Persistent pelvic pain is often brushed off as "just bad periods," but for many women, it's a sign of an underlying condition that deserves proper investigation. Endometriosis is one of the most common causes of chronic pelvic pain, yet it frequently goes unrecognised for years. Dr Mandana Master takes pelvic pain seriously from the first consultation, working to get to the bottom of what's really going on so you can get on with feeling like yourself again.
Endometriosis is a chronic condition in which tissue similar to the lining of the uterus is found growing in other parts of the body, most often within the pelvis – on the ovaries, fallopian tubes, the outer surface of the uterus, or the lining of the pelvic cavity itself. Less commonly, it can also be found beyond the reproductive organs, including on the bowel, bladder, or in rare cases, even outside the abdomen altogether.
This misplaced tissue still responds to the hormonal signals of the menstrual cycle, thickening and breaking down in a similar way to the uterine lining. Unlike a normal period, however, this blood and tissue has nowhere to go, which triggers local inflammation and, over time, can lead to scarring and adhesions that bind pelvic structures together.
Pain is the hallmark symptom of endometriosis, but it can present in a number of different ways, including:
Not every woman with endometriosis experiences pain, and the severity of symptoms doesn’t always reflect how extensive the disease is internally. Some women with widespread endometriosis have minimal symptoms, while others with relatively limited disease experience debilitating pain.
The exact cause of endometriosis isn’t fully understood, and is likely the result of several contributing factors working together rather than one single cause. The most widely accepted explanation is known as retrograde menstruation, in which menstrual blood and tissue flow backward through the fallopian tubes into the pelvis instead of leaving the body, where they can implant and grow. However, this process occurs in many women without going on to cause endometriosis, suggesting that other factors, including genetics, immune system function, and hormonal influences, also play an important role in determining who develops the condition.
Other contributing factors that may increase the risk of developing endometriosis include:
One of the most frustrating aspects of endometriosis is how long it can take to receive a diagnosis, often years from the first onset of symptoms. This delay frequently comes down to symptoms being mistaken for “normal” period pain, irritable bowel syndrome, or other pelvic conditions.
Diagnosis usually begins with a detailed discussion of your symptoms and medical history, followed by a pelvic examination. From there, further investigations may include:
To look for endometriomas (cysts associated with endometriosis) or other visible signs of disease.
For more detailed imaging, particularly where deep infiltrating endometriosis is suspected.
A minimally invasive surgical procedure that allows direct visualisation within the abdomen, and remains the only way to definitively confirm endometriosis, while also allowing treatment to be undertaken at the same time.
Dr Mandana takes a thorough approach to diagnosis, recognising that getting an accurate picture early can make a meaningful difference to how effectively your symptoms are managed.
Treatment for endometriosis is tailored to your symptoms, your goals, and the extent of the disease, and often involves a combination of approaches over time. Options may include:
Pain from endometriosis may be relieved with simple anti-inflammatory medication or require stronger prescription medications. Other non-invasive treatments that can help with pelvic pain include heat therapy, acupuncture, and dietary changes.
Hormone therapies such as the contraceptive pill, hormone intrauterine device, or other hormone-based treatments, can help to relieve pelvic pain and cause your periods to become lighter or stop altogether. As many of these hormone therapies also act as contraceptives, it is important to discuss your family plans before starting treatment.
Laparoscopy is the most common surgical approach for removing endometriosis lesions and adhesions, which can significantly improve pain for many women, as well as fertility.
Working with a physiotherapist with specific expertise in managing pelvic floor disorders can help address muscular tension through targeted exercises and stretches. This may improve symptoms of pelvic pain, including during intercourse.
Input from pain specialists or psychologists where chronic pain has had a broader impact on daily life can be beneficial for a more holistic approach to endometriosis treatment.
Because endometriosis can also affect fertility, Dr Mandana will discuss this with you as part of your care if it’s relevant to your circumstances, particularly if you are currently trying to conceive or planning to in the future.
You deserve a gynaecologist who listens carefully, explains things clearly, and treats your concerns with evidence-based, patient-centred management strategies. Get in touch with Dr Mandana Master at Embrace Fertility today to arrange a consultation.
