Pelvic Pain & Period Management

Menstrual problems occur in up to 80% of women in Australia. The GPs at Evoca will take the time to understand the pattern and nature of your cycle in detail, and additionally understand how this is impacting your life. Assessment of menstrual problems will commonly include a range of blood tests including hormone analysis and assessment for anaemia, as well as a pelvic ultrasound scan to try to identify an underlying cause.

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“Menstrual problems are broad and varied, and can occur in up to 80% of women in Australia

Menstrual Problems Explained

Menstrual problems are broad and varied and are categorised as follows:

  • Dysmenorrhoea (painful periods) may be caused by adenomyosis, endometriosis or pelvic infection
  • Menorrhagia (heavy periods) may be caused by benign muscle growths called fibroids arising from the uterine muscle wall, or as a result of bleeding disorders, thyroid problems, some forms of contraception and other causes
  • Oligomenorrhoea (fewer periods than expected) commonly caused by PCOS (polycystic ovarian syndrome) in which the ovaries will produce more than the usual number of follicles in each cycle. As a result of this the ability to produce a mature follicle from which an egg is released is reduced, and ovulation may be missed, causing absence of periods. Other causes include some hormonal contraceptives and hormonal therapies
  • Amenorrhoea (no periods) cessation of periods may occur for a variety of reasons including significant mental and psychological stress, significant weight loss, contraceptive use, and menopause
  • Intermenstrual bleeding (bleeding between periods) always needs to be assessed. Commonly it arises in the presence of hormonal contraception or hormonal therapy but may arise without this. Assessment seeks to rule out infection, and other causes of the bleeding for example polyps arising from the skin cells in the uterus (endometrioum)
  • Post coital bleeding (bleeding after intercourse) is another condition which always needs to be assessed. It is one of the red flag symptoms for cervical cancer, and as such cervical screening should be performed to ensure there are no pre-cancerous or cancerous changes on the cervix. Other causes include, cervical ectropion, which is a benign skin change on the cervix commonly occurring because of hormonal influence. Additionally, cervical polyps may exist, which are usually benign but should be removed. Many of the GPs at Evoca are able to remove cervical polyps, removing the need to visit a gynaecologist.
  • Dysfunctional uterine bleeding (erratic bleeding inconsistent with the menstrual cycle) occurs mostly under the influence of hormonal contraception or therapy. In the absence of this, the whole gynaecological system must be assessed alongside hormones such as thyroid hormones, must be investigated to find the cause of the bleeding

Our Pelvic Pain Services

Pelvic pain affects up to 1 in 5 women in Australia. It may arise from any of the multiple organs in the pelvis, namely, the uterus, ovaries, fallopian tubes, bladder and bowel. It can be caused by a number of conditions.

Doing a thorough assessment of the pelvic pain is key to finding the cause, formulating the diagnosis, and then providing treatment. Your GP at Evoca will take the time to gather a full and extensive history, understanding your symptoms well before arranging any necessary investigations. Once your GP has an

understanding of your history and symptoms, they will provide options for treatment, or a referral if necessary. Managing pelvic pain often requires a multidisciplinary approach given the response of the pelvic muscles to pain arising from the pelvic organs, as well as the brain’s response to this. As such your GP at Evoca may also refer you on to specialist pelvic floor physiotherapists and psychologists to help in the holistic management of the pain. See below for a list of types of pelvic pain:

  • Menstrual pain – pain relating to periods is very common and over 90% of women experience menstrual pain at some point in their lives
  • Ovulation – many women experience lower pelvic cramping around the time of ovulation, commonly mid cycle
  • Endometriosis – this is caused when cells that line the uterus begin to grow in other parts of the body such as on the fallopian tubes, bowels and bladder. These cells undergo the same menstrual changes as those inside the uterus, however, with no means of escape, they build up and cause scarring which results in pain
  • Adenomyosis – this is similar to endometriosis, but the abnormal cell growth occurs in the muscular wall of the uterus, and giving rise to similar symptoms, and additionally painful heavy periods with painful intercourse
  • Pelvic muscle pain – muscles in and around the pelvis may contract in response to pain arising from any of the organs in the pelvis. This contraction, though initially intermittent can become more constant and give rise to constant pelvic pain
  • Pelvic infection/inflammation – this commonly arises from STIs which haven’t been treated in a timely manner, though can occur from other infective sources. The infection is initially low down in the genital tract in the vagina, which then ascends and involves the cervix followed by the uterus and fallopian tubes. The inflammation arising from the infection causes pain
  • Vulval pain – the external party of the female genitalia including the clitoris and labia can become painful as a result of irritation, infection, inflammation and trauma. While this is usually a transient symptom and can be resolved when the cause is identified and treated, occasionally vulvodynia (vulva pain) can become chronic in nature and sever, affecting the ability to use tampons or even have intercourse. In this scenario a condition called vaginismus may arise in which the vagina also becomes painful in these scenarios
  • Recurrent UTI – repeated urinary tract infections can cause chronic pelvic pain
  • Intersitital cystitis – this occurs as a result of chronic inflammation of the bladder lining without urinary tract infection, but usually with symptoms of such, for example urgency and frequency of urination and pain on passing urine, usually in the bladder or pelvic area
  • Bowel problems – conditions which cause pain in the bowel such as Irritable Bowel Syndrome (IBS), Inflammatory Bowel Disease (IBD), and chronic constipation, can also cause pain in the pelvis due to the proximity of the bowel to the pelvic organs.

 
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How to prepare for your visit

Keep a diary of your symptoms noting relieving and exacerbating factors or triggers

Keep a diary of your menstrual cycle so that your GP can correlate this with your symptoms. Details such as dates, length, and details of flow are important

Consider and score your pain on a scale of 0-10, with 0 being no pain at all and 10 being the worst you have ever experienced

Come prepared to talk about how these symptoms affect your life day to day, including sexual function, bowel function and bladder function. This will help us tailor a management plan to improve your symptoms.

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Katie Harris is an Accredited Practicing Di...
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Natasha Lim

Dietitian

Completing her Master of Dietetics Studies ...
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Chrissy Eze

Counsellor

Robina, QLD 4226
Chrissy is a compassionate and dedicated pr...
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Dr Gayathri Kosaka

General Practitioner

Oxley QLD 4075
After completing her medical degree and int...
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Dr Olivia Waturuocha

General Practitioner

Springfield, QLD 4300
With initial post graduate training in psyc...
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Dr Rachael Norman

General Practitioner

Southport QLD 4215
Dr Rachael Norman obtained her medical degr...
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Dr Rashida Perveen

General Practitioner

Springfield, QLD 4300
Dr. Rashida Perveen is a versatile General ...
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Dr Samantha Taylor

General Practitioner

Springfield, QLD 4300
Dr. Samantha Taylor studied medicine at the...
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Dr Sanda Bonchis

General Practitioner

Springfield, QLD 4300
Graduating in Romania in 1990, Dr Sanda tra...
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Dr Swati Sharma

General Practitioner

Springfield, QLD 4300
After obtaining her medical degree from Mah...
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Dr. Audris Wong

Specialist Obstetrician and Gynaecologist

Robina, QLD 4226
Dr Audris Wong is an experienced specialist...
Dr. Caroline van der Vlugt

General Practitioner

Robina, QLD 4226
Graduating from the University of Cape Town...
Dr. Fatima Elnaggar

General Practitioner

Victoria Point, QLD 4165
Dr Fatima has been working in Australia for...
Dr. Jay Kotecha

General Practitioner

Robina, QLD 4226
After completing his medical training in th...
Dr. Jennifer Cortez

General Practitioner

Robina, QLD 4226
In 2005, Dr Jennifer finished her obstetric...
Dr. Jody Waters

General Practitioner

Victoria Point, QLD 4165
Dr Jody Waters acquired her Bachelor of Med...
Dr. Shilpi Wahi

General Practitioner

Victoria Point, QLD 4165
An experienced General Practitioner,...
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Katie Harris

Dietitian

Katie Harris is an Accredited Practicing Di...
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Natasha Lim

Dietitian

Completing her Master of Dietetics Studies ...
Dr Alison Clarke

General Practitioner

Norwood SA 5067
Dr Alison Clarke has worked in various Gene...
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Dr Nevin Gabra

General Practitioner

Norwood SA 5067
Dr. Nevin Gabra, a fellow of the Royal Aust...
Dr. Ignatius Oyugbo

General Practitioner

Modbury, SA 5092
With 25 years of experience in medicine, Dr...
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Katie Harris

Dietitian

Katie Harris is an Accredited Practicing Di...
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Khush Kaur

Physiotherapist

Modbury, SA 5092
An APA Titled Sports & Exercise Physiothera...
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Natasha Lim

Dietitian

Completing her Master of Dietetics Studies ...
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Dr Alicia Altson

General Practitioner

Highett, VIC 3190
Beginning her studies at Melbourne Universi...
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Dr Amatun Rashid

General Practitioner

Craigieburn, VIC 3064
Having been a doctor for more than sixteen ...
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Dr Ann Marie Uy Kimpang

General Practitioner

Werribee, VIC 3030
Obtaining her medical degree, along with sp...
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Dr Bindi Sethi

General Practitioner

Ringwood, VIC 3134
After completing her medical degree in 2001...
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Dr Cindy Sun

General Practitioner

Narre Warren, VIC 3805
Dr. Cindy graduated from Monash University ...
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Dr Donna Nobleta

General Practitioner

Moonee Ponds VIC 3039
Having graduated from Davao Medical School ...
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Dr Elahe Arbabiaval

General Practitioner

Werribee, VIC 3030
Dr Elahe has been a Doctor for 10+ years. S...
Dr Faiza Mehfooz

General Practitioner

Ballarat, VIC 3350
Graduating from Sindh Medical University in...
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Dr Garry McInerney

General Practitioner

Highett, VIC 3190
Having been a doctor for over 40 years, Dr ...
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Dr Josephine Salazar

General Practitioner

Ballarat, VIC 3350
A Fellow of The Royal Australian College of...
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Dr Loba Haque

General Practitioner

Ballarat, VIC 3350
Having now been a GP in Australia for 7 yea...
Dr Mahua Sharmin Huq

General Practitioner

Ballarat, VIC 3350
Graduating in Bangladesh in 2006, Dr Mahua ...
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Dr Mar Mar Thet

General Practitioner

Highett, VIC 3190
Originally graduating from Myanmar, Dr Mar ...
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Dr Mokhlesur Rahman

General Practitioner

Melton VIC 3337
Graduating from Dhaka University, Banglades...
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Dr Myra Kamene Mpungu

General Practitioner

Werribee, VIC 3030
A worldly woman, Dy Myra grew up in Mombasa...
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Dr Nicola Cahill

General Practitioner

Ballarat, VIC 3350
Completing her medical degree at the Univer...
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Dr Parastoo Eijadi

General Practitioner

Ringwood, VIC 3134
Graduating in 2004 from Azad Medical Univer...
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Dr Rahul Verma

General Practitioner

Werribee, VIC 3030
Dr. Rahul finished his medical studies in I...
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Dr Regina Cabuang

General Practitioner

Frankston VIC 3199
Completing her degree in 1999 in the Philip...
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Dr Sheila Manmathan

General Practitioner

Frankston VIC 3199
Dr. Sheila Manmathan graduated from St. Bar...
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Dr Shoma Chowdhury

General Practitioner

Narre Warren, VIC 3805
Completing her MBBS degree in 2003 in Bangl...
Dr Sidra Imtiaz

General Practitioner

Ballarat, VIC 3350
Graduating from the University of Health Sc...
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Dr Sudhish Sudhan

General Practitioner

Craigieburn, VIC 3064
During his internship in Kerala State in In...
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Dr Sue-Ann Steer

General Practitioner

Highett, VIC 3190
Initially completing her MBBS medical degre...
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Dr Sushma Chaparala

General Practitioner

Melton VIC 3337
Having previously worked in India and the U...
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Dr Sushma Chaparala

General Practitioner

Moonee Ponds VIC 3039
Having previously worked in India and the U...
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Dr Thandar san

General Practitioner

Frankston VIC 3199
Dr. Thandar San graduated from Myanmar in 2...
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Dr Thomas Shashian

General Practitioner

Narre Warren, VIC 3805
Graduating from Flinders University in 2002...
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Dr Zulaiha Ghazaly

General Practitioner

Werribee, VIC 3030
Dr. Zulaiha hails from Sri Lanka and pursue...
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Dr. Clare Oliver

General Practitioner

Werribee, VIC 3030
Dr Clare Oliver completed her medical degre...
Dr. Imelda Te

General Practitioner

Preston, VIC 3072
Originally finishing her medicine degree in...
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Dr. Jin Gao

General Practitioner

Epping Plaza, VIC 3076
Dr. Jin Gao is a compassionate and dedicate...
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Dr. Jin Gao

General Practitioner

Preston, VIC 3072
Dr. Jin Gao is a compassionate and dedicate...
Dr. Palmyra de Banks

Clinical Director - VIC

General Practitioner

Preston, VIC 3072
Dr Palmyra has been a doctor for more than ...
Dr. Vidya Prabhu

General Practitioner

Epping Plaza, VIC 3076
With more than 12 years’ experience as a ...
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Katie Harris

Dietitian

Katie Harris is an Accredited Practicing Di...
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Natasha Lim

Dietitian

Completing her Master of Dietetics Studies ...
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Dr Danise Theron

General Practitioner

Rockingham, WA 6168
A wealth of knowledge and expertise, Dr Dan...
Dr Sid Viswanath

General Practitioner

Rockingham, WA 6168
Dr. Sid has been working in Australian gene...
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Dr Thinn Soe

General Practitioner

Morley, WA 6062
Dr Thinn Soe has dedicated over 3 years to ...
Dr. Gagandeep Kundal

General Practitioner

Rockingham, WA 6168
Completing his medical degree in India (Amrtistar) in 2002, Dr Gagandeep br...
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Katie Harris

Dietitian

Katie Harris is an Accredited Practicing Di...
Natasha-Lim-400
Natasha Lim

Dietitian

Completing her Master of Dietetics Studies ...

FAQ’s

Management of pelvic pain comes down to first identifying the cause. In some cases, this may take time to identify. Pelvic pain can be managed by a number of different modalities ranging from TENS, acupuncture and simple pain control, to nerve injections and pelvic floor physiotherapy

Not necessarily. Pelvic pain can arise for a number of reasons and from a number of sources, so it isn’t always caused by endometriosis. All the organs in the pelvic area have the potential to cause pain as well as the ligaments nerves and muscles in the area too.

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