More than on half of women with chronic pelvic pain have an undiagnosed cause, according to a recent review published June 1 in American Family Physician. Estimates in the U.S. show that 15% more women have chronic pelvic pain than migraines, asthma or low back pain, and 61% of women never learn why they have pelvic pain. According to David D. Ortiz, MD, from CHRISTUS Santa Rosa Family Medicine Residency Program, in San Antonio, Texas, the definition of chronic pelvic pain is “noncyclic pain that lasts six months or more; is localized to the pelvis, the anterior abdominal wall at or below the umbilicus, or the buttocks; and is of sufficient severity to cause functional disability or require medical care. Other definitions do not require that the pain be noncyclic. Because the definition of chronic pelvic pain varies, it is difficult to ascertain its exact prevalence."
Frequently, your doctor may discover endometriosis, irritable bowel syndrome, interstitial cystitis or adhesions from infection or past surgeries, but you might never learn what’s causing the pain even after diagnostic tests are performed. Treating the pain can become challenging when you don’t know the cause. Knowing your options can open up discussion with your doctor that will allow you to explore multiple avenues to manage the pain.
What Options are Available?
It might take several approaches to get pain relief – your doctor can recommend pain medication, and surgical consult. Some women require hysterectomy. Neuromodulation therapy has been found to help with pain control, but limited evidence proves that any of these are certain to work.
Contraceptive pills, gonadotropin-releasing hormone (GnRH) agonists (drugs that stop estrogen production), intramuscular medroxyprogesterone, trigger point (similar to acupuncture, but no needles), and botulinum A toxin injections are recommended treatments that you can discuss with your healthcare provider that might help. Medroxyprogesterone acetate, 50 mg. /day is the only medication that shows some benefit for women with chronic pelvic pain, but it’s not to be taken by women with endometriosis, irritable bowel syndrome, pelvic inflammatory disease or dysmenorrhea.
The unfortunate thing is that medications, surgery and hormones all carry the risk of side effects, and surgery can be dangerous, inducing a series of frustrating and frightening options for women.
Trigger point therapy is safe, and can be performed by a massage therapist. Acupuncture is also scientifically sound for the treatment of pain.
Homeopathy is worth a try, and is unlikely to do harm, though studies are lacking as to the benefit. Many people use homeopathic medications, and the practice of homeopathy has been around for centuries. For best results, you should find a practitioner who is well versed in homeopathic remedies.
Self Hypnosis is shown to provide distraction from pain and help with sleeplessness.
Chiropractic care can provide short-term pain relief, but is not recommended as a long-term solution. Patients can learn manipulation techniques that can be performed at home.
Biofeedback is a wonderful tool for anyone looking for pain relief. Help with chronic pelvic pain can be achieved through relaxation techniques and calmness.
If you decide to use complementary therapy for chronic pelvic pain, make sure you tell your doctor, and choose a complementary alternative medicine (CAM) practitioner that is well credentialed. It’s best to avoid taking herbs, as many can cause bleeding and interfere with other treatments such as injections and oral medications. Some can do more harm than good. Scientific evidence does support the use of some herbal and nutritional supplements to reduce pain and treat inflammation. You can read more here.
Chronic pelvic pain can be debilitating. It can interfere with quality of life and other healthy activities. Women need to be aware of their options, and explore treatment on an individual basis when no cause of pain can be found. Speak with your doctor. Know your resources. There is help, and you do have choices.
National Pain Foundation
Using Complementary Therapy to Relieve Pain
National Center for Complementary and Alternative Medicine - NIH