Chronic pelvic pain is pain below your belly button and between your hips that lasts six months or longer. It can be constant or come and go, and it may or may not be tied to your period. The American College of Obstetricians and Gynecologists estimates it affects roughly 15% to 20% of women between the ages of 18 and 50, which makes it far more common than most patients realize when they are sitting alone with it.
The frustrating part is that chronic pelvic pain is rarely one thing. Two or three conditions that overlap is the norm rather than the exception, which is exactly why a single test often comes back clean while the pain continues.
Endometriosis
Endometriosis occurs when tissue similar to the uterine lining grows outside the uterus, on the ovaries, the pelvic wall, the bowel, or the bladder. That tissue responds to your hormones each month, bleeding where it cannot drain, and creates inflammation and scarring.
The classic signs are periods painful enough to interfere with work or school, pain with sex, pain with bowel movements around your period, and infertility. The World Health Organization estimates endometriosis affects about 10% of reproductive-age women, and diagnosis is frequently delayed for years because severe period pain gets normalized.
Fibroids and Adenomyosis
Uterine fibroids are noncancerous growths in the muscular wall of the uterus. Depending on size and location, they cause heavy bleeding, pelvic pressure, a feeling of fullness, back pain, and frequent urination.
Adenomyosis is a related but distinct condition where uterine lining tissue grows into the muscle wall itself. It typically causes heavy, painful periods and a uterus that feels enlarged and tender. It is often diagnosed alongside fibroids or endometriosis.
Interstitial Cystitis and Pelvic Floor Dysfunction
Interstitial cystitis, also called bladder pain syndrome, produces bladder pressure and pelvic pain along with urinary urgency and frequency, often with repeatedly negative urine cultures. Many women are treated for UTIs several times before someone considers this diagnosis.
Pelvic floor dysfunction is one of the most underrecognized causes of pelvic pain on this list. The muscles of the pelvic floor can become chronically tight and go into spasm, producing deep aching, pain with sex, difficulty with tampons, and urinary or bowel symptoms. It commonly develops as a response to another source of pain, which means it can persist even after the original problem is treated.
Digestive and Other Contributors
Irritable bowel syndrome causes cramping, bloating, and pain that changes with bowel movements, and it frequently coexists with gynecologic pain.
Ovarian cysts, pelvic adhesions from prior surgery or infection, and pelvic congestion syndrome, which involves enlarged veins in the pelvis, round out the common causes.
How Is Pelvic Pain Diagnosed?
There is no single test. The evaluation usually starts with a detailed history, and this is where you can help most. Track when the pain happens, what makes it better or worse, how it relates to your cycle, sex, urination, and bowel movements, and bring this information with you.
From there, an evaluation typically includes:
- A pelvic exam that maps exactly where the pain is, including checking pelvic floor muscle tension
- Transvaginal ultrasound, which shows fibroids, ovarian cysts, and signs suggestive of adenomyosis
- Urine testing and cultures, plus STI screening when appropriate
- A sonohysterogram or hysteroscopy to evaluate the inside of the uterus when bleeding is part of the picture
- Diagnostic laparoscopy in selected cases, which remains the only way to visually confirm endometriosis, though current ACOG guidance supports starting treatment based on symptoms rather than requiring surgery first
The Ob-Gyn Center provides transvaginal and pelvic ultrasound, sonohysterogram, and in-office hysteroscopy on site, which shortens the stretch between guessing and diagnosis.
Why a Team Approach Works Better
Because the causes overlap, the treatments usually do too. Hormonal management, including combined contraceptives, progestin-only options, or a hormonal IUD, addresses endometriosis, adenomyosis, and heavy bleeding. Pelvic floor physical therapy is a first-line treatment for muscle-driven pain and is often the missing piece for women who have tried everything else. Dietary changes help IBS-related pain. Nerve-targeted medications, trigger point injections, and minimally invasive surgery each have a role in the right situation.
Chronic pain also affects sleep and mood, and treating that is not a suggestion that the pain is psychological. It is part of the standard approach.
What to Do When You Have Been Dismissed Before
Many women arrive having been told their imaging is normal and their pain is stress. Normal imaging rules out some causes and misses others entirely, including endometriosis, pelvic floor dysfunction, and interstitial cystitis, none of which reliably show on an ultrasound. Persistent pain is information, and discussing it is important.
Seek prompt care for sudden severe pelvic pain, pain with fever, fainting, heavy bleeding, or pain with a positive pregnancy test, since those need same-day evaluation.
The Ob-Gyn Center in Las Vegas treats pelvic pain, endometriosis, fibroids, ovarian cysts, and PCOS, with a team of board-certified physicians and nurse practitioners led by Dr. Anita Gondy, MD, FACOG, and in-office ultrasound and procedures. Call (702) 978-8900 or schedule an appointment at lasvegasobgyncenter.com to get a real workup.
