Pelvic Pain/ Endometriosis

Health information and resources for patients.
Chronic pelvic pain

Pain is often described as persistent or chronic if it lasts longer than 3-6 months. Usually when the original “injury” heals, the pain gradually decreases. However, in some cases when the original “injury” or condition has healed, the pain continues because the body’s alarm system has become hyper-sensitive. When this happens, many sensations that are normally pain-free, such as stretching, are painful. This process is referred to as “central sensitization”. This can apply​ to pain anywhere in the body, including the pelvic area.

Chronic pelvic pain syndrome can result when the pain has lasted for a long time and has become more severe than would be expected. As the woman tries to cope with the pain, she may undergo emotional and behavioural changes that may affect her relationships, mood, sleep patterns, appetite, and physical activity. Chronic pelvic pain syndrome is a combination of physical symptoms, psychological symptoms and changes in behaviour. For more information visit: pelvicpain.org.

Conditions that can lead to pelvic pain

  • Endometriosis (see tab 2, Endometriosis for more information)
  • Disorders of the bowel such as irritable bowel syndrome
  • Interstitial cystitis or painful bladder syndrome
  • Previous abdominal surgery or infection that has resulted in adhesions
  • Musculoskeletal/myofascial pain (pain that arises from bones, joints or muscles in the abdomen or pelvic floor)

Frequently asked questions

 

Chronic pelvic pain (CPP) occurs in about 20% of women aged 18 to 50. CPP is defined as pain that persists for longer than 3 to 6 months. Pelvic pain can be felt in the uterus, ovaries, cervix, vagina, vulva, bladder, bowel, hips, or lower back such as the tailbone and sacrum. There are many factors that can contribute to chronic pelvic pain – gynecological, musculoskeletal, bowel/bladder, vaginal/vulvar, psychosocial, and central nervous system sensitization.

 

 

If a woman has chronic pelvic pain, she does not necessarily have endometriosis. There are many factors that can contribute to chronic pelvic pain – gynecological, musculoskeletal, bowel/bladder, vaginal/vulvar, psychosocial and central nervous system sensitization. Pain is always produced by the brain and nervous system, regardless of where you feel it. It is important for a woman who has persistent pelvic pain to see a physician with specialized experience in pelvic pain.

 

 

At BC Women's, we offer an interdisciplinary approach that has been shown to be very effective in the treatment of chronic pelvic pain. It can include any combination of medical management, surgical management (including advanced laparoscopic excision), pain education, pelvic floor physiotherapy, and counselling approaches that include mindfulness-based and cognitive techniques.

 

Many women experience a reduction in pain and an improvement in quality of life without the use of medications or surgery. Our interdisciplinary approach has been found to be very effective in treating pelvic pain. This may include any combination of medications, surgery, physiotherapy, counselling, and pain education workshops. Some women also find that diet and lifestyle changes can improve their pain.

 

 

Endometriosis can be removed with surgery, but that does not guarantee that pelvic pain will go away. Some pelvic pain can occur as a result of several things, such as musculoskeletal factors and central nervous system sensitization, and may require other types of treatment instead of, or in addition to surgery.

Our interdisciplinary approach has been shown to be very effective in the treatment of chronic pelvic pain. It can include any combination of pain education, pelvic floor physiotherapy, counselling approaches that include mindfulness-based and cognitive techniques, medications and surgery. Our gynecologists are trained to perform advanced laparoscopic excision which offers better outcomes than traditional cauterization of endometriosis.

 

To make an appointment please visit the Centre for Pelvic Pain & Endometriosis main page.

Endometriosis

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Frequently asked questions

 

A woman is diagnosed with endometriosis when endometrial-like tissue (the uterine lining that is built up and then shed with each menstrual cycle) has begun to grow in areas other than the uterus. Endometriosis occurs in about 10% of women of reproductive age.

What causes endometriosis?

The exact causes are still not yet fully known. Some theories include changes in the immune system, environmental exposures, and genetic predisposition.


See Endometriosis: An Overview for more information.  This quick Endometriosis Video also provides a brief overview.

 

 

Research has shown that a woman with a close relative (mother or sister) who has endometriosis is about 7 times more likely to develop the disease than women with no affected close relatives.

 

 

The most common symptom of endometriosis is pelvic pain, usually at menstruation. Endometriosis can also present as pain at other times during the cycle, such such as at ovulation or during sexual intercourse, or with bowel movements. Other symptoms of endometriosis can be diarrhea or constipation (often at the time of the menstrual period), abdominal bloating, heavy periods, fatigue, and in some cases infertility.

If you have pelvic pain, you may or may not have endometriosis. And women with endometriosis do not always have pelvic pain. In fact, some women with endometriosis have no symptoms at all. It is important for a woman who has persistent pelvic pain to see a physician with specialized experience in endometriosis and pelvic pain.

 

 

Yes. Endometriosis can develop in a woman at any time during her reproductive years. The reproductive years occur between the onset of the first menstrual period (menarche) and the last menstrual period (menopause).

 

 

The good news is that 60 to 70% of women with endometriosis are able to become pregnant without any difficulties. About 30 to 40% of women with endometriosis will experience infertility. Predicting whether you will have infertility depends on the severity of the disease and how long it has been present. 


Contrary to popular opinion, having a baby does not "cure" endometriosis. The health care team at the BC Women's Centre for Pelvic Pain & Endometriosis have knowledge and experience working with endometriosis and infertility; please ask them if you have any concerns.

 

 

Gynecologists who are experienced in working with endometriosis may be able to offer a preliminary diagnosis of endometriosis based on symptoms, pain mapping exams, and/or ultrasound findings. At our centre we offer advanced dynamic pelvic ultrasound which can allow the detection and diagnosis of advanced stages of endometriosis (deep disease and/or endometrioma cysts in the ovaries). We can also diagnose other associated painful conditions such as adenomyosis. 

However, some types of endometriosis (superficial peritoneal) cannot be seen on ultrasound and the only way to definitively diagnose that type of endometriosis is through a surgical procedure called a laparoscopy. 

 

 

Laparoscopy is a surgical procedure in which a small telescope-like instrument is inserted into the abdomen through a few tiny incisions. It is a minimally invasive type of surgery (MIS) that is used to diagnose and treat various conditions, including endometriosis. The surgeons at our clinic are specially trained to provide excisional laparoscopy for the removal of endometriosis.

 

There are some very effective treatments for endometriosis. Most specialists like to begin treatment using medications that include hormones or pain relievers. Suppression of the menstrual cycle using hormones is often an effective first line of treatment. If symptoms persist and are severe, surgical treatments can be very effective. Our gynecologists are trained to provide advanced laparoscopic excision of endometriosis, which offers very good outcomes. See Surgery for Pelvic Pain & Endometriosis.

 

 

Surgeons can remove endometriosis with surgery, but that does not guarantee that pelvic pain will go away. There are often many contributing factors to chronic pelvic pain that need to be addressed, such musculoskeletal, bowel/bladder, vaginal/vulvar, psychosocial and nervous system factors. The best way to treat chronic pelvic pain is using an interdisciplinary approach to address all the factors.

 

 

No, there is presently not a cure for endometriosis. However, most women who are diagnosed with endometriosis can improve their quality of life and lead healthy, active lives.

 

 
Why this study is important

Endometriosis has been understood as primarily a hormonal and inflammatory condition. Our study suggests that gene changes ('mutations') may be involved in the growth of endometriosis cells. While it is true that endometriosis can, in a few cases, become cancerous – it is exceptionally rare. Therefore, we do not believe these gene changes cause cancer in women with endometriosis. Instead, they may help us explain why endometriosis can develop, and thus potentially lead to better treatment of endometriosis in the future.

Was I born with these gene changes (mutations)?

No. We found that these gene changes occurred only in the endometriosis cells themselves. They are not present in other cells of the body. Thus, there is no risk of passing on these mutations to children.

How to find out if you have these mutations

At this stage, mutation testing is not done as part of the clinical care of women with endometriosis. However, patients at the BC Women's Centre for Pelvic Pain and Endometriosis may be informed about research studies where mutation testing may be performed. Because these are research studies, mutation results are not released to patients. In the future, as we gain a better understanding of how these gene changes contribute to endometriosis, mutation testing may be available to doctors and patients, but additional research is needed before this can happen.

Risk of developing cancer

The current findings do not indicate any increased risk of developing cancer. The risk of developing cancer from endometriosis is quite low (0.5%).

We hope that the discovery of these mutations is a step towards reclassifying endometriosis based on genetic information. Right now, we need to learn more about how common these mutations are, what kinds of endometriosis have mutations, and how we might use this information to tailor or improve treatment of endometriosis.

Enrolling in a study at the BC Women's Centre for Pelvic Pain and Endometriosis

Currently, only patients referred to the BC Women's Centre for Pelvic Pain and Endometriosis are eligible to participate in research studies for mutation testing.

Testing for mutations

Right now, we don't know enough about these mutations to recommend any sort of testing. More research is needed before endometriosis mutation testing is available to the public.

To make an appointment please visit the Centre for Pelvic Pain and Endometriosis main page.

Patient resources

Videos

Patient handouts (PDFs)

Preparing for surgery

Websites of interest

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