Chronic pelvic pain is one of the most common reasons women visit a gynecologist and one of the most undertreated. Women often describe living with pelvic pain for months or years before seeking care, sometimes because they assumed the discomfort was just part of being a woman, or because a previous provider dismissed their concerns. Neither of those things should be true.
At Cary OB/GYN, we want to be direct: pelvic pain that persists, interferes with your life, or simply doesn't feel right deserves a thorough evaluation. You should not have to manage it alone, push through it indefinitely, or accept that nothing can be done. There are answers and there are effective treatments.
What Counts as Chronic Pelvic Pain?
Chronic pelvic pain is generally defined as pain in the lower abdomen or pelvis lasting six months or longer. But that definition shouldn't be a reason to wait six months before calling your doctor. If your pain is recurring, worsening, or affecting your quality of life, that's worth addressing now; not six months from now.
The pain might be constant or come and go. It might be tied to your menstrual cycle or completely unpredictable. It might feel like a dull ache, sharp cramps, pressure, or burning. All of these presentations matter and all of them deserve attention. Our pelvic pain team is experienced in working through the complexity.
“The front office workers were very welcoming and the nurse is always so nice and inviting. A lot of the women in my family see Dr. Piper. She is absolutely professional, always taking time with her patients and she is very knowledgeable of her job about everything. If you need help with menopause she is the 'it doctor'.”
— Cary OB/GYN Patient Review
What Could Be Causing It?
Pelvic pain rarely has a single, simple cause. It can originate from gynecologic, urologic, gastrointestinal, or musculoskeletal sources and often involves more than one. Common contributors include:
- Endometriosis — where tissue similar to the uterine lining grows outside the uterus, causing inflammation and pain that often worsens around menstruation
- Uterine fibroids — noncancerous growths that can cause heaviness, cramping, and pressure
- Ovarian cysts — which may cause intermittent or sudden pain depending on size and behavior
- Pelvic inflammatory disease (PID) — infection of the reproductive organs, often resulting from an untreated STI
- Pelvic floor dysfunction — tightness, weakness, or coordination problems in the pelvic floor muscles
- Interstitial cystitis — a chronic bladder condition causing persistent pelvic pressure and urinary urgency
- Irritable bowel syndrome (IBS) or other gastrointestinal conditions
In some cases, chronic pelvic pain is connected to past trauma or a sensitized nervous system, which requires a compassionate, whole-person approach to care. Whatever the underlying cause, a correct diagnosis is the foundation of effective treatment.
When Should You Call Us?
There's no need to wait until you're debilitated. You should schedule an evaluation if your pelvic pain:
- Has lasted more than a few days and isn't explained by a known cause like menstruation
- Is getting worse over time, not better
- Makes it hard to work, exercise, sleep, or go about daily life
- Occurs during or after sex
- Is accompanied by abnormal bleeding: between periods, after sex, or unusually heavy
- Hasn't responded to over-the-counter pain relievers
If you experience sudden, severe pelvic pain, seek care immediately. This can sometimes signal an urgent condition like ovarian torsion or ectopic pregnancy.
“The provider that I saw, Jessica Ramirez-Trower, CNM, MSN, was incredible. She made sure I am comfortable with the exam and the procedure, she explained everything really well and answered all my questions. She also made sure that I understood my treatment options and she also educated me on proper breast exams. I will highly recommend her to my friends and family. The staff at the registration also was very kind.”
— Cary OB/GYN Patient Review
How We Diagnose the Cause
Getting to the root of chronic pelvic pain often requires more than a single test. At Cary OB/GYN, your evaluation is comprehensive and paced to what your symptoms suggest. We typically begin with a detailed health history and pelvic exam, and move from there into in-office ultrasound imaging, lab work, or STI testing as indicated.
When imaging or medication trials suggest something more structural, such as endometriosis or fibroids, a laparoscopy may be the next step. Laparoscopy is a minimally invasive surgical procedure that allows us to both diagnose and, in many cases, treat the underlying cause at the same time.
Treatment: More Options Than You May Realize
Once we understand what's driving your pain, we build a treatment plan around your specific situation. This might include hormonal therapies, such as birth control pills, hormonal IUDs, or other medications to manage conditions like endometriosis or abnormal uterine bleeding associated with fibroids.
For patients whose pain has a structural cause that doesn't respond to medical management, minimally invasive surgery is often highly effective. Our surgeons specialize in laparoscopic and hysteroscopic techniques that achieve real results with less recovery time than traditional surgery.
Pelvic floor physical therapy is another powerful tool, particularly when muscle tension or pelvic floor dysfunction is contributing to the pain. If a PT referral is appropriate for your situation, our on-site pelvic health specialist, Kaitlyn Bachman, DPT, can work with you directly.
You Deserve to Be Heard
Chronic pain is invisible to the people around you, but it is absolutely real and it affects every part of your life. If you've felt dismissed before, or if you've been managing this on your own, we want you to know that you will be listened to here.
Our team is ready to help you find answers. Call us at (919) 467-5941 or schedule online at our Cary or Morrisville location.