How Regenerative Medicine Can Bring Healing to Women with Chronic Pelvic Pain

Jonathan Vellinga, MD

Pelvic pain in women is often chronic and can be caused by a mixture of multiple disorders that together create severe pain and discomfort. Pelvic pain can lead to disruption of all aspects of life and negatively impacts the lives of at least 1 in 4 women in the United States (1).

Women with Chronic Pelvic Pain

Chronic pelvic pain is defined as any recurring, non-cyclic pain in the pelvic area that lasts six or more months. This pain can be constant or intermittent, a dull ache or sharp cramp, or even pressure and heaviness. Typical treatments involve ongoing pain management via medication, hormone therapy, surgery, and for some women, hysterectomies. While these treatments can be effective, they can also cause harmful side effects and make little difference in decreasing long-term pain and recovery. In contrast, regenerative medicine is proving to bring healing to women with chronic pelvic pain in ways that conventional medicine has not.

Chronic Pelvic Pain and Conventional Treatment

Disorders that commonly cause chronic pelvic pain are endometriosis, pelvic inflammatory disease, fibroids, musculoskeletal problems, painful bladder syndrome (interstitial cystitis), pelvic congestion syndrome, and certain psychological disorders (2). Unfortunately, because of the psychological aspect of some chronic pelvic disorders, pain, and emotional distress can feed into each other and turn into an increasingly painful cycle (3).

Once a pelvic ultrasound is performed to rule out abnormalities, most physicians turn to evidence-based therapies that are available, based on the limited research that has been done concerning conventional methods. Unfortunately, finding a curative treatment can be difficult, and treatment for many women reduces to symptom management (2). Depending on the symptoms and potential diagnosis, this can involve using a hormonal contraceptive (injection or oral), nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, pelvic floor physical therapy, and even behavioral therapy. As mentioned above, hysterectomies are often considered a last resort, and actually only help about half of patients long-term (2). Even if any known disorders are treated, pain may not actually decrease (2).

Pelvic Floor Dysfunction and Conventional Treatment

The pelvic floor is a group of muscles that attach on all sides to the inside of the pelvic bone and sacrum. It acts to support the reproductive, urinary, and digestive organs, and its ability to both contract and relax is what allows for urination, defecation, and sexual intercourse (4). While too little tension in the pelvic floor is easily diagnosed, especially in women who have given birth, non-relaxing pelvic floor muscles are less obvious (4, 5). Pelvic floor dysfunction can lead to pain, problems urinating and defecating, painful intercourse, pelvic floor spasms, and other disorders such as interstitial cystitis (5). Conventional treatment generally involves taking NSAIDs for pain management, improving posture, physical therapy that may include pelvic floor exercises, and massage (5). For severe cases of prolapse, surgery is often recommended (6). For women who still want to have children, muscle-plumping injections to keep the bladder opening closed is recommended to manage the symptoms over surgery (6).

Endometriosis and Conventional Treatment

Endometriosis is the chronic condition that occurs when tissue similar to the lining of the uterus grows outside the uterus (7). This uterine tissue can begin to grow on the ovaries, fallopian tubes, and other parts of the pelvic region. Pain and problems arise when this tissue swells and bleeds like the rest of the uterus during the menstrual cycle, leading to inflammation, cysts, and scar tissue (7). Endometriosis is commonly known to cause pain, excessive cramping, irregular or heavy bleeding, infertility, and digestive issues (7,8). Because this condition is worsened by menstruation, hormone therapy (either contraceptives, gonadotropin-releasing hormone (GnRH) agonists, or danazol (synthetic testosterone)), combined with NSAIDs, is usually the recommended treatment, though surgery is another alternative (8).