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Women's Health Q1 2022

The challenge of diagnosing the cause of chronic pain

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Dr Swati Jha

Consultant Gynaecologist and Spokesperson for the Royal College of Obstetricians and Gynaecologists

There is a growing need to raise awareness of some of the less well-known gynaecological conditions which can lead to women suffering with chronic pain if left untreated.


Awareness of gynaecological conditions such as endometriosis is growing, but there is limited public awareness of some gynaecological causes of chronic pain. Overlapping symptoms of many conditions can make it difficult to distinguish between them. Here are some that can cause chronic pain.

Adenomyosis

In endometriosis, the tissue of the endometrium (lining of the womb) is found outside of the uterus, most commonly in the wider pelvic region including the ovaries and bowels. Adenomyosis is where the tissue of the endometrium is found deep within the muscle of the uterus.

Adenomyosis can affect women of any age, though it is more common in women in their 40s and 50s who have had children. While some people have few or no symptoms, others have chronic pain and painful or heavy periods.

Pelvic congestion syndrome

Pelvic congestion syndrome (PCS) affects the veins in the pelvic region. This can affect both men and women but is more commonly found in women. Due to a lack of research and awareness, it can be misdiagnosed and untreated.

Chronic pelvic pain is thought to make up to two fifths of all gynaecological outpatient department referrals but identifying the cause of this pain can be difficult with overlapping symptoms

PCS is caused by veins in the pelvic region dilating, which then fill with blood. The veins then swell and this puts pressure on the pelvic area, causing a dull ache which some women find more painful around menstruation.

Adhesions

Adhesions are scar tissue which develop from previous surgery or past infections, including pelvic inflammatory disease. Adhesions can be painless, but some women experience chronic pelvic pain, especially when they cause the ovary to be buried within the scar tissue. These can be difficult to prevent and treatment may simply cause more to form.

Chronic pelvic pain is thought to make up to two fifths of all gynaecological outpatient department referrals but identifying the cause of this pain can be difficult with overlapping symptoms.

Several non-gynaecological conditions can also cause chronic pelvic pain, including irritable bowel syndrome (IBS). Chronic pain can severely impact the daily lives of women, negatively affecting their ability to work, their mental health and relationships.

No one should be left to suffer in silence with chronic pain. We encourage women to speak to their GP, and ask to be referred to a gynaecologist, if they are still concerned about painful symptoms.

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