Pelvic pain can be a frustrating issue at any time in life, but the pain and frustration can escalate during perimenopause. In one survey, abdominal pain, which encompasses pelvic pain, was one of the three most troubling menopause symptoms adversely impacting women’s quality of life. The pain can be so bad that it’s responsible for 11 percent of all emergency room visits each year. Yet many women grin and bear it.
“A lot of women think it’s a natural part of aging and that nothing can be done,” says Dr. Yashika Dooley, an OB/GYN who specializes in Urogynecology, Female Pelvic Medicine and Reconstructive Surgery. “There are lots of women who don’t have pelvic pain. Just because you’re in your 50s, 60s, or 70s, it doesn’t mean you have to give up your favorite activities or the life you want to live. This is a prime time of your life. You should be traveling, hanging out with your significant other, not suffering.”
Unlike some menopause symptoms that you can try to self-treat, pelvic pain is best managed in collaboration with your doctor or healthcare provider. You may be experiencing pelvic pain for many reasons, and treatment varies depending on the cause. Your doctor can quickly treat some causes like urinary tract infections, constipation, and sexually transmitted diseases. Depending on what’s causing your pain though, some remedies could make it worse. For example, Kegels are a popular recommendation for problems down there, but they can worsen some conditions. Working with your doctor or healthcare provider will enable you to get the most effective treatment more quickly for pelvic pain.
Pelvic pain is a complex problem because it has many causes and presents differently from one woman to the next. “The pain can range from a sharp, stabbing pain to a dull ache,” says Dr. Dooley. “It can be in the lower abdomen, going into the groin. It can be a deep, throbbing pain that’s felt more in the vagina. Some women feel it in their rectal area and have pain with bowel movements or while sitting on the toilet. Everybody describes it a little differently.” According to the North American Menopause Society, pelvic pain can be in the pelvis, front of the abdomen, lower back, or even the buttocks, and it can be hard to distinguish from other medical conditions.
Chronic pelvic pain affects about 15 to 20 percent of women ages 18 to 50. While pelvic pain or conditions that cause it doesn’t tend to increase with age, women in perimenopause and postmenopausal women aren’t immune to it. Some problems that cause abdominal pain, like diverticulitis, are more common as you age. Even worse, pelvic pain during this stage of life is often more debilitating. “In menopause, you may experience pain as being more severe,” says Dr. Dooley. “Because hormones are changing and tissues and muscles aren’t as pliable, the level of pain you may experience can be so much worse.” For example, women who have had irritable bowel syndrome (IBS) report a worsening in the severity of their pain in menopause. Research shows that estrogen reduces pain severity. Hence, as estrogen levels decrease, your pain, whether due to a new or existing condition, may increase.
Acute conditions like infections or gastrointestinal issues can result in pelvic pain. And just like IBS, conditions you may have had for years, such as endometriosis or fibroids, can still cause pain, possibly even worse during menopause. Sometimes it’s due to cramping even if you’re not getting your period. A common cause, especially if you notice pain during intercourse, can be vaginal atrophy, which results in changes in the lining of your vagina due to a lack of estrogen.
Trauma, sometimes that you don’t even notice, or overuse can cause pelvic pain. One of Dr. Dooley’s patients developed pelvic pain after a bike trip. “She was sitting on a bike for two weeks, and when she got back, she had problems,” she says. “Your muscles can get into a spasm because you’re doing something they’re not used to doing.” A fall or an injury like a sprain that causes you to change your gait can also lead to spasms. Intercourse can also be a trigger.
Often, pelvic pain can be a combination of things, and the fastest way to unravel the mystery is with the help of your doctor. They’ll usually start by getting a complete history, asking you lots of questions about the pain and your lifestyle, and doing a physical exam. Based on all of that information, your doctor may also order diagnostic tests such as lab work, blood tests, an ultrasound, or other imaging tests such as an MRI or CT. Here’s what you can do to help.
Keep a pain diary. Be specific about when and where the pain occurs and any activities, situations, or foods that trigger it. This is valuable information that can help your doctor get to the root cause of your pain more quickly.
Stop doing what makes it hurt. Some women find that the pain worsens with specific activities, such as exercise or intercourse. “If you notice a trigger causing the pain, it’s best to stop doing that until you see your doctor,” says Dr. Dooley. “If you’re constantly irritating and retraumatizing it, the pain will get worse.”
Skip the Kegels. Kegels strengthen the pelvic floor muscles and can be an effective therapy for urinary incontinence. However, if muscle spasms are causing your pain, the last thing you want to do is contract those muscles. “If you have a spasm in your back or get a Charlie horse in your leg, you don’t go to the gym and work out,” says Dr. Dooley. “You massage or stretch it. You want to relax the muscles. You need to do the same in the vagina, but it’s hard to relax them on your own. That’s when a pelvic floor physical therapist can help.”
Curb stress and anxiety. We know it’s tough to escape the pressure, especially during this stage of life. But the effort may be worth it. Research shows that when you’re stressed out or anxious, pain increases, and when you relax, it decreases. Stress may influence some types of pain more than hormone levels do. The good news: There are many ways to relax. Some take just a few minutes, like deep breathing. Others—like dancing to your favorite tunes, petting your dog or cat, or walking in nature—can be enjoyable. There’s no right way to relax, so find what works for you and do it regularly.
Sometimes pelvic or abdominal pain requires immediate attention. If your pain is accompanied by unintentional weight loss, changes in your bowel habits, nausea or vomiting, blood in your urine or feces, abdominal swelling, or painful sex, talk to your doctor or healthcare provider as soon as possible. If you experience sudden, severe pain on the lower right side of your abdomen, it could be appendicitis and needs immediate attention. If there is any chance you could be pregnant (it can happen in perimenopause), pain could be a sign of an ectopic pregnancy and needs immediate attention. The pain associated with an ectopic pregnancy is sudden, severe, and on the lower right or left side of your abdomen.
Quality menopause care begins with a conversation between the provider and patient. Gennev’s board-certified OB/GYNs initiate care of their patients with a 30-minute consultation, dedicated to listening and learning about your menopause symptoms and experiences, as well as offering medical guidance. Book a virtual visit today.
The information on the Gennev site is never meant to replace the care of a qualified medical professional. Hormonal shifts throughout menopause can prompt a lot of changes in your body, and simply assuming something is “just menopause” can leave you vulnerable to other possible causes. Always consult with your physician or schedule an appointment with one of Gennev's telemedicine doctors before beginning any new treatment or therapy.
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