Dull aches, discomfort during sex, heavy periods – this is the reality for up to one in four women globally who experience chronic pelvic pain, many of whom will live with it undiagnosed.*

Brushed off as ”women’s problems”, endometriosis, fibroids and pelvic congestion syndrome are just some of the conditions ignored by doctors.

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Many women are dismissed, while others are left languishing on waiting lists for months – often for more than a year, according to statistics from the Royal College of Obstetricians and Gynaecologists.

In fact, there has been a historic lack of care for women’s reproductive health conditions, and such is the ”gender pain gap” that many don’t even realise their pain is out of the ordinary, and are yet to seek help.

“Gynaecology itself is disproportionately the worst affected for waiting times of any other surgical speciality,” explains consultant gynaecologist Dr Sophie Strong.

“It is important that women know it’s not normal to have debilitating pain that stops them from going to work or being able to do what they need to do.”

As the lead consultant at The Pelvic Pain Clinic at The Whiteley Clinic – the first private medical centre for women’s pelvic pain in the UK, which opened last month in London – Dr Strong wants you to know when to seek help.

Pelvic Congestion Syndrome

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Did you know you can get varicose veins in your pelvis?

They are more likely in women who’ve had multiple pregnancies, but they do also have a hereditary link.

Called pelvic congestion syndrome (PCS), symptoms include pain during or after intercourse, painful periods and heaviness in the pelvis – which often gets worse at the end of the day or after long periods of standing. It can affect post-menopausal women, too.

“The veins affected might cause symptoms around the bladder, such as pain or irritation, or around the back passage, which can present as constipation,” says Dr Strong.

These symptoms may be familiar to many women, but Dr Strong says if they are persistent, it could be PCS.

“Once there’s a problem with the veins, it won’t get better by itself and needs to be treated,” she adds.

“The type of patients I see have usually had these symptoms for years.”

Traditional MRI scans can fail to detect the problem, which is partly why the chronic condition is underdiagnosed.

It is typically treated with pain management, hormonal therapy or minimally invasive procedures on problematic veins.

Fibroids

Around two in three women develop a fibroid at some point, usually between the ages of 30 and 50, but not everyone will need treatment and only one in three women will have symptoms**.

Fibroids growing inside the cavity of the womb can cause heavy periods. “They could also impact fertility,” says Dr Strong.

“Those growing on the outside of the womb have the potential to fill the abdomen, which can cause bloating or pressure on the bowel or bladder.”

This can lead to symptoms such as bladder irritation, frequent urination or constipation.

Hormone medications can shrink fibroids and small procedures can cut the blood supply.

Early detection is crucial, as Dr Strong says: “When fibroids are smaller, the range of treatments is much wider.

“It’s often diagnosed too late because people haven’t heard of them.”

Endometriosis

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Agonisingly painful periods are not normal and could be a sign of endometriosis.

“This is when the lining of the womb cells have implanted outside of the womb, usually in the pelvis and organs including the fallopian tubes, ovaries, bowel or bladder,” says Dr Strong.

“If it’s eating into the bowel wall or the kidney tubes, that’s what we call severe or deeply infiltrating endometriosis.”

Adenomyosis, the “sister” of endometriosis, is when the womb-lining cells spread into the womb’s muscle.

The symptoms of these conditions cross over, but with adenomyosis, Dr Strong says: “The womb itself becomes really heavy and boggy.”

New guidelines state that endometriosis should be considered if a woman has a history of painful periods, pain deep inside the vagina during penetrative sex, and opening their bowels or in the bladder during their period.

The World Health Organisation says it affects 10% of women globally, yet, shockingly, it takes eight to 12 years to get a diagnosis after first seeing a GP.***

It’s considered incurable, but treatments can help – hormone-blockers, such as the Pill or coil, can stall the condition.

Some medicines can induce a temporary medical menopause and, depending on the severity, surgery might be needed to remove the endometriosis tissue.

Pelvic Inflammatory Disease

This occurs when bacteria travels from the vagina or vulva higher into the reproductive system, reaching the ovaries or fallopian tubes, where it causes infection.

“Pelvic inflammatory disease (PID) can be mild or very severe,” says Dr Strong. “It often presents with new onset pain in the pelvis, change in vaginal discharge (yellow/green/foul-smelling) and fever symptoms.

Sometimes all you need is a course of antibiotics, but it can form a ball of pus and infection that might need to be drained.

If an abscess ruptures, you could have up to a 10% chance of dying as a result of sepsis.”

Left untreated, PID can significantly reduce fertility in the future or result in chronic pelvic pain due to pelvic scarring.

The most common causes of PID are STIs, particularly chlamydia and gonorrhoea, which are not just limited to young people.

But it could also be caused by bacterial vaginosis, when the pH of the vagina is off-balance.

Speak Up

Women’s conditions can often be dismissed, so it’s important to be your own health advocate, says Dr Strong.

Ask your surgery if there is a GP with an interest or specialism in women’s health and consider taking someone with you to your consultation.

“Support during appointments can be helpful to get the message across to doctors,” she says.

“Not every person with period pain needs to see a specialist. But if treatments have not worked, that’s where specialists come in.”

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• Sources: *The Conversation **NHS ***British Journal Of General Practice