Pelvic pain can be difficult to explain.
Maybe your periods have always been painful. Maybe you’ve started experiencing pressure or discomfort that wasn’t there before. Perhaps sex has become painful, or you’re dealing with heavy bleeding, bloating, or pain that seems to have no obvious cause.
For many women, these symptoms are initially dismissed as “normal period pain” or something they simply have to live with.
But persistent or severe pelvic pain deserves attention.
Fibroids, endometriosis, and other gynecologic conditions can cause similar symptoms, making it difficult to determine the underlying cause based on symptoms alone. A thorough evaluation can help uncover what’s really happening and identify treatment options.
At Michigan Women’s Care, women in Canton, Plymouth, Dearborn, and surrounding western Wayne County communities have access to comprehensive gynecologic care, including evaluation and treatment for conditions that can cause pelvic pain.
Pelvic Pain Isn’t Always “Just Period Pain”
Some cramping around your period can be normal.
But pain that is severe, persistent, worsening, or interfering with your everyday life is worth discussing with an OB/GYN.
Pelvic pain may feel like:
- Cramping or aching
- Sharp or stabbing pain
- Pressure or heaviness
- Pain during or after sex
- Lower abdominal or back pain
- Pain during bowel movements
- Pain with urination
- Pain that worsens around your period
- Pain that occurs even when you’re not menstruating
The location and timing of pain can provide clues, but they don’t always reveal the cause.
That’s why a detailed evaluation matters.
Fibroids: When Growths in the Uterus Cause Symptoms
Uterine fibroids are common, noncancerous growths that develop in or around the uterus.
Some women have fibroids without experiencing any symptoms. Others may have significant problems depending on the size, number, and location of the fibroids.
Common symptoms can include:
- Heavy menstrual bleeding
- Longer periods
- Pelvic pressure
- Pelvic pain
- Abdominal fullness or enlargement
- Frequent urination
- Constipation
- Pain during sex
- Difficulty becoming pregnant in some circumstances
Fibroids can develop within the uterine wall, beneath the uterine lining, or on the outside of the uterus.
Their location can influence the symptoms they cause.
For example, fibroids that grow toward the inside of the uterus may contribute to heavy or irregular bleeding, while larger fibroids may create pressure on nearby organs.
Endometriosis: When Tissue Outside the Uterus Causes Pain
Endometriosis is a condition in which tissue similar to the lining of the uterus grows outside the uterus.
It can affect the pelvic organs and cause inflammation and pain.
Symptoms may include:
- Severe menstrual cramps
- Pelvic pain
- Pain during or after sex
- Pain with bowel movements
- Pain with urination, particularly during menstruation
- Heavy or irregular periods
- Fatigue
- Difficulty becoming pregnant
One challenge with endometriosis is that symptoms can vary significantly from woman to woman.
Some women experience severe pain with relatively limited disease, while others may have extensive endometriosis with fewer symptoms.
A lack of obvious findings on an initial examination doesn’t necessarily mean your pain isn’t real.
Fibroids vs. Endometriosis: What’s the Difference?
Fibroids and endometriosis can both cause pelvic pain and heavy or uncomfortable periods, but they are different conditions.
| Fibroids | Endometriosis |
| Noncancerous growths in or around the uterus | Tissue similar to uterine lining grows outside the uterus |
| Can cause heavy or prolonged bleeding | Often causes significant menstrual and pelvic pain |
| May cause pelvic pressure or fullness | Can cause pain during sex or bowel movements |
| May cause frequent urination or constipation | Can cause pain outside the menstrual period |
| Often visible on pelvic imaging | Diagnosis can sometimes be more complex |
Having one condition doesn’t necessarily mean you have the other. Some women can have both.
This is one reason an individualized evaluation is important.
Other Causes of Pelvic Pain
Fibroids and endometriosis aren’t the only possible explanations for pelvic pain.
Other causes can include:
- Adenomyosis
- Ovarian cysts
- Uterine or cervical polyps
- Pelvic floor conditions
- Urinary tract conditions
- Gastrointestinal conditions
- Pelvic infections
- Adhesions or scar tissue
- Hormonal changes
Because symptoms overlap across many conditions, diagnosing pelvic pain can sometimes require looking at the bigger picture.
Symptoms You Shouldn’t Ignore
Consider scheduling an appointment with an OB/GYN if you experience:
- Severe menstrual pain
- Pelvic pain that interferes with daily activities
- Pain that is getting worse over time
- Pain during or after sex
- Heavy menstrual bleeding
- Bleeding between periods
- Persistent pelvic pressure
- Pain with bowel movements or urination
- Unexplained infertility
- Pelvic pain that continues after your period ends
You don’t need to wait until the pain becomes unbearable.
If your symptoms are affecting your quality of life, that’s enough reason to seek an evaluation.
What Does a Thorough Evaluation Look Like?
A good evaluation starts with listening.
Your provider will want to understand more than just where it hurts.
You may be asked:
- When did the pain begin?
- Where exactly do you feel it?
- Is it constant or intermittent?
- Does it occur during your period?
- How severe is the pain?
- Does anything make it better or worse?
- Do you experience pain during sex?
- Do you have heavy or irregular bleeding?
- Do you experience bowel or urinary symptoms?
- Have you had previous surgeries or pregnancies?
- Are you trying to become pregnant?
These details can help your provider identify patterns and determine which diagnostic steps may be appropriate.
Diagnostic Tools Can Help Find the Cause
Depending on your symptoms and medical history, your provider may recommend different types of evaluation.
Pelvic Examination
A pelvic examination can provide important information about the uterus, ovaries, cervix, and surrounding pelvic structures.
Your provider may look for tenderness, changes in the size or position of pelvic organs, or other findings that could help explain your symptoms.
Ultrasound
Pelvic ultrasound is commonly used to evaluate the uterus and ovaries.
It can help identify conditions such as fibroids, ovarian cysts, and other structural abnormalities.
Ultrasound can be an important part of the diagnostic process, but it doesn’t necessarily identify every cause of pelvic pain.
Hysteroscopy
Hysteroscopy allows a physician to look directly inside the uterus using a thin, lighted instrument called a hysteroscope.
It can be used to evaluate the uterine cavity and identify abnormalities such as certain polyps or fibroids.
In some situations, hysteroscopy can also allow treatment of an abnormality during the same procedure.
Laparoscopy
Laparoscopy is a minimally invasive surgical procedure that allows a physician to examine the pelvic and abdominal organs using a small camera inserted through a small incision.
It can be particularly useful when conditions such as endometriosis are suspected and other evaluations have not provided a clear explanation for symptoms.
Whether hysteroscopy, laparoscopy, or another diagnostic approach is appropriate depends on your individual symptoms and clinical situation. Michigan Women’s Care uses advanced techniques with hysteroscopy, laparoscopy, and robotic surgery to pinpoint the cause. We create a program of care, including medical, surgical and supportive options to reach the desired outcomes.
Why a Listening-First Approach Matters
When you’ve been experiencing pelvic pain for months or years, you may already have a long list of things you’ve tried.
You may also have heard that painful periods are normal, that your symptoms are “just hormones,” or that you simply need to learn to manage the discomfort.
But persistent pain deserves to be taken seriously.
A listening-first evaluation means giving you the opportunity to describe what you’re experiencing in your own words and asking questions about how your symptoms affect your life.
The goal isn’t to assume that every case of pelvic pain is endometriosis or fibroids.
It’s to investigate the possibilities and determine what makes sense based on your symptoms, history, examination, and appropriate testing.
What Happens After a Diagnosis?
Finding the cause of your symptoms is an important first step, but it isn’t the final one.
Treatment depends on the condition involved, the severity of your symptoms, your age, overall health, and your reproductive goals.
Depending on the diagnosis, treatment may include:
- Medication
- Hormonal therapy
- Pain management
- Observation and monitoring
- Minimally invasive procedures
- Hysteroscopy
- Laparoscopy
- Surgical treatment
Your provider can explain the available options and help you understand the potential benefits and risks of each approach.
If preserving fertility is important to you, make sure your provider knows. Treatment decisions can often be influenced by whether you’re hoping to become pregnant in the future.
When Pelvic Pain Affects Your Life, It’s Time to Get Answers
You shouldn’t have to organize your life around your pain.
You shouldn’t have to routinely miss work or social activities because of your period. You shouldn’t have to avoid intimacy because sex hurts. And you shouldn’t have to accept severe pelvic pain simply because you’ve been experiencing it for a long time.
Fibroids, endometriosis, and other gynecologic conditions can be complex, and finding the cause isn’t always immediate.
But seeking an evaluation gives you the opportunity to understand what’s happening and explore treatment options.
Michigan Women’s Care provides comprehensive gynecologic care for women in Canton, Plymouth, Dearborn, and surrounding western Wayne County communities, including evaluation and treatment for conditions that can cause pelvic pain and abnormal bleeding.
If you’ve been searching for answers, the next step can start with a conversation.
Frequently Asked Questions About Fibroids, Endometriosis, and Pelvic Pain
Are painful periods normal?
Mild cramping can be a normal part of menstruation. However, severe pain that interferes with work, school, relationships, exercise, or daily activities should be evaluated by a healthcare provider.
Can fibroids cause pelvic pain?
Yes. Fibroids can cause pelvic pressure, discomfort, abdominal fullness, and pain. They can also contribute to heavy or prolonged menstrual bleeding.
What does endometriosis pain feel like?
Endometriosis pain can vary. Some women experience severe menstrual cramps, while others have pelvic pain throughout the month, pain during sex, or pain with bowel movements or urination. The severity and pattern of symptoms can differ significantly between individuals.
Can you have both fibroids and endometriosis?
Yes. Fibroids and endometriosis are separate conditions, but they can occur in the same person. Because symptoms can overlap, a thorough evaluation can help identify whether one or more conditions may be contributing to your symptoms.
Can an ultrasound detect endometriosis?
Ultrasound can help identify some findings associated with endometriosis and can also help rule out or identify other pelvic conditions. However, endometriosis is not always visible on standard imaging. Your provider will determine whether additional evaluation is appropriate based on your symptoms and other findings.
What is a hysteroscopy?
A hysteroscopy is a procedure that allows a physician to view the inside of the uterus using a thin, lighted instrument. It may be used to evaluate or treat certain abnormalities within the uterine cavity, including some polyps and fibroids.
What is a laparoscopy?
Laparoscopy is a minimally invasive surgical procedure that uses a small camera to examine the pelvic and abdominal organs. It may be used when conditions such as endometriosis are suspected or when additional evaluation or treatment is needed.
Can pelvic pain affect fertility?
Some conditions associated with pelvic pain, including endometriosis and certain types of fibroids, may affect fertility. If you’re experiencing pelvic pain and are trying to become pregnant, tell your OB/GYN so your evaluation and treatment options can take your reproductive goals into account.
When should I see a gynecologist for pelvic pain?
Make an appointment if your pelvic pain is persistent, severe, worsening, occurs outside your period, interferes with daily life, or is accompanied by heavy bleeding, painful sex, bowel or urinary symptoms, or difficulty becoming pregnant.
What if I’ve been told my pelvic pain is normal?
If your pain is significantly affecting your quality of life, it’s reasonable to seek another evaluation. Menstrual and pelvic pain can have many causes, and an experienced gynecologist can help determine whether additional evaluation is warranted.
When is pelvic pain an emergency?
Sudden or severe pelvic pain, particularly when accompanied by fainting, significant weakness, fever, heavy bleeding, vomiting, or possible pregnancy, may require urgent medical evaluation. If you are experiencing severe or rapidly worsening symptoms, seek immediate medical care rather than waiting for a routine appointment.
