What are the most common causes of chronic pelvic pain in women?

The most common gynecologic causes include endometriosis, adenomyosis, uterine fibroids, ovarian cysts, and pelvic adhesions. Non-gynecologic causes — including pelvic floor dysfunction, irritable bowel syndrome, interstitial cystitis, and musculoskeletal issues — are also common and frequently coexist.

When should pelvic pain be evaluated urgently?

Seek urgent evaluation for sudden severe pelvic pain, pain with fever or chills, pain with heavy vaginal bleeding, pain with fainting or dizziness, or pain in a known or possible pregnancy. These may indicate ectopic pregnancy, ovarian torsion, or pelvic infection.

Can pelvic pain be caused by something other than the reproductive organs?

Absolutely. The pelvis contains the reproductive organs, bladder, bowel, pelvic floor muscles, and multiple nerve networks. Pelvic floor tension, bladder conditions, bowel disorders, nerve sensitization, and prior trauma can all cause or worsen pelvic pain.

Does pelvic pain always require surgery to diagnose or treat?

No. Many causes of pelvic pain can be diagnosed and managed without surgery through clinical history, pelvic exam, advanced ultrasound, lab work, and medical therapy. Surgery is considered when diagnosis is unclear after non-invasive workup or when surgical treatment is the most appropriate option.

Pelvic Pain Specialist

Q: Is physical therapy helpful for pelvic pain?

Yes. Pelvic floor physical therapy is one of the most effective non-surgical treatments for many types of pelvic pain, especially when pelvic floor muscle tension or dysfunction is contributing. It is often recommended alongside medical or surgical treatment.

Your Pain Is Real. We Listen.

Pelvic pain is one of the most common — and most often misunderstood — concerns in women's health. Many women go years without answers, sometimes told their pain is "normal," "just hormonal," or "something they have to live with."

At Haven OBGYN, we believe your pain is real, valid, and deserves thoughtful, expert evaluation.

Our Approach to Pelvic Pain

Our goal is to understand the source of your pain, help ease your symptoms, and support your quality of life with compassion and evidence-based care.

Compassionate Listening

Advanced 2D & 3D Ultrasound

Evidence-Based Therapies

Minimally Invasive Surgery

Personalized Treatment Plans

Clear Communication and Shared Decision-Making

When to See a Pelvic Pain Specialist

We encourage evaluation if pain is affecting your daily life, including:

Chronic pelvic pain (lasting 6+ months)

Painful periods (dysmenorrhea)

Pain with intercourse

Pain with bladder filling

Pain with bowel movements

Pain between periods

Pelvic pressure or heaviness

Ovulation pain

Pain after childbirth or surgery

Common Causes of Pelvic Pain

Pelvic pain often has multiple contributing factors. We evaluate the full range of gynecologic causes, including:

Endometriosis

Painful periods, chronic pelvic pain, fertility challenges. May require laparoscopic evaluation and treatment.

Adenomyosis

Heavy bleeding, cramping, chronic pain. 3D ultrasound can provide helpful features for evaluation.

Ovarian Cysts

Sharp or dull pain, bloating, irregular cycles.

Fibroids

Pelvic pressure, heavy bleeding, cramping.

Pelvic Floor Dysfunction

Pain with intercourse, postpartum discomfort, burning or tension.

Musculoskeletal & Scar Tissue

Pain after childbirth, trauma, or prior surgery.

Your pain deserves attention, understanding, and a thorough evaluation.

Our Diagnostic Approach

We begin with your story and a focused, respectful examination.

Detailed History & Symptom Discussion

Exploring patterns, triggers, hormonal influences, severity, and impact on daily life.

Trauma-Informed Pelvic Exam

Only when appropriate and always with consent. Comfort, privacy, and communication are central.

2D + 3D Pelvic Ultrasound

Ultrasound helps assess:

Fibroids
Ovarian cysts
Adenomyosis features
Endometrial concerns
Structural abnormalities

3D ultrasound provides enhanced detail that may help in evaluating:

Adenomyosis features
Uterine anomalies
Subtle fibroids
Cavity differences
Surgical planning needs

Learn About Our Ultrasound

Laboratory Testing

Thyroid function, hormone levels, infectious testing, inflammatory markers (when indicated).

Evaluation for Overlapping Conditions

Pelvic floor dysfunction, bladder pain syndrome, GI conditions — we look at the whole picture, not just one organ system.

How We Treat Pelvic Pain

1

Lifestyle & Medical Management

Anti-inflammatory strategies

Hormonal therapy

Cycle regulation

Pain management approaches

Pelvic floor physical therapy referral

Sexual wellness support

2

Minimally Invasive Gynecologic Surgery (MIGS)

When structural issues contribute to pain, minimally invasive surgery may help reduce symptoms and support long-term wellbeing. Surgery is only recommended when appropriate and after discussing alternatives.

Procedures may include:

Laparoscopic endometriosis excision

Minimally invasive hysterectomy

Ovarian cystectomy

Myomectomy (fibroid removal)

Hysteroscopic polyp/fibroid removal

Adhesiolysis (scar tissue removal)

These techniques can offer smaller incisions, shorter recovery, and improved visualization for diagnosis.

3

Endometriosis-Focused Treatment

Medical therapy

Hormonal management

Laparoscopic excision

Fertility counseling

Ongoing follow-up and symptom support

4

Pelvic Floor Support

For pelvic floor dysfunction or postpartum pain:

Pelvic floor physical therapy referral
Sexual wellness evaluation
Scar tissue management
Postpartum pelvic healing support

5

Perimenopause-Related Pain

Hormonal changes can exacerbate pain. We provide:

Menopause hormone therapy (when appropriate)
Non-hormonal options
Bleeding evaluation
Support for dryness and discomfort

What Makes Haven Different

We Listen

Your experience and history matter.

On-Site 2D & 3D Ultrasound

Timely evaluation without extra appointments.

MIGS Surgical Expertise

Experienced care for fibroids, endometriosis, and cysts.

Trauma-Informed Approach

Consent, respect, and comfort at every step.

Whole-Person Care

Hormones, pelvic floor, lifestyle, emotional wellbeing.

Virtual Follow-Ups

Convenient support for busy lives.

When to Seek Urgent Evaluation

Seek immediate care for:

Sudden, severe pelvic pain

Fever with pelvic pain

Fainting or dizziness

Heavy bleeding

Positive pregnancy test + pelvic pain

Known ovarian cyst with sharp, worsening pain

If you're unsure, call us — we can help guide your next steps.

Frequently Asked Questions

Common questions about pelvic pain, answered by Dr. Nikita Mishra

Chronic pelvic pain has many possible causes, often overlapping. The most common gynecologic causes include endometriosis, adenomyosis, uterine fibroids, ovarian cysts, and pelvic adhesions from prior surgery or infection. Non-gynecologic causes — such as pelvic floor dysfunction, irritable bowel syndrome, interstitial cystitis, and musculoskeletal issues — are also common and frequently coexist. A thorough evaluation is essential to identify the full picture.

Seek urgent evaluation if you experience sudden severe pelvic pain, pain with fever or chills, pain with heavy vaginal bleeding, pain accompanied by fainting or dizziness, or pain in a known or possible pregnancy. These symptoms may indicate an ectopic pregnancy, ovarian torsion, or pelvic infection — all of which require prompt medical attention.

Absolutely. The pelvis contains the reproductive organs, bladder, bowel, pelvic floor muscles, and multiple nerve networks — any of which can contribute to pain. Pelvic floor muscle tension, bladder conditions, bowel disorders, nerve sensitization, and even prior trauma can all cause or worsen pelvic pain. This is why a multidisciplinary approach — often including pelvic floor physical therapy — is part of comprehensive pelvic pain care.

Yes — pelvic floor physical therapy is one of the most effective non-surgical treatments for many types of pelvic pain, especially when pelvic floor muscle tension, spasm, or dysfunction is contributing. It is often recommended alongside medical or surgical treatment, not instead of it. At Haven OBGYN, we regularly coordinate care with pelvic floor physical therapists as part of an integrated treatment plan.

No. Many causes of pelvic pain can be diagnosed and managed without surgery — through a combination of clinical history, pelvic exam, advanced ultrasound, lab work, and a trial of medical therapy. Surgery (such as laparoscopy) is considered when the diagnosis remains unclear after non-invasive workup, when symptoms are severe and not responding to medical treatment, or when surgical treatment is the most appropriate option for an identified condition.

Understanding Endometriosis

You Don't Have to Live With Pelvic Pain

You deserve answers, relief, and compassionate care. Schedule a pelvic pain evaluation today.

Request Appointment (916) 269-8865