Getting Pregnant

Pelvic Pain: What Causes It and What Does It Mean for Fertility?

Pelvic pain is an important symptom to talk to your doctor about because it can signal trouble in one of the reproductive organs, such as the uterus, ovaries, fallopian tubes, or cervix. Ranging from treatable illness to chronic conditions, pelvic pain can be indicative of many different conditions that have different implications for fertility. To help you understand this pain symptom, this post will cover:

  • What is pelvic pain, and when is it considered a chronic condition?
  • What are the primary causes of pelvic pain?
  • How do these causes affect fertility?

What is pelvic pain?

Pelvic pain broadly refers to pain that occurs in the lower abdomen (below the belly button). Sometimes pelvic pain can be sharp, or it can be a dull ache. It can also come and go in waves, or it can be a consistent pain.

It’s also important to note when pelvic pain happens in relation to your cycle: whether it coincides with your period or not is an important clue as to whether or not hormones are involved.

What qualifies as chronic pelvic pain?

If pelvic pain persists for six months of more, then it is considered chronic pelvic pain. Chronic pelvic pain doesn’t necessarily mean that the pain has lasted every single day for six months. Whether the pain is constant, fluctuates with your period, or simply comes and goes over a six month period, these are conditions that warrant investigation of having chronic pelvic pain.

Causes of Pelvic Pain: Endometriosis

Pelvic pain may also be the result of endometriosis. Endometriosis occurs when uterine tissue that is usually expelled with menstruation instead transplants and sticks to other areas of the body, like the bladder, fallopian tubes, ovaries, and bowels. In following cycles, this tissue grows and sheds with menstruation, resulting in pain and even scarring.

Additionally, endometriosis can also make conceiving more difficult, BUT it is still possible to get pregnant with this condition. If you have been struggling with unexplained infertility and pelvic pain, particularly during menstruation, talk to your doctor about endometriosis.

To assess this possibility, your doctor can perform a pelvic exam. Surgical removal of endometrial growth is an option that could potentially improve fertility outcomes, although it largely depends on your particular case of endometriosis, where the growths are, and how severely they have grown.

Causes of Pelvic Pain: Uterine Fibroids

Uterine fibroids, or non-cancerous growths in the uterus, can also be a source of pelvic pain. These growths can vary in presentation, ranging in size, number, location within the uterine cavity, and how quickly they grow. While 50% of uterine fibroid cases present with no symptoms, the other 50% of cases with symptoms can include pelvic pain or even back and general abdominal pain.

As in the case of endometriosis, uterine fibroids can compromise fertility depending how they grow. It is definitely possible to become pregnant natural with uterine fibroids, but if you’ve been struggling to conceive and know you have these growths, talk to your doctor about your options.

While surgical removal doesn’t necessarily mean improved fertility, it’s important to consult with your doctor about your options and how likely these fibroids are impacting your fertility.

Causes of Pelvic Pain: Miscarriage

Cramping and pelvic pain aren’t definitive miscarriage signs. In fact, it’s perfectly normal to experience cramps during pregnancy because cramping is related to changes in progesterone levels. So, while it’s tempting to analyze painful cramping as an early pregnancy symptom or worry about causes of miscarriage, there isn’t any evidence that this type of pain means anything besides changing hormones.

However, if you experience cramping along with spotting or bleeding, then it’s a good idea to consult with a medical professional.

Causes of Pelvic Pain: Ectopic Pregnancy

Ectopic pregnancy, or when implantation occurs outside of the uterus in areas like the fallopian tube, can result in pelvic pain. Ectopic pregnancy signs include pelvic pain or cramping on one side as well as spotting. It’s important to seek a medical professional because ectopic pregnancies can rupture, which is a medical emergency. Unfortunately, an ectopic pregnancy cannot be saved, but many women go on to have healthy pregnancies after experiencing this complication.

Causes of Pelvic Pain: Painful Bladder Syndrome

Painful bladder syndrome (or interstitial cystitis) is a condition which results in pain in the bladder and pelvic region. The presentation is highly variable from case to case, with symptoms including urgent need to urinate, frequent need to urinate, or both. The pain can also change depending on when the bladder is full or when the bladder empties. While researchers are still trying to understand why this condition happens and how to improve treatments, currently available treatments include medications to help with bladder spasms and behavioral interventions to help with identify triggers related to the pain.

To date, there doesn’t seem to be any evidence that this condition affects fertility. However, if the pain increases during intercourse, then this could reduce how often you have sex, so if this was the case, it would be a good idea to talk to your doctor about managing this condition.

Causes of Pelvic Pain: Pelvic Floor Disorders

Pelvic floor disorders broadly refer to when the pelvic muscles and surrounding tissue that supports the reproductive organs are damaged or injured, such as during the stages of labor. These disorders can result in pelvic pain as well as impaired pelvic function, such as urinary incontinence.

As in the case of painful bladder syndrome, there isn’t any evidence to date connecting pelvic floor disorders and infertility directly. However, if the pelvic floor muscles and tissue is injured such that having intercourse is too painful that frequency of intercourse decreases, then this could reduce your chances of conceiving naturally. Pelvic floor disorders can be treated with physical therapy and muscle relaxants, and it’s important to consult with a medical professional to decide what’s the right option for you.

Causes of Pelvic Pain: Pelvic Inflammatory Disease

Pelvic inflammatory disease (or PID) is a sexually transmitted disease that results in bacterial infection of the uterus, fallopian tubes, and ovaries. While PID often has no symptoms, in cases with symptom presentation, pelvic pain along with changes in vaginal discharge, fever, and painful urination.

If you suspect that you might have PID, it’s important to see a medical professional as soon as possible for treatment as PID can damage the reproductive organs, creating infertility problems.

Causes of Pelvic Pain: Vulvodynia

Vulvodynia refers to pain of the vulva, and even though this is outside of the pelvic region, this condition can still cause pain in the entire area. The pain can be particularly prominent during intercourse, so as in the case of painful bladder syndrome and pelvic floor disorders, it can indirectly affect fertility by making intercourse too painful and consequently reduce the chance of conceiving naturally.

Aarthi Gobinath, PhD

Aarthi Gobinath earned her PhD in neuroscience from the University of British Columbia. Her research covers the ways that stress affects the male and female brain differently.

She tackled the issue of sex bias in research by looking at why standard treatments for depression don't always work in the case of postpartum depression. Her work has been covered by Vice and Massive Science.

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