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).
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).
However, in most cases of women with endometriosis and chronic pelvic pain, pain resumes 6-12 months after the treatments listed above are completed, even surgery (9). Further, over 20% of women who receive treatment don’t find relief from either the NSAIDs or hormone therapy (9). GnRH agonists are potentially the most effective of all hormonal therapies to treat endometriosis but can cause extensive side effects, including bone loss of up to 13% from only 6 months of treatment (8, 9).
Painful Periods and Conventional Treatment
Dysmenorrhea, commonly known as painful periods, are experienced by more than 50% of women at least one day a month. Primary dysmenorrhea is generally experienced at the beginning of menstruation in the form of cramps and alleviates over the course of the period (10). Secondary dysmenorrhea can cause pain before, during, and after menstruation, and generally worsens over time. It can be caused by disorders of the reproductive system, including adenomyosis (tissues that line the uterus growing in the muscle of the uterus), endometriosis, narrowing of the cervix, pelvic inflammatory disease, or fibroids (growths on the uterine wall) (10).
Similarly to endometriosis, hormonal birth control and non-steroidal anti-inflammatory drugs like ibuprofen are considered the most successful treatments for dysmenorrhea, though the evidence that hormonal birth control is effective is limited (10, 11). It is recommended that NSAIDs are taken 2-3 days before the onset of a period and continued on a regular schedule for the first 2-3 days. Other pain management options are lifestyle changes, including regular exercise and getting enough sleep (11). Surgery or other procedures may be suggested to treat underlying conditions such as fibroids or cervical narrowing.
Pelvic Congestion Syndrome and Conventional Treatment
Chronic pelvic pain that worsens throughout the day, especially when standing for long periods of time, generally points to pelvic congestion syndrome. This syndrome develops when veins of the ovaries or pelvis become enlarged, or varicose (12). Because the veins are enlarged, the valves don’t close properly and blood pools in the veins, causing pressure and pain (12, 13). Women of childbearing age who have experienced more than one pregnancy are at the highest risk of developing pelvic varicose veins (12).
As with many of the aforementioned disorders, hormonal birth control (including GnRH agonists), medication to manage pain, surgery to tie off or remove veins, and hysterectomies may be recommended (12). Embolization of the affected veins to shut off their blood supply is another option, though it is not uncommon for other veins to become varicose following this procedure if the condition is chronic (13).
Ineffectiveness and Side Effects of Common Conventional Treatments
Despite having quite a number of underlying causes, symptoms, and disorders accounted for across all types of chronic pelvic pain, nearly all of the recommended treatments involve hormonal birth control, and all involve NSAIDs for pain management.
Hormonal birth control can cause a number of side effects, including headaches, mood swings, depression, decreased libido, weight gain, and acne (14). Additionally, it is not an option for women who are trying to conceive, or for women who experience severe or intolerable side effects from hormone therapy.
Beyond that, many women don’t want to take NSAIDs on a regular basis to manage pain, and for good reason. Long-term NSAID use is linked to increased risk of serious side effects, such as stroke, heart disease, ulcers, and severe intestinal damage (15, 16). So, what options are left for these women?
Regenerative Therapies to Treat Chronic Pelvic Pain
Regenerative therapies act to promote the body’s existing healing processes in order to create long-term healing. They are safe, effective, and are an incredible option to combat chronic pelvic pain (16).
Pulsed electromagnetic field therapy (PEMF) helps revitalize cellular tissue that has been damaged or degenerated by restoring our cells’ magnetic charge to healthy levels. In terms of pelvic pain caused by endometriosis, dysmenorrhea, and other chronic disorders, PEMF provides “unusually effective and long-lasting relief” (17). In one study considering its effects on 17 women with chronic pelvic pain, all 17 women experienced a drastic improvement in 18 of the 20 recorded episodes (17). PEMF treatment is short, economical, and can prevent sufferers of chronic pelvic pain from needing hormonal birth control, GnRH agonists, surgery, or NSAIDs to manage pain (17, 18). Beyond that, it seems to make a difference in the psychosocial implications that affect pain perception in those who receive it, helping to end the vicious cycle of emotional distress and physical pain (18).
Another regenerative option is ozone clot matrix therapy (OCM). It combines ozone therapy (ozone is injected to stimulate an immune response to encourage further healing in the body) with platelet-rich plasma therapy (a patient’s own blood full of activated platelets is injected to actively stimulate healing) (16). OCM therapy is pain-relieving, anti-inflammatory, and creates an opportunity for the body to heal itself more fully than it would on its own (16, 19). In terms of pelvic pain, OCM can protect from endometriosis and other pelvic and reproductive disorders, as well as relieve pain (19). It is also used to repair the muscle and tissue degeneration that causes chronic pelvic disorders like interstitial cystitis, as well as positively affect incontinence problems that can come from many other chronic pelvic issues (20).
Stem cell therapy is a third treatment option. Since stem cells have regenerative and anti-inflammatory properties, this treatment is effective to reduce the effects of some inflammation-related pelvic disorders, including pelvic inflammatory disease or associated infertility (21).
If you are looking for long-term relief for any of the pelvic disorders mentioned in this article, or have questions about regenerative medicine, please reach out to us. Our practitioners are here to create an individualized treatment plan for you. Depending on your specific situation, we may use one specific therapy, or your treatment plan may include a combination of regenerative and functional medicine therapies as well as assistance in implementing lifestyle changes. We would be happy to set up a consultation with you to discuss our regenerative treatments and how you can achieve health and healing from chronic pelvic pain.
Jonathan Vellinga, M.D. is an Internal Medicine practitioner with a broad interest in medicine. He graduated Summa cum laude from Weber State University in Clinical Laboratory Sciences and completed his medical degree from the Medical College of Wisconsin.
Upon graduation from medical school, he completed his Internal Medicine residency at the University of Michigan. Dr. Vellinga is board-certified with the American Board of Internal Medicine and a member of the Institute for Functional Medicine.
U.S. Department of Health and Human Services. (2015, September 28). Roughly One Quarter of U.S. Women Affected by Pelvic Floor Disorders. National Institutes of Health. https://www.nih.gov/news-events/news-releases/roughly-one-quarter-us-women-affected-pelvic-floor-disorders.
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Faubion, S. S., Shuster, L. T., & Bharucha, A. E. (2012, February). Recognition and management of nonrelaxing pelvic floor dysfunction. Mayo Clinic proceedings. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3498251/.
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Osayande, A. S., & Mehulic, S. (2014, March 1). Diagnosis and Initial Management of Dysmenorrhea. American Family Physician. https://www.aafp.org/afp/2014/0301/p341.html.
Ignacio, E. A., Dua, R., Sarin, S., Harper, A. S., Yim, D., Mathur, V., & Venbrux, A. C. (2008, December). Pelvic congestion syndrome: diagnosis and treatment. Seminars in interventional radiology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3036528/.
Northwestern Medicine. Causes and Diagnoses of Pelvic Congestion Syndrome. Northwestern Medicine. https://www.nm.org/conditions-and-care-areas/cardiovascular-care/center-for-vascular-disease/vein-center/pelvic-congestion-syndrome/causes-and-diagnoses.
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ScienceDaily. (2005, January 16). Study Shows Long-term Use Of NSAIDs Causes Severe Intestinal Damage. ScienceDaily. https://www.sciencedaily.com/releases/2005/01/050111123706.htm.
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Varcaccio-Garofalo G., Carriero C., Loizzo MR, Amoruso S., Loizzi P. G. Analgesic properties of electromagnetic field therapy in patients with chronic pelvic pain. Clinical and experimental obstetrics & gynecology. https://pubmed.ncbi.nlm.nih.gov/8777794/.
Merhi, Z., Garg, B., Moseley-LaRue, R., Moseley, A. R., Smith, A. H., & Zhang, J. (2019). Ozone therapy: a potential therapeutic adjunct for improving female reproductive health. Medical gas research. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6607862/.
Ke, Q.-S., Jhang, J.-F., Lin, T.-Y., Ho, H.-C., Jiang, Y.-H., Hsu, Y.-H., & Kuo, H.-C. (2019). Therapeutic potential of intravesical injections of platelet-rich plasma in the treatment of lower urinary tract disorders due to regenerative deficiency. Ci ji yi xue za zhi = Tzu-chi medical journal. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6559029/.
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