Pelvic Pain - Unknown and Worried

[SpiceyCat]

New here so hopefully I've posted in the right place...

At the start of June, I felt like I had a bit of a bladder infection as the stinging was on and off but this progressed to bloating and a heavy feeling in the pelvic area. I started to get a bit worried about it as I've never had a UTI with pelvic pain, it's always just been consistent stinging so it was odd for me to not have that and just the pain. I did a pregnancy test just in case even though I'm on the pill and this was negative so I spoke to the pharmacist who did think it sounded like a UTI and gave me 3 days of antibiotics on 10th June.

This seemed to clear it up for maybe a couple of weeks maximum and it started getting a bit niggly again, with the odd stinging and feeling like I needed to stay on the toilet. I drank tonnes to flush anything out but then it felt bad again so I went back to the pharmacy and he gave me one more 3 day course on 10th July. It went for a couple of days and a week later, the pelvic pain came back with added lower back pain, thigh and sometimes hip pain.

I went to the doctors mid July and they did a dip test for a UTI and it was clear. He also applied pressure around my stomach and there was significant discomfort on my bladder area so they referred me for blood tests as he was unsure what it could be as there were too many possibilities he said. I also bought a Canesten pH testing kit just in case it's bacteria there instead but that was normal too.

I had a full blood profile done and everything was completely normal. STI tests all clear too.

The last couple of weeks it seemed to disappear a bit but it's back in full force again.

I also recall that around the time this had all started, I had sudden pain in the pelvic area on the right hand side during intercourse and I was actually quite uncomfortable to the point of having to stop. It went away pretty quickly after stopping but since then, I have had discomfort in the same place on and off. I'm wondering if it's all linked? The symptoms of ovarian cysts do match up with it but the scans seem invasive and I suffer with agoraphobia so I'm worried about going to have this done if it is in the hospital.

It doesn't hurt during any physical activity or movement and although we have been careful during sex, that has been okay too.

Does anyone recognise any of these symptoms and have experience of the same thing? With it being very intermittent with say 2 or 3 weeks of nothing, I'm just confused what it is and currently quite uncomfortable. It doesn't make me feel sick or anything though. It's just painful.

Sorry for the long post! Thank you. (I'm 31yo)

Maybe look around at other private venues near you which do both transvaginal and pelvic and perhaps also a Urinary tract ultrasound and do that instead. It's probably more worth your while to check for everything and then you'll know if there's something or not.

Home test are not as accurate as the ones you do in a lab and by the GP. I've done them before and then done the proper ones and I had it but the home test results I did were inconclusive or negative. Due to the persistence of your symptoms I'd aks them to do it and not tell them you've done a home one. Just double check it shouldn't take too long to come back - only a week.

I've just had an US scan/examination of ovaries for pain in my pelvic region. They couldn't see well enough with the first so they went on to do an internal scan with the wand and it was absolutely fine, no pain at all and really didn't feel anything. Took about two minutes and it was done.

I hope that reassures you, and I hope it all turns out ok for you.

I had it done at my local hospital.

I’m 53 and suffer from pelvic pain similar to what you’re describing. A transvaginal US revealed pelvic congestion syndrome, a vascular disorder that often gets overlooked or else erroneously treated by gynaecologists who often go about treating it incorrectly. It needs to be addressed by a vascular consultant.
The other disorder that comes to mind is interstitial cystitis- bladder pain syndrome.

Note: Don’t eat much or anything too ‘gassy’ before your scans so that the clinician gets a good view. Kinda gross but necessary advice. 😆

Those of you that have had fibroids, cysts, endometriosis etc, what was the treatment? Because everywhere online it pretty much says to either wait and monitor for it to potentially go on its own or manage any pain symptoms unless so severe then you might have surgery.

I'm just thinking that even if I get the scan and find what it is, it doesn't necessarily change anything.

And to those that did just wait and it cleared up, how long did it take?

Thank you!

Endometriosis, fibroids etc do not just 'clear up' fibroids require surgery to remove them, and endometriosis is a chronic condition.

Are you symptoms just on your period or elsewhere during the month? (Because if its just on your period, unlikely to be endometriosis). What symptoms do you have during your period? And if you have symptoms not on your period - what are they? Is the pain worse on or off period?

If you had a transvaginal and/or pelvic ultrasound normally it can pick up adenomyosis (different to endometriosis).

I recommend asking the GP to try the pill and/ or mirena coil can be amazing with heavy bleeding and pain. You might try different pills first. The mirena will may the uterus lining thinner, less bleeding and less cramps). Sometimes the progesterone only pill (mini-pill) can be better for some.

Also ask your GP for mefenamic acid and/or naproxen (NSAIDs which help a lot) and tranexamic acid (helps reduce heavy bleeding) - you need to start taking it days before your period starts so that it can work at best capacity. The same with ibuprofen and/or paracetamol. Start taking it 3/4 days before and it will be much better

You may have 1. Primary dysmenorrhea (heavy bleeding and painful periods and pelvic pain with no condition or cause or 2. Secondary dysmenorrhea so a condition e.g endometriosis or adenomyosis causing it.

You will need to try NSAIDs and mirena/pill and Tranexamic acid first before any further scans like ultrasound and MRI. Often if the pain is significantly reduced with said treatments its more likely (not 100%) to be primary dysmenorrhea. Also very dependant on whether you only have symptoms on your period or across the month as to whether you have primary or secondary.

Then if ultrasounds pick up on anything (pelvic ultrasound or transvaginal) you may need to have an MRI to see endometriosis. However, the only way for definite diagnosis is a diagnostic laparoscopy and then they will often excise the endometriosis tissue if they find it etc.

But endometriosis is a chronic illness and cannot be cured, after surgery it will grow back, it cannot be excised from everywhere to leave organ functioning intact and then post-surgery adhesions often form.
The main symptom of endometriosis is not actually period pain because endo is not a period condition - it's a whole body inflammatory condition where the endometriosis tissue even produces its own oestrogen and the pain is felt throughout the month not just when on your period. Often endometriosis on the ovaries can form cysts containing old blood called endometriomas (also known as chocolate cysts) which can be very painful. Another popular cyst is haemorrhagic ovarian cysts with endometriosis.

But you could also be adenomyosis where the lining of the womb grows into the muscle of it, but unlike endo is localised to the uterus only. Thus, symptoms are mainly a couple days before a period and during your period. Main endo symptoms:
• Irregular or heavy periods
• Pelvic pain
• Pelvic pain on opening bowels (dyschesia) and wider gastrointestinal symptoms (diarrhoea amd constipation)
• Pelvic pain on passing urine (dysuria) and bladder symptoms sometimes
• Referred pain to the tops of the legs or back
• Fatigue

Crucially you can still have endo even if they don't see it on the scan, the only clear way for diagnosis is a diagnostic laparoscopy and then mangagement can look like pain medication depending on how severe your pain and symptoms are (can be opioids which are mainly given for temporary use for a few days at a time, NSAIDs) and contraception and hormonal treatments (gonadotrophin releasing hormones).

The links below have much more detailed and useful information.
https://www.leedsth.nhs.uk/patients/resources/endometriosis-2/

https://www.nhs.uk/conditions/adenomyosis/

Personally, I have endometriosis, adenomyosis and other unrelated conditions, I am disabled by it. Cannot walk or stand lots (across the whole month with or without a period, and use a walking stick/rollator). Drugs to stop my period do nothing as my period whilst painful is the least of my worries (even without it every day is horrible so it doesn't matter personally to me). For others it's life changing. Again mirena for years nothing (horrible initially and worsened bleeding - this happens to many people and then settles but has gotten worse over time with me. I live on high dose opiods (I wouldn't if I didn't have to but it means I'm not completely bed bound). Again I've maxed out NSAID doses and have chronic cycles of constipation and diarrhoea (going through both gastrology and colorectal surgery) and severe bladder issues including incontinence and an overactive bladder (I see urology as well), persistent thrush etc and vaginal cramps all the time which are incredibly painful.

Ovarian cysts, however, can sometimes shrink on their own - but this depends on how big they are and how many of them are there.

Till now you seem to have asymptomatic (from what you've said - I'd be surprised if this was a chronic condition as it seems to be more like inter or an embedded UTI that may be a kidney infection as well). Find out about doing tests from your GP for BV and thrush first) and get (either private or NHS ) and abdominal ultrasound as well to look at the kidneys, liver, stomach etc.

If you do have a long-term condition, if they find, normally the pill/mirena and NSAIDs should resolve it long-term after the cyst is removed.

Secondary dysmenorrhea is where a condition, e.g, endometriosis or adenomyosis, is causing it. Have you had long-term and chronic issues with mobility, back and sciatica, debilitating pelvic pain, pain with sex and insertion to the vagina, severe vomiting and nauesa, cycles of severe constipation and/or diarrhoea. These are some symptoms of both adenomyosis and endometriosis.

You will need to try NSAIDs and mirena/pill and Tranexamic acid and if your endometriosis pain and symptoms are managed quite well/go away then you likely have less severe endometriosis in terms of symptoms and impact.

The stages of endometriosis (Stages 1-4) are actually about how it impact your fertility - so a higher stage more impact on fertility but not pain. So a person with stage 1 endo could be disabled by it and have severe complications but a person with stage 4 may not.

Just to note about my own situation - the majority of people find relief from many things above and at least one of the things I've tried so don't worry (anecdotes are not stats and i have other health issues etc).

For fibroids, they will do a surgery called a myomectomy in which they remove them. They won't shrink or go away themselves. Soemtimes, in surgery, people have a mirena coil inserted as well. If you have issues with heavy bleeding again try tranexamic acid and perhaps the mirena coil as well for the pain and cramps and bloating and more. Normally, people with fibroids are bleeding a lot (even not on their period) and have much heavier periods, so get and use tranexamic acid until surgery. In surgery, they then often get a mirena coil inserted.

If the insertion is what worries you, you can get pain relief - paracetamol and ibuprofen an hour before, numbing sprey/gel, and Licodaine injection into the cervix. I'd make sure when you book the appointment, you ask and say you want all of the above rather than walking in and expecting it. As if you don't tell them, they may not have it set up, and you may not get it then.

You may also have as PP suggested interstitial cystitis, an embedded UTI, BV, or thrush. So get tested for the BV and thrush by your GP. And look into the other two and the symptoms they have. You may also want to get an abdominal ultrasound as well as the pelvic one, transvaginal one, and a urinary tract one - so that all bases are covered.

If you have these scans, they may reveal any of the above diagnoses or something else - you can then be treated for that. You may also find an ovarian cysts you can then get the private center to send this over to your GP and get a referral to gyne and put on the waiting list for removal (depending on the size of the cysts and the amount of them) - you can get NSAIDs for the pain. You can also get scans every few months to check if it's grown or not as you wait for surgery. It may twist or rupture, in which case know the symptoms, so you can go to A&E immediately. If they find fibroids, you can get on the list for a myomectomy and then get pain relief again NSAIDs and tranexamic acid.

I'm sorry to hear what you have to go through.

I've been on the progesterone only pill for about 10 years so I don't have periods. I'm 31 and have not had any children.

I haven't had any bleeding, no spotting or anything.

The pain isn't debilitating, I can still carry on with things as normal, it's just some days are worse than others but not to the point where I'm bed bound. The pain goes with simple paracetamol. It just feels like burning over the full pelvic area and sometimes more of a niggly crampy sensation on the right side but sometimes it could be the left but more often it is the right though.

There is nothing that makes it worse or better, doesn't make me pee more or constipated, doesn't hurt to go, doesn't hurt if my bladder is full or empty. It's just sort of there. If I'm active, standing, sitting, whatever, it doesn't change. It doesn't disrupt my sleep either.

Thank you everyone.
I went for the private transvaginal scan today and it is a cyst on my right ovary.

They said they will send me a report with my results today and I guess I'll send them to the GP. They said it is only small and quite common, they tend to go on their own but presumably they can't diagnose it. Does the doctor have to do that or do they organise that? I've never had to do this before.

They'll likely send it to the GP if you ask, or you should and then also book an appointment and bring it so you can show them and talk to them about it.How big is the cyst - depending on the size and the amount (if you have multiple) they may try medication first to reduce it and them some regular ish scans to see if ts growing or shrinking. Then based on how it responds, they may schedule you for a surgery to remove it. I'd alert reception and ask them what email to send it over to - so then they can scan it into your NHS record.

Also just wondering was it a simple cyst - as those are the normal cysts everyone produces when they ovulate. As its attached to your ovary, it's unlikely. If they didn't tell you, I'd ask and check the report as it's important for the treatment plan - whether they wait for it to shrink and check with regular scans, or take it out surgically. That also depends on size and the amount.

Or was it a dermoid cyst, haemorrhagic?

They didn't say what type it was as they said they can't diagnose, they can only say what their findings are. They said I will need to send the report to the GP so at the moment, I don't have any details on it but the sonographer did say it was small and likely to be the common type.

Their website says "diagnosis will not be given on the day and any results should be discussed with your GP."
So maybe they only supply a report with the findings and nothing else?

From what they said, hopefully they put the diagnosis or even a provisional one into the report they send to the GP. I'd book an appointment with the GP as soon as you get the report to discuss it and form a plan. If it's a simple cyst it will likely just be waiting it out, but if it's a different one they may want to remove it quicker.

I'd bring the report to the GP to discuss it and perhaps if they don't send the report to the GP, you can show the receptionists and they should be able to scan it into your NHS patient record.

Thank you so much.

If they do remove it, I'd ask for a biposy just to make sure it's not something more sinister but I think it's unlikely with your symptoms.

I had the report and it says:

Right Ovary Contains a Follicle Measuring 18.2 Follicles.

What does that mean?

Apparently it's an extra charge to get the images!

I'd try and get the images - it will be hard for the NHS GP to use it as diagnostic evidence otherwise. 18.2 mm right? Well that seems like a normal follicle that comes out during ovulation, especially if it says 'contains' rather than attached to. That's just a normal developing egg at the minute, which everyone produces each month when they ovulate/get ready to.

If they saw plenty of follicles it could indicate PCOS but one is normal. At its size it's fully mature as so would be released soon for ovulation.

Thank you. I have requested the images.
If it's regular and just getting ready for ovulation, is it normal to have caused discomfort for two months?

No it won't be the cause, you can't completely if it's been there for 2 months (but it should be larger if it has - it seems pretty normal size for a monthly cycle and that it's maturing and will be released soon). You produce one every month, as does everyone else, it's within the ovary as it should be and as its 18.2 mm should be released soon because that size indicates full maturity. One for 2 months would be larger, and likely on the ovary or attached to it.

If the ultrasound didn't find anything else, I'd be looking at getting an abdominal ultrasound. I'd ask the GP about testing for thrush and BV and then go from there, potentially some bloods.

Got the images, this is the right ovary. I'm waiting for them to clarify because during the scan, the sonographer said it was a cyst but the report says follicle. If it's a regular follicle ready to release an egg, it wouldn't make sense on the discomfort. Nothing else was found though.

As much as I'm not a radiologist, I think that it may be a follicle and if so it wouldn't be the cause of your discomfort. Some people, myself included, get some cramps and ovulation pain, but it wouldn't be as severe as your current symptoms. Have you booked an appointment to see your GP?

Would you be willing to bring up trying NSAIDs, the mirena coil and Tranexamic acid for a while to see what happens. I'd also ask about getting a urinary tract ultrasound or a cystoscopy (looks at the bladder etc) - you may have interstitial cystitis or BV, thrush - which could have turned into PID. I'd ask the GP to test for thrush and BV. It's always best to cover all bases.

Thank you. It has been confirmed it is a dominant cyst.

That's good, have they given you some sort of plan for treatment? Or will that have to be with your NHS GP?