When you have pelvic pain, the affected area is below your belly button and between your hips. If it is chronic, the pain won’t be confined to a single area but will travel throughout your pelvic region. It could be mild or intense to the extent that it will affect your daily living. There are various reasons for pelvic pain; in women, the causes could be ovulation, menstrual cramps, ovarian cysts, uterine fibroids, etc.
Pelvic pain is pretty common in perimenopause and menopause. The reasons for the pain are many. However, the main trigger is the low estrogen levels, which aggravates the pain, causing discomfort.
Let’s get into a detailed explanation of what causes pelvic pain in perimenopause, alongside the symptoms and solutions.
What Causes Pelvic Pain in Perimenopause?
Around 15-20% of women aged between 18 and 50 go through chronic pelvic pain, primarily felt in the frontal abdominal area, lower back, or buttocks.
Some may experience pain in the lower abdomen traveling up to the groin. A few may even feel it in the rectal area, mainly during bowel movements. The intensity of the pain also varies, as it could be a dull ache or throbbing pain.
One of the main reasons why your pain quotient elevates is because of the low estrogen levels. A study(1) suggests that women with fibromyalgia suffered less pain when their estrogen levels were steady.
A drop in these hormone levels caused the pain to aggravate. So, it is pretty evident that when women have increased pelvic pain in perimenopause, the low estrogen levels could serve as a trigger for increasing the pain. However, it is essential to know the reasons that lead to pelvic pain in perimenopause. Is it the fluctuating hormones, or is there any other reason behind the same? Let’s check out the possible causes:
1. Menstrual Cramps
In perimenopause, your periods are irregular due to the unpredictability of your ovulation. The gap between your periods could either be short or long. Moreover, your period flow could also vary – it may be too light or increasingly heavy. You could even go without periods for some months. Now, in perimenopause, when you have periods, you will experience increased pain from the cramps. The reason is the fluctuating estrogen levels, which go through a series of rise and fall in perimenopause. When there’s a rise in estrogen levels, it means that more amounts of prostaglandins, responsible for uterine contraction, are released by your body. The outcome is cramping, which aggravates in intensity due to hormonal imbalances. The cramping is often described as ovary pain, mostly felt around the pelvic region or lower back.
2. Underlying Medical Conditions
Suppose you have underlying conditions like endometriosis or pelvic inflammatory disease. In that case, they will increase in severity or intensity in perimenopause due to hormonal imbalances. However, if you do not have these conditions and are constantly plagued by pelvic pain, you need to get in touch with the doctor at once. You could have developed one of the above-mentioned conditions or any other health issue.
If you have had endometriosis in your premenstrual years, when you step into the perimenopausal phase, the fluctuating hormones could worsen your condition. Studies(2) have deduced that those suffering from the third and fourth stages of endometriosis could experience more pronounced symptoms in perimenopause.
The good news is that once you’ve passed the menopausal stage, the endometriosis symptoms lessen, and if you are lucky enough, it could even resolve. The reason is that the endometrial tissues require estrogen for their growth. Reduced estrogen levels control their growth.
2. PID (Pelvic Inflammatory Disease)
PID is a condition affecting the ovaries, uterus, and fallopian tubes. It could affect any of these reproductive organs or all of them.
So, if your pelvic pain doesn’t seem to go away or keeps getting severe, it may not be due to hormonal fluctuations. You are likely to be affected with pelvic inflammatory disease.
If the fibroids are of increased size, then it is likely for women to experience heaviness or pressure in the lower abdominal or pelvic area. Women could develop fibroids in the perimenopause phase when the estrogen levels are significantly high.
In fact, in perimenopause, the levels of this hormone undergo a rise and fall till they finally decrease. So, during times when there is a spike in estrogen levels, there are chances for women to develop fibroids, significantly if their uterine wall is thinned or damaged.
4. Uterine Cervical Stenosis
It’s a condition where the cervix narrows or closes off completely. Due to this, the passage between the vaginal canal and the uterus is blocked. There are several reasons for cervical stenosis. The condition could be caused due to several reasons. It could be congenital or may be caused due to uterine or cervical cancer or even as a side effect of radiation therapy.
Menopause could even trigger this condition. In fact, with menopause, the cervix’s opening becomes tighter and smaller, often leading to several conditions.
5. Ovarian Cyst
Another highlighting cause of pelvic pain is ovarian cysts. The symptoms will come to prominence if the cyst has gotten bigger or has ruptured. So, if you are in your 40s or 50s and experiencing constant pelvic pain, or even sharp, sudden ones, do not do away with it by considering it to be one of the perimenopausal symptoms. Consult your doctor immediately.
Symptoms of Perimenopause Pelvic Pain
The symptoms of pelvic pain vary according to the condition you are suffering from. The intensity of pain could vary from dull and mild to throbbing, sudden, and severe. Here are the other issues you may face alongside pelvic pain, which varies as per the underlying medical condition.
1. For Menstrual Cramps
When you are going through menstrual cramps in perimenopause or premenopause, these are some of the symptoms that you may experience:
- Cramping or throbbing pain in the pelvis or lower abdomen, varying in intensity from mild to severe.
- The pain could start a day or two from your periods and subside in a few days after your menses have begun.
- The pain could radiate from the pelvis and abdomen to your thighs and lower back.
- A few women may experience associated symptoms like nausea, headache, dizziness, and loose stools.
2. For Endometriosis
The common symptoms to watch out for in endometriosis include:
- Pain in the pelvic region during or between your menstrual cycles.
- Increased period bleeding and spotting between your menses
- Pain during bowel movements and sexual intercourse
So, if you have persistent pelvic pain, along with any of these symptoms in your late 40s or 50s, consult your healthcare provider. It could signal endometriosis.
3. For PID
Take a look at the common symptoms of PID that will make you aware and help to distinguish your pelvic pain from perimenopausal cramps.
- Mild, moderate, or severe pain in the lower abdomen and pelvic region
- Increased vaginal discharge with an unpleasant odor
- Increased vaginal bleeding during or after sexual intercourse
- Vaginal spotting
- Fever with chills
- Difficulty in urinating
4. For Fibroids
Here are the symptoms of fibroids to watch out for in perimenopause, which will assist you in identifying your symptoms with ease.
- Fullness or pain in the pelvic region
- Increased bleeding during periods, accompanied by pain
- Urge to urinate frequently
- Pain during intercourse
- Low back pain
5. For Uterine Cervical Stenosis
Some of the symptoms of the significant symptoms of uterine cervical stenosis include:
- Painful menstruation
- Pelvic and lower abdominal pain
- Abnormal bleeding
6. For Ovarian Cyst
Most of them are small and come without symptoms. However, when they increase in size, the cysts could produce several symptoms. These include:
- Abdominal bloating or swelling
- Painful bowel movements
- A problem in emptying bowels
- Pelvic pain (which can range from dull pain to sharp and severe pain; the pain could worsen during or after your menses or sexual intercourse)
- Light, heavy, or irregular periods (that could be misleading as that’s how your menses
- A feeling of fullness after eating in smaller amounts
Solutions to Manage Pelvic Pain in Perimenopause
When you have recurrent episodes of pelvic pain with other signs of discomfort, you should contact the doctor immediately rather than thinking about home remedies. However, between the appointment with your healthcare provider and even after it, there are things to do to manage the pain and lessen its intensity. Here are some of the probable solutions:
1. Identify the Triggers and Avoid it
This is one of the essential things to do. You have to identify if your pelvic pain intensifies after any particular activity if it happens all the time. For instance, it could be that your pelvis region starts paining after intercourse or a workout. Under such circumstances, you must restrict the activities that trigger or aggravate the pain till the time you consult the doctor.
2. Maintaining a Pain Diary Would Help
An extension of the above point is that maintaining a pain diary is essential. It will help you keep track of the severity, intensity, and frequency.
The details that should go into the pain diary include how often you have the pain, the areas where it pains the most, what particular time the pain increases, and the triggers, if any. This would help the doctor in the diagnosis.
3. Avoid Kegels
Kegel exercises strengthen your pelvic floor muscles, helping to manage urinary incontinence. Doing kegels helps support the rectum, bladder, uterus, and small intestine.
However, when you are experiencing muscle spasms in the lower abdomen, pelvic region, or anywhere else, it is better not to add further stress to your muscles until you talk to the doctor. Exercising may make matters worse and exacerbate the pain.
4. Work on Reducing Your Stress Levels
It is a two-way communication – pelvic pain can trigger stress and vice versa. Studies(3) have deduced that the painful and sore muscles within the pelvic floor have myofascial trigger points. These points are immensely affected due to stress.
In perimenopause, your stress levels are already high due to the hormonal imbalances and the physical changes you encounter. So, the increased anxiety levels may trigger pelvic pain. That’s why it is essential to find out ways to manage stress. Relaxation techniques like deep breathing would be of immense help. You can also try yoga to calm your mind and relieve stress.
5. Go for a Warm Shower
If pelvic pain becomes difficult to bear, you may get temporary relief with a hot water bottle or heating pad on the area of pain. Always use a towel to wrap the water bottle rather than directly applying it on your skin to avoid burns and scalding. Research(4) suggests continuous application of low-level topical heat was as effective as OTCs in treating dysmenorrhoea.
6. Keep Yourself Hydrated
You must be wondering what connection water has with pelvic pain. There is a link. When you drink a sufficient amount of water and remain hydrated throughout the day, the muscles of your pelvic floor remain more relaxed. This helps you to deal with the discomfort.
When the home remedies don’t work, you will have to opt for OTC medications to manage the cramping and pain. However, it is advisable never to take medicines without consulting the doctor.
Yes, in perimenopause, along with pelvic pain, you could also have low back pain, primarily due to the low levels of estrogen. Also, when you have pelvic pain, it can often spread to other parts of the body like your thigh, lower back, and buttocks.
If you have pelvic pain once in a while, then you could perhaps wait for some time. However, if you experience heavy flow and the pain lasts for more than two to three days, then you should seek medical help.
Moreover, if your pelvic pain triggers vaginal bleeding, or hampers your daily living, then too medical intervention is required. In rare cases, pelvic pain could mean uterine or ovarian cancer. So, do not ignore your symptoms. It’s an emergency when there’s heavy vaginal bleeding, blood in your urine, nausea, vomiting, dizziness, shoulder pain, etc.
Constant pain in the pelvic area during perimenopause could highlight an underlying menopause. So, when you are troubled with frequent episodes of pain alongside other symptoms, talking to the doctor is essential.
The doctor will advise for blood work, urine tests, and even testing of cervical and vaginal swabs. Your healthcare provider may even prescribe ultrasounds, MRIs, and transvaginal ultrasounds based on the severity of your symptoms and treat them accordingly.