It is not uncommon to have discomfort in the pelvis at various stages of the menstrual cycle. Ovulation (release of the egg) may be associated with discomfort usually to one side or the other and may last a day or two. Some women have central low discomfort immediately prior to or at the start of their period. This discomfort often resolves with simple pain killers and does not necessarily require any investigations. More severe pain may be as a result of gynaecological problems such as infection, ovarian cysts, endometriosis, adhesions, fibroids, bladder irritation or polyps and do require investigation. Following a detailed history and examination you will usually have a swab taken to rule out infection, a urine sample checked and a pelvic ultrasound. Rarely exploratory surgery (laparoscopy/hysteroscopy) will be required. Treatment will be aimed at managing the cause.
A cyst is a fluid-filled sac. It is entirely normal to find cysts on the ovary and most are as a result of a normal functioning ovary. Immediately before an egg is released it will be contained within a cyst measuring up to 2.5cms in diameter. Again just before a period a cyst will usually be found on the ovary as it is this cyst that will produce hormones to support an early pregnancy should this occur. These ‘functional cysts’ are not of any concern.
Occasionally these cysts will grow a little too big and may cause symptoms (pelvic pain or pain during intercourse). They often disappear without treatment, although if the symptoms are severe the cysts can be removed. Other types of cyst may develop on the ovaries which are not part of the normal functioning of the ovary. Such cysts include endometriomas, cystadenomas and dermoid cysts. Cysts may cause pressure or a sense of fullness in the tummy, pain, difficulty passing urine or irregular bleeding. A cyst may be evident on examination but will definitely be visible via pelvic ultrasound.
Fibroids are known as ‘leiomas’ and are benign (non-cancerous) growths in the muscle and connective tissue of the womb. They affect approximately 1 in 4 women. Whilst many women do not know they have them, fibroids can sometimes cause troublesome symptoms. They can cause heavy and painful periods, anaemia, pressure on the bladder or bowels, a sensation of a lump in the tummy or problems with pregnancy.
Whilst it may not be necessary to treat fibroids if they do not cause any problems, some women do require treatment. The type of treatment chosen will depend on the individual symptoms.
Polycystic Ovarian Syndrome (PCOS)
Approximately 1 in 5 women have polycystic ovaries. This is where the ovary is larger than usual and has at least 10 uniform small cysts around the edge (viewed on ultrasound). PCOS is a condition where the balance of hormones is affected causing problems such as greasy skin, acne, problematic hair growth in abnormal places (especially the face), hair loss on the scalp, irregular periods, problems with weight and problems in pregnancy. There may be longer term health concerns.
PCOS can be diagnosed on the basis of the symptoms together with a transvaginal scan or by blood test. The treatment options for PCOS depend on the individual’s specific symptoms.