody discharge for two weeks to several months following the procedure.
Serious complications are rare (less than 1%). There is some concern about damage to the ovaries from migrating particles. A few women have suffered a temporary or even permanent disruption of ovarian function. The risk is greater after age 45. In some cases, sloughed-off fibroid tissue becomes stuck in the cervix on its way out of the body and has to be removed surgically.
UAE is an option for a woman who doesn’t want or can’t have surgery, or who would like to preserve her uterus. It generally isn’t recommended for women wanting to conceive after treatment: pregnancy rates are lower — and pregnancy complication rates are higher — following UAE than after myomectomy.
UAE is most effective for fibroids that are not pedunculated (growing on a stalk). Surveys show that 85% to 90% of women are satisfied with the results up to three years after the procedure. It’s faster than hysterectomy and involves a shorter hospital stay and less recovery time. Quality of life scores are similar for the two procedures. But follow-up data indicate that 20% to 24% of women undergoing UAE will need surgery (hysterectomy or myomectomy) within a couple of years.
Some gynecologists are looking for ways to interrupt the blood supply of fibroids without injecting foreign material into the body. In laparoscopic uterine artery occlusion, the clinician places a small clip or clamp on the uterine artery during a laparoscopic procedure. Another technique requires no incision at all; the surgeon approaches the artery through the vagina to apply a clamp, which stays in place for a few hours and shrinks the fibroid. Blood flow returns to the artery when the clamp is removed.
Magnetic resonance–guided ultrasound
Magnetic resonance–guided focused ultrasound surgery (MRgFUS) is a noninvasive technique that works by heating and shrinking the fibroid with high-intensity ultrasound waves. MRI is used to visualize the fibroid and monitor temperature changes in the tissue during the procedure.
The device used to perform MRgFUS (the ExAblate 2000) gained FDA approval in 2004, so there’s little information on its long-term safety and effectiveness. Two- and three-year follow-up studies suggest that MRgFUS helps reduce symptoms, but it hasn’t been compared directly with hysterectomy, myomectomy, or UAE.
How does MRgFUS work?
The patient lies on her stomach on a table inside the MRI scanner, positioned over a transducer that emits high-intensity ultrasound energy and focuses it on a tiny area of the fibroid. Each such “sonication” heats and destroys a small amount of tissue; multiple sonications are required for each fibroid. The patient is sedated but fully awake during the procedure, which takes three hours, on average. Patients can go home shortly afterward and usually return to normal activities the next day.
MRgFUS is not recommended for multiple small fibroids, pedunculated fibroids, or fibroids located deep in the pelvis, behind bowel loops, or close to the sacral nerves in the lower spine. Although it is approved only for women not concerned about preserving their fertility, some pregnancies have occurred following MRgFUS. The procedure isn’t widely available and may not be covered by insurance. For now, it should be considered promising but still unproven.
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What causes pelvic pain in women?
1. Menstrual pain and cramps
Share on PinterestMenstrual cramping is a common cause of pelvic pain.
Menstrual pain and cramping are a common cause of pelvic pain in women.
Of all menstrual disorders, women most commonly report experiencing pain, say the American College of Obstetricians and Gynecologists (ACOG).
Over half of women who menstruate will experience some pain for at least 1–2 days each cycle.
Menstrual cramping will typically occur immediately before a woman starts her period, as the uterus contracts and sheds its lining. The pain may feel similar to a muscle spasm or a jabbing pain.
Using a warm heat pad may relieve the sensation. Over-the-counter medications, such as ibuprofen (Advil) and naproxen (Aleve), may also help relieve pain.
In cases of severe pain from menstruation, doctors can recommend other medications.
If a woman feels a painful sensation on one side of her pelvis in the middle of her menstrual cycle, she may be experiencing mittelschmerz. Doctors use this German word to describe painful ovulation.
When a woman ovulates, the ovaries release an egg, along with some other fluid. The egg will then travel down the fallopian tube and into the uterus. The fluid released by the ovary can spread within the pelvic area, sometimes, causing irritation in the pelvis and leading to pain.
The discomfort may last for minutes or hours, and it may switch sides of the body, depending on which ovary released the egg. The pain is temporary and requires no specific treatment.
3. Interstitial cystitis
It is also possible for a woman to experience ongoing bladder inflammation that has no known cause. The medical term for this is interstitial cystitis, and doctors are currently unsure why it happens.
Interstitial cystitis can cause pelvic pain and symptoms such as painful urination, needing to urinate frequently, and pain during sex. Treatment often involves managing symptoms as best as possible.
4. Cystitis or urinary tract infections
Cystitis refers to inflammation in the bladder due to a bacterial infection. This happens because vaginal, rectal, or skin bacteria can enter the urethra and make their way to the bladder.
A urinary tract infection (UTI) is one that can occur anywhere in the system, while cystitis occurs only in the bladder.
Both conditions are common in women. These infections will sometimes clear up on their own, but a short course of antibiotics will typically treat cystitis and other UTIs.
5. Sexually transmitted infections
Share on PinterestA sexually transmitted infection can cause pelvic pain.
Pelvic pain may indicate the presence of a sexually transmitted infection (STI) such as gonorrhea or chlamydia. STIs occur in people who are sexually active.
Chlamydia affects around 2.86 million people each year in the United States, according to the Centers for Disease Control and Prevention (CDC).
The CDC also estimate that gonorrhea affects 820,000 people every year.
Along with pelvic pain, other symptoms of STIs may include painful urination, bleeding between periods, and changes in vaginal discharge.
Anyone experiencing these changes should see their doctor who will be able to diagnose an STI and prescribe treatment, usually including antibiotics. It is also critical to inform sexual partners about the infection to prevent it from spreading.
6. Pelvic inflammatory disease
Pelvic inflammatory disease (PID) is an infection in the womb that can damage the surrounding tissue. PID can arise if bacteria from the vagina or cervix enter the womb and take hold.
It is usually a complication of an STI such as gonorrhea or chlamydia. Along with pelvic pain, women may experience other symptoms, including abnormal vaginal discharge and bleeding.
PID increases a woman’s risk of infertility. The CDC note that 1 in 8 women who have had PID also have trouble becoming pregnant.
Treatment typically involves taking antibiotics to treat the bacterial infection. However, they cannot treat scarring, which is why early treatment is crucial.
Endometriosis occurs when endometrium, or tissue that lines the inside of the uterus, grows outside of the womb.
Endometriosis may be a source of chronic, long-lasting pelvic pain in some women. When a person’s period begins, this tissue outside of the uterus responds to hormonal changes, which may cause bleeding and inflammation in the pelvis.
Some people may experience mild to severe pain. Endometriosis may make it difficult for some women to become pregnant. Doctors may recommend various treatments, depending on symptom severity.
8. Irritable bowel syndrome
Irritable bowel syndrome (IBS) is a gut disorder that causes pain and symptoms, including constipation, diarrhea, and bloating.
The symptoms of IBS tend to flare up and go away over time, especially after a bowel movement. There is no cure for IBS, so treatment focuses on managing symptoms through changes in diet, stress levels, and medications.
Appendicitis is inflammation in the appendix, which is a small organ in the lower-right abdomen. An infection causes this condition, and, although it is common, it can be severe.
Anyone experiencing a sharp pain in their lower-right abdomen, along with other symptoms such as vomiting and fever, should seek immediate medical care, as this may be a sign of appendicitis.
10. Urinary stones
Stones in the urinary tract consist of salts and minerals, such as calcium, that the body has trouble getting rid of in the urine.
These minerals can build up and form crystals in the bladder or kidneys that often cause pain in the pelvis or lower back. Stones may also cause the urine to change color, often turning it pink or reddish with blood.
Some stones do not require treatment, but passing them can be painful. At other times, a doctor may recommend medications to break up stones or surgery to remove them.
11. Ectopic pregnancy
An ectopic pregnancy occurs when an embryo implants itself anywhere outside of the uterus and starts growing.
A woman may feel very sharp pain, and cramps in her pelvis, which are usually focused on one side. Other symptoms include nausea, vaginal bleeding, and dizziness.
Anyone who suspects that they have an ectopic pregnancy should seek immediate medical care, as this is a life-threatening condition.
12. Pelvic adhesions
An adhesion is scar tissue that occurs inside the body and connects two tissues that should not be connected. This may result in pain, as the body struggles to adapt to the adhesion
The scar tissue could form due to an old infection, endometriosis, or other issues in the area. Pelvic adhesions may lead to chronic pelvic pain in some women, and they may cause other symptoms, depending on where the scar tissue appears.
A doctor may recommend some minimally invasive surgeries to help reduce adhesions and relieve symptoms.
13. Ovarian cysts
Ovarian cysts occur when the ovaries fail to release an egg. The follicle holding the egg may not open completely to release the egg, or it may become clogged with fluid.
When this happens, a growth called a cyst forms in the area, which may cause bloating, pressure, or pelvic pain on the side of the body with the cyst.
As the ACOG explain, most cysts are noncancerous. In many cases, ovarian cysts go away on their own. In some cases, a cyst may bleed or burst, which can cause sharp, severe pain in the pelvis and may require medical treatment.
Doctors can identify ovarian cysts using ultrasound, and they may recommend treatments that range from watchful waiting to surgery.
14. Uterine fibroids
Fibroids are lumps of muscle and fibrous tissue within the uterus. While they are noncancerous and do not tend to cause symptoms, these growths can be a source of pain. They may cause discomfort in the pelvis or lower back or pain during sex.
Fibroids may also cause excessive bleeding or cramping during menstruation.
Some fibroids do not require treatment. If a woman finds her symptoms difficult to manage, doctors may recommend one of many treatments, including medications, noninvasive procedures, or surgery.
In rare cases, a malignant growth in the reproductive system, urinary tract, or gastrointestinal system may be the reason for pain in the pelvis. The tumor may also cause other symptoms, depending on where it appears.
Doctors will need to perform a thorough evaluation, often using blood and imaging tests, to identify a tumor. Once they have diagnosed the issue, they will recommend possible treatments.