Pelvic pain? 3 causes to consider

Posted on 28 August 2019

Pelvic pain broadly refers to sharp pain – or a dull ache – that occurs in the lower abdomen (below the belly button).

If pain in your lower abdomen persists for three months or more, it is considered chronic pelvic pain. Mediclinic specialists unpack three possible causes.


Ovarian cysts

‘During ovulation, your mature egg is released from your ovary and pushed down the fallopian tube, making it available to be fertilised, says Dr Neelan Pillay, a specialist gynaecologist and obstetrician and co-founder of the Pelvic Pain Unit for Women at Mediclinic Sandton. ‘If this doesn’t happen, and the egg continues to grow in the ovary, it may cause follicular cysts. Symptoms may include pain and menstrual abnormality or disruption. 90% of follicular cysts will resolved by themselves and do not need surgery. They are generally observed and treated with medication.’

More pathological ovarian cysts include endometrioma. ‘This is a benign collection of cysts arising from ectopic endometrial tissue within the ovary. Because it contains thick, brown, tar-like fluid, it is often referred to as a “chocolate cyst”,’ Dr Pillay explains. ‘Laproscopic surgery might be required if they cause pain.’

Ovarian teratoma, also called dermoid cysts, are usually benign and typically contain a diversity of tissues including hair, teeth, bone, thyroid. Women with ovarian teratoma are born with it.


Uterine Fibroids

‘Fibroids are a condition that affects the uterus muscle layers. They are benign growths that may affect fertility,’ explains Dr Sibusiso Nhlapo, a gynaecologist and obstetrician at Mediclinic Secunda.

‘It’s estimated that 15% of the general population of women have uterine fibroids, which may range in size from as small as a pea to as big as a football,’ says Dr Pillay. ‘African women have a higher incidence of fibroids than white women – and if you have a family history of fibroids you have a higher chance of having them.

You may be unaware that you have uterine fibroids, as they can be asymptomatic. That said, Dr Pillay explains that larger fibroids can cause intense pelvic pain and heavy menstrual bleeding. ‘Fibroids are a condition that affects the uterus muscle layers. They are benign growths that may affect fertility,’ explains Dr Sibusiso Nhlapo, a gynaecologist and obstetrician at Mediclinic Secunda. ‘Medically, uterine fibroids are also called uterine leiomyoma, myoma or fibromyoma,’ adds Dr Ameera Adam, a gynaecologist and obstetrician at Constantiaberg Mediclinic. ‘In approximately 95% of fibroid cases, the tumours are benign, meaning non-cancerous,’ says Dr Pillay. Although there are often no symptoms, ‘abnormal and excessive endometrial [menstrual] bleeding’ can be a tell-tale sign, says Dr Adam. Urination, lower-back pain and pain during intercourse are other possible symptoms.

If the fibroids are small and asymptomatic, conservative treatment can be followed,’ says Dr Adam. This includes taking anti-inflammatory painkillers; medication that lowers levels of oestrogen and trigger a ‘medical menopause’; anti-hormonal agents that oppose oestrogen; and anti-progestins, which block the action of progesterone. Surgery may be an option if the fibroid is larger than or similar to the size of the uterus in a pregnancy at 14 weeks; is causing pain or heavy persistent heavy bleeding, or is causing infertility.



This is a common condition (up to 10% of women suffer from it) where tissue that normally lines the inside of your uterus begins to grow on the outside of the uterus, typically on the ovaries and the lining of the pelvic area. Dr Almero Viljoen, a gynaecologist and obstetrician at Mediclinic George and Mediclinic Geneva, says these ‘patches’ of endometrium can attach to the ovaries, fallopian tubes, large bowl and bladder, too.

Symptoms usually include pain in the lower part of your abdomen, which usually begins a few hours before your period starts. ‘Other symptoms include painful intercourse, painful periods, heavy bleeding and infertility,’ says Dr Pillay. ‘Remember, a painful period is when your cycle interferes with social activities or if you need to take pain medication or apply soothing devices (such as a hot water bottle) when you menstruate.’

If the endometriosis attaches to your bladder, you may have back ache, constipation and find it painful to urinate These symptoms may worsen during your period. If you have patches on or near your bowel, you may experience bloating, diarrhoea and / or constipation. ‘Endometriosis excision surgery should be performed by a specialist using laparoscopy,’ says Dr Pillay. ‘Endometrial tissue is removed while preserving the uterus and fertility whenever possible.’


Published in Gynaecology

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