Chronic pelvic pain? You’re not alone.

Chronic pelvic pain is fairly common, affecting about one in seven women. About 30% of those women will seek treatment for the pain from their primary care or Ob/Gyn physician.

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“Chronic pelvic pain is defined as pain in the lower abdomen, pelvis or genital area that lasts longer than six months,” says Cara King, DO, a Cleveland Clinic Ob/Gyn physician and surgeon who specializes in minimally invasive gynecologic surgery. Dr. King treats patients at Cleveland Clinic Hillcrest Hospital and main campus. “For many women, the pain can be traced to the reproductive organs, but it can also come from the bladder, the gastrointestinal system, or nerves of pelvic and abdominal muscles. In some cases, the pain comes from multiple causes, making it difficult to diagnose the exact cause.”

As a result, Dr. King explains that a woman could experience and deal with pain for seven to 10 years before seeking care and receiving a formal diagnosis.

“During those years, a lot of things can start to contribute to the pain. Years of painful periods can be from endometriosis, which can then lead to pelvic floor issues or changes to nerve pathways, and affect other systems like the bowels and ovaries,” she says. “The longer a woman has lived with the pain, the longer it often takes to get better.”

Dr. King explains that due to its many possible causes, it is truly a team effort to diagnose, then treat, chronic pelvic pain. Cleveland Clinic’s Center for Endometriosis and Chronic Pelvic Pain includes a team of physicians, nurses, psychologists, counselors, physical therapists and occupational therapists working together to address all aspects of care.

The most common causes of chronic pelvic pain are adenomyosis and endometriosis. The inner lining of the uterus, called the endometrium, is shed through the vagina during menstruation. In adenomyosis, tissue from the lining of the uterus grows into the uterine wall, enlarging the uterus. Symptoms include heavy periods, cramping, painful sex and infertility. In endometriosis, tissue similar to the lining of the uterus grows outside the uterus and may involve the ovaries, fallopian tubes, pelvic side walls or bowel. It’s most common in women ages 25 to 40.

Other causes of chronic pelvic pain include uterine fibroids, interstitial cystitis (painful bladder syndrome), pelvic floor dysfunction, irritable bowel syndrome and vulvodynia (chronic pain of the vulva).

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Endometriosis and fibroids are among the many possible causes of chronic pelvic pain.


"If you experience pain during your period, during bowel movements, when urinating, or during intercourse, you should see your primary care doctor or gynecologist,” says Dr. King. “When it comes to diagnosis and treatment, we start with the least invasive options first. In many cases, medication or hormonal therapy — specifically, the use of birth control — that stop or decrease menstrual flow can help.”

Dr. King cautions that if you are trying to get pregnant, hormonal therapy is not the answer. She also recommends seeing a specialist if pain persists after three months of medication or hormonal treatment. If left untreated, endometriosis can lead to infertility, bowel obstructions and more. The longer it goes untreated, the more other things can be impacted, and treatment becomes more difficult.

“A specialist will conduct a physical exam and learn your health history. We may also order imaging — a pelvic ultrasound or MRI — in order to help with diagnosis and treatment,” says Dr. King. “Imaging may show that immediate surgical intervention is needed, say in the case of a large cyst. Other less invasive treatment options include physical therapy to address pelvic floor issues, urologic care to help with bladder problems, or gastroenterology care for bowel problems.”

While a physical exam or imaging may suggest endometriosis, surgery is the only way to formally diagnose the condition.

“With minimally invasive gynecologic surgery, we can make a formal diagnosis by removing and testing tissue. Because endometriosis is considered a chronic condition, it can come back,” says Dr. King. “The highly skilled surgeons at Cleveland Clinic excise the lesions — which is the gold standard. With all lesions removed, there is less chance it will come back.”

In addition, there are many benefits of laparoscopic surgery. “Endometriosis can look like many different things. The high-definition camera that is inserted into the abdominal cavity gives us a clear picture of what we are dealing with,” says Dr. King. “In addition, most laparoscopic surgery patients go home the same day, and experience less postoperative pain, less risk of infection, and quicker recovery.”

To schedule an appointment with Dr. King or another Women’s Health specialist, visit ClevelandClinic.org/WomensHealth or call 216.444.6601.

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