V. Possible REASONS, SYMPTOMS and TREATMENTS for pelvic pain and irregular bleeding

I. FIBROIDS

Fibroids are very common growths of the uterus.  They are almost always benign. Most of the time they can be monitored and require no intervention unless the woman has symptoms such as pain, heavy periods with anemia, fertility concerns or the fibroids are enlarging rapidly. Diagnosis is made by exam and radiographic imaging of the pelvis. Treatment depends on signs and symptoms and future reproductive plans.

 i. Pain control with a non-steroidal anti-inflammatory

ii.  Estrogen and Progesterone Hormones (birth control pill)

iii.  GnRh antagonists and agonists

iv.  Embolization of blood flow to the uterus

v.  Surgery to remove the fibroids (myomectomy) or remove the uterus (hysterectomy)

II. UTERINE POLYPS

Uterine polyps are growths, that are usually benign, but can have precancerous or cancerous changes. Irregular bleeding in woman over 40 or post-menopausal bleeding should be assessed. Treatment and management of uterine polyps can include:

i.  Pelvic exam 

ii.  Pelvic ultrasound

iii. Hysterogram/sonohysterogram to better see the cavity of the uterus

iv. Hysteroscopy to examine the inside of the uterus

v.  Endometrial biopsy

III. ENDOMETRIOISIS

Endometriosis is a condition where the tissue that normally grows in the cavity of the uterus and sheds with menstruation, grows outside of the uterus in other areas of the pelvis.  This can be very painful. The pain can occur during menstruation, with sex and when going to the bathroom. Treatment for endometriosis is available and the best method depends upon how bad and how often the pain occurs as well as future fertility plans. Treatment options may include:

i.  Non-steroidal anti-inflammatory medications

ii.  Hormone therapy (birth control pill)

iii.  Hormonal IUD

iv. Hormones called GnRH antagonists and Elagolix

v.   Surgery to remove the endometriosis tissue, ovary removal or hysterectomy

 IV. OVARIAN CYSTS

The significance of an ovarian cyst, and therefore the treatment, depends on the level of the patient’s discomfort, her age and menopausal status, pregnancy status and future fertility plan, family history, size and characteristics of the cyst on ultrasound as that can help determine if their is concern for cancer.

Ovarian cysts symptoms and treatments may include:

i.  Small, functional and painless cysts can be observed/followed

ii.  Painful cysts, larger cyst or complicated cysts can be managed with medication but sometimes need to be removed

iii.  Cysts can sometimes twist or undergo torsion, and this needs to be surgically managed

iv.  Recurrent painful cysts can be managed with pain medication or birth control to suppress ovarian function

v.   Cancerous cysts need surgical intervention

 V. INFECTION/PID
When a woman initially gets a pelvic infection, she is often asymptomatic. However, when left untreated, it can cause problems. If you suspect a pelvic infection, then it is important to contact your doctor for testing and possible treatment. 

Signs and symptoms may include:

i. Pelvic pain

ii. Vaginal discharge that can be uncomfortable and foul smelling

iii. Bleeding especially after sex

iv. Pelvic abscess which often requires antibiotics and sometimes requires surgical intervention

v.   impaired fertility due to scar tissue that can occur on account of the infection.

Consult with your doctor if you are experiencing any pelvic pain, irregular bleeding or symptoms. Verbena does not provide medical advice, diagnosis, or treatment and is not a medical provider. If you think you may have a medical emergency, call your doctor or 911 immediately.