Written by: Dr. Kira Balkcom, MD, FACOG
Board certified Gynecologist at Springfield Gynecology
Springfield Hospital
Chronic pelvic pain (CPP) is so common that most likely you or someone you know is affected by it. CPP may look like exceptionally painful periods, pain with urination or bowel movements, pain with sex, and/or general discomfort in the pelvis that affects a woman’s ability to carry out normal activities such as working, exercising, and caring for loved ones. The pelvis is a shared space with muscles, bones, the uterus and ovaries, bowel, and the lower urinary tract. Pain can originate from any one or combination of these structures, so understanding what is causing the pain takes time. In the office we review where the pain is, what it is like, and when it occurs. We may check labs, complete imaging studies, or screen for infection. We might discuss dietary changes and supplements or prescription medications. I may recommend and refer for physical therapy.
One of the most common chronic pelvic pain entities that I encounter is endometriosis. It is estimated that ten percent of women have endometriosis. If you have chronic pelvic pain, the chance that you have endometriosis may be up to thirty to forty percent. Endometriosis is a chronic condition in which the lining of the uterus, called the endometrium, grows outside of the uterus. The endometrium normally sheds when the uterus gets the hormonal message that there is no pregnancy each month. Most of that tissue exits the uterus and is part of a woman’s “period”, but some of the tissue also goes through the fallopian tubes and into the abdomen. For those of us without endometriosis, our bodies simply break down and absorb the waste products. In women with endometriosis, however, that tissue can attach to one of the surfaces in the abdomen and establishes a blood supply. These areas are often quite small, but can cause a lot of inflammation and pain, like having a splinter in your hand.
Diagnosing endometriosis is challenging. Sometimes there are clear signs on ultrasound or MRI, but more often the imaging looks normal. Endometriosis is similar to the tissue it attaches to, and so it blends in on imaging. If imaging is normal but symptoms make endometriosis likely, we will often move forward with endometriosis treatments. The medications used to treat painful and heavy periods in women who do not have endometriosis are the same medications used to treat chronic pain caused by endometriosis. The female hormone estrogen acts like food for endometriosis spots, making them worse over time, therefore the medications used to treat endometriosis contain hormones or affect hormone levels. If medications work well, then they should be continued until menopause if possible.
If medications do not work or have undesirable side effects, a diagnostic laparoscopy will prove that endometriosis is present, help to rule out other possibilities such as scar tissue around the pelvic organs, and allow for the direct destruction of endometriosis spots. While these spots are invisible on ultrasound, to the trained gynecologic laparoscopist’s eye threy are usually obvious. Treating the spots can immediately decrease overall pain, improve periods, lead to more comfortable urination and bowel movements, and/or improve sexual function depending on where the spots are. The surgery is a same day procedure, and typically patients are back to their normal activities within a couple of weeks. My partner and I have been performing these surgeries together for over 7 years and have seen how drastic the improvement can be. Unfortunately, new endometriosis spots can still form over time, bringing with them new symptoms, and endometriosis must be treated as a chronic condition that will require different interventions at different times.
Chronic pelvic pain can be difficult to diagnose and treat, and many women suffer for years before getting the help that they need. If you are one of them, I recommend prioritizing your wellness and seeking help.
To make an appointment at Springfield Gynecology, call 802-885-7561.