What to Know About Your Pelvic Pain and Abnormal Periods

This article is for women who have pelvic pain and/or abnormal periods, or anyone who wants to learn more about them. The goal of this activity is to help women who may be living with uterine fibroids (UF) and/or endometriosis talk to and work with their doctor about their pain and periods.

You will learn about: 

• What pelvic pain and abnormal periods are and possible causes

• Impact of pelvic pain and abnormal periods on your overall health and well-being

• Tests that your doctor may recommend

• Tips for talking with your doctor and healthcare team

During your reproductive years -- approximately ages 9 to 45 -- a normal menstrual cycle or period will happen about every 28 days and usually last 4 to 7 days. This is when your uterus sheds blood to prepare for a possible pregnancy. 

But about 1 in 4 women can have abnormal periods, such as those that:

• Happen more frequently (less than every 21 days)

• Happen farther apart (more than every 35 days)

• Last longer than 7 days

• Come with pain, cramping, nausea, or vomiting

• Have blood flow that is heavier or lighter than usual

Abnormal periods can also include missing 3 or more periods in a row and bleeding or spotting between periods and after sex.

You may also experience other symptoms during or in between your periods such as:

• Pain in your lower back, legs, or pelvis (the area in your belly or abdomen that supports your spinal column and protects your organs)

• Pain that’s not related to your period, including during sex

• Fatigue (tiredness)

• Problems with your bladder such as trouble urinating (peeing) or going frequently

• Constipation and bloating

These symptoms can be caused by different factors, some that you may be able to change, like your lifestyle. But others may be related to a serious medical condition. 

Possible causes or factors can include:

• Lifestyle factors like changes in your weight, diet, or exercise patterns; stress; traveling; not getting enough sleep; getting sick; or other disruptions in your daily routine 

• Birth control pills that have hormones (estrogen and/or progestin). These can help regulate periods for some women, but you may have irregular or missed periods after stopping them or if you don’t take them as directed

Other possible causes or factors for these types of symptoms can be a health condition affecting your uterus -- the organ located in your pelvis between your bladder and rectum -- such as:

• Endometriosis where the tissue normally found inside the uterus called the endometrium grows outside, causing pelvic pain

• Uterine fibroids (UF) where noncancerous fibroids (growths made of muscle and connective tissue) grow inside your uterus. You can have one or many, ranging in size from very large to very small, and heavy bleeding, a bulging belly, and pain

Endometriosis and UF are 2 of the most common uterine conditions and can happen separately or even, for some women, at the same time. 

Other possible causes or factors for these symptoms can include:

• Family history: Certain uterine conditions can run in families. You might be at a higher risk for endometriosis if your mother or sister has it

• Living with obesity or overweight: Fat cells make estrogen, and too much estrogen may make some uterine conditions, like UF, worse

• Other health conditions: Hormone imbalances, thyroid problems, cancer, infections, and pregnancy can all cause uterine conditions for some women

Endometriosis and/or UF are chronic (long-lasting) conditions, meaning that they can affect your health and life every day. And while rarely life-threatening, they can be serious. 

They can even impact your: 

• Work, school, and social life resulting in missed events due to disabling pain

• Mental well-being and lead to depression, higher levels of stress, and feeling very tired

• Relationships and physical and sexual activity

• Infertility or pregnancy by causing problems with getting pregnant or issues with pregnancy such as a miscarriage

• Wallet, in the form of healthcare costs for medical care or surgery

Endometriosis and UF can have overlapping symptoms, which can make it hard to diagnose. But there are tests that your doctor may recommend to help rule out certain causes of your abnormal periods, like an infection.

Endometriosis or UF can be diagnosed with tests such as: 

• Clinical exam to check your belly and pelvic area for tenderness or pain

• Imaging tests, such as a pelvic or vaginal ultrasound or magnetic resonance imaging (MRI)

• Laparoscopy where a small cut is made to see inside the belly and pelvic area

• Biopsy where a small piece of tissue is removed with a special needle and examined

You can work with your doctor and healthcare team to make a plan to help manage endometriosis and/or UF and their symptoms that may include: 

• Lifestyle changes such as a healthy diet and physical activity

• Medicines

• Surgery or procedures

It’s important to discuss the risks and benefits for every treatment with your doctor. Finding a doctor who is trained and knowledgeable about women’s health and who understands what you are experiencing will be important.

Questions you can ask your doctor and healthcare team can include: 

• What could be causing my pelvic pain and/or abnormal periods?

• What can we do to help relieve my symptoms?

• Are there any lifestyle changes I should make?

• What treatment are available, and what are their side effects?

• Can you refer me to a doctor who specializes in treating these women’s health conditions?

Congratulations!

You have successfully completed the program What to Know About Your Pelvic Pain and Abnormal Periods.

View Additional Materials on this topic that you may find useful:

What Are Menstrual Irregularities?

Uterine Conditions

Endometriosis

Uterine Fibroids