What’s Causing Your Pelvic Pain?
By Alicia Armeli


In the United States alone, as many as nine million women between the ages of 15 and 50 years suffer from chronic pelvic pain.1 If you’re one of these women, you know just how frustrating it can be. Not only because you’re experiencing pain, but also because it can be a challenge to find what’s causing it. Although there are many explanations for female pelvic pain, research shows endometriosis and other gynecological conditions make up two-thirds of the cases.1

“When it comes to pelvic pain, we first look at things like a woman’s reproductive age because it can be one problem from adolescence to late teens versus if a woman is over 60,” explained Dr. Linda Bradley, Gynecologic Surgeon, Professor of Surgery, Vice Chair of OB/GYN & Women’s Health Institute, and Director of the Center for Menstrual Disorders, Fibroids, and Hysterscopic Services at the Cleveland Clinic in Cleveland, Ohio. “In general, conditions that cause pelvic pain could be adenomyosis, endometriosis, uterine fibroids, ovarian cysts, and sexually transmitted infections like gonorrhea or chlamydia.”

It’s nearly impossible for a woman to self-diagnose because, in several cases, other common symptoms like heavy menstrual bleeding are seen to coexist alongside pelvic pain. For example, adenomyosis and uterine fibroids are both conditions involving noncancerous growths that invade the uterine wall, causing heavy painful periods and pelvic pressure.

Pelvic pain and pressure can also be a symptom of a condition entirely unrelated to the uterus—as seen with ovarian cysts. Even though the growths described are specific to each disease, it’s important to receive proper examination, diagnosis, and treatment. Especially since pelvic pain, Dr. Bradley noted, might be extremely affected by ovarian cancer.

Pelvic pain—and heavy menstrual bleeding—can also occur when the uterine lining begins to grow outside the uterus, as seen with endometriosis. But just as important as the pain itself, Dr. Bradley noted, observing when the pain occurs during a woman’s cycle is a significant part of the puzzle.

“Endometriosis tends to be more cyclical,” Dr. Bradley clarified. “It’s associated with pelvic pain, but it seems to worsen around week two of the three during the menstrual cycle and then also a day or two after your period is over. So while there is some overlap there may be some distinguishing features based upon menstruation.”

To understand where your pain is coming from, seeking medical attention is a must. And still, some studies show that 20 percent of women don’t receive diagnostic testing despite their pain.1 Living with the pain without diagnosis and treatment could lead to infertility, as seen with pelvic inflammatory disease caused by chlamydia and gonorrhea infections.

Spreading from the vagina to the cervix, uterine lining, fallopian tubes, and ovaries—pelvic inflammatory disease can manifest with pelvic pain and other symptoms like vaginal discharge—but signs and symptoms can be subtle.

“Commonly, patients will come in and say, ‘I had pain last month, I’ve never had it before, now it’s back or it’s not going away and it’s impacting me in different ways,” Dr. Bradley shared. “If pain is persistent—don’t ignore it.”

When a woman experiences pelvic pain and reaches out for medical attention, knowing everything she can about her pain is a significant part of the diagnosis. This means keeping track of the type of pain, its severity, onset, location, and whether anything worsens it—such as exercise, sex, urinating, or even stress.

Dr. Bradley noted the importance of having access to all previous medical records and discussing any treatments that were tried in the past. Following this dialogue, a woman can expect a physical examination and diagnostic imaging—such as an MRI or ultrasound—to collect more information. Since each woman is different, further tests may be called for at the discretion of her doctor.

Gynecological conditions may be the culprit the majority of the time, yet other explanations for female pelvic pain like bladder complications, gastrointestinal issues, and disorders of the muscles and nerves can’t be ruled out.

What’s more, approximately one-third of pelvic pain cases lack a direct cause—which could lead to unnecessary surgery. Studies show between 25 and 40 percent of women who undergo hysterectomy for pelvic pain will still have symptoms after their surgery, suggesting that the cause of their pain was something else entirely.1

Depending on the condition, several treatment options are available. In addition to surgery, treatments include minimally invasive procedures, counseling, hormone therapy, pharmaceuticals to manage pain, and procedures to block nerve sensitivity.1

To help receive the right diagnosis and treatment, Dr. Bradley advises women “to notice everything about your pain because doctors are always specific. If you’re experiencing pelvic pain, it’s best to be seen by a doctor sooner rather than later.”

ABOUT THE AUTHOR Alicia Armeli is a Health Freelance Writer, Registered Dietitian Nutritionist, and Certified Holistic Life Coach. She has master’s degrees in English Education and Nutrition. Through her writing, she empowers readers to live optimally by building awareness surrounding issues that impact health and wellbeing. In addition to writing, she enjoys singing, traveling abroad and volunteering with her local animal shelter.

ABOUT THE DOCTOR Linda Bradley, MD is an internationally recognized gynecologic surgeon, professor of surgery, Vice Chair of OB/GYN & Women’s Health Institute, and Director of the Center for Menstrual Disorders, Fibroids, and Hysterscopic Services at the Cleveland Clinic in Cleveland, Ohio. As founder of the Celebrate Sisterhood program and recipient of the American College of Obstetricians and Gynecologists Pete and Weesie Hollis Community Service Award, Dr. Bradley is dedicated to empowering women to take charge of their health, embracing self-care, and creating positive change in the world.


1. Apte, G., Nelson, P., Brismee, J., Dedrick, G., Justiz, R., & Sizer, P. S. (2011). Chronic female pelvic pain—part 1: clinical pathoanatomy and examination of the pelvic region. doi: 10.1111/j.1533-2500.2011.00465.x. Retrieved March 3, 2016, from