Lower Body Pain in Postmenopausal Women: Causes and Solutions

Pelvic pain

Hello, doctor! My mother is 63 years old and has been in menopause for over 10 years.
She has been in poor health, with a history of hypertension, diabetes, adrenal adenoma, and a previously excised maxillary pleomorphic adenoma.
She also experienced upper gastrointestinal bleeding and was hospitalized in the intensive care unit due to influenza in 2016, during which she required ECMO and received nearly 60 units of blood.
Although her life was saved, she developed some complications.
Due to the ECMO and the extensive use of steroids, she suffered severe bone loss, and less than two months after discharge, she experienced a vertebral compression fracture and underwent two procedures for vertebroplasty.
Shortly thereafter, she began to complain of pain in her lower body, both during bowel movements and urination, which has been quite distressing for her.
Over the past year, we have taken her to see various gynecologists and urologists at both local clinics and major hospitals, undergoing numerous tests, but they have mostly indicated that there are no significant issues, aside from a small amount of bacteria in her urine.
She has been prescribed several courses of antibiotics, but there has been no improvement.
I wonder if you have any suggestions?

Ai Yo Wei, 30~39 year old female. Ask Date: 2018/06/08

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, I have been experiencing pain in my lower body and have visited various clinics and major hospitals' obstetrics and gynecology departments over a dozen times.
They indicated that there shouldn't be any major issues, and it may be due to changes related to menopause.
Generally, pain relievers can be used to manage the discomfort.
Wishing you good health.

Reply Date: 2018/06/08

More Info

Understanding lower body pain in postmenopausal women, especially in the context of your mother's complex medical history, requires a multifaceted approach. Given her age and the various health issues she has faced, including osteoporosis due to steroid use, it is crucial to consider both musculoskeletal and systemic factors that could contribute to her discomfort.

Firstly, the pain your mother is experiencing in her lower body could be attributed to several causes. Osteoporosis, which she has developed as a side effect of steroid treatment, significantly increases the risk of fractures and can lead to chronic pain. The vertebral compression fractures she experienced could also be a source of referred pain, affecting her lower body. Additionally, the loss of bone density can lead to changes in posture and gait, which may further exacerbate pain in the hips, pelvis, and lower back.

Moreover, the history of urinary tract infections (UTIs) and the presence of bacteria in her urine could suggest a chronic infection or inflammation in the urinary tract, which can sometimes manifest as pelvic or lower abdominal pain. While antibiotics have been prescribed, the persistence of symptoms indicates that there may be an underlying issue that has not been fully addressed. Conditions such as interstitial cystitis or bladder pain syndrome could be considered, especially if the pain is associated with urinary urgency or frequency.

Given her extensive medical history, including hypertension, diabetes, and previous surgeries, it is also essential to consider the possibility of neuropathic pain. Diabetes can lead to diabetic neuropathy, which may cause pain or discomfort in the lower extremities. This type of pain is often described as burning, tingling, or shooting, and it may not respond well to standard pain management strategies.

In terms of management, a comprehensive approach is necessary. Here are some suggestions:
1. Pain Management: Consult with a pain specialist who can evaluate her pain and consider options such as physical therapy, pain medications (including non-steroidal anti-inflammatory drugs or neuropathic pain medications), or even interventional procedures like nerve blocks.

2. Physical Therapy: A tailored physical therapy program can help strengthen the muscles around the spine and pelvis, improve mobility, and alleviate pain. A physical therapist can also provide guidance on safe exercises that consider her osteoporosis.

3. Urological Evaluation: Since there have been recurrent urinary issues, a thorough evaluation by a urologist may be warranted. This could include cystoscopy or other diagnostic tests to rule out conditions like interstitial cystitis.

4. Bone Health: Given her history of osteoporosis, it is crucial to manage her bone health proactively. This may involve medications such as bisphosphonates or denosumab, along with calcium and vitamin D supplementation. Regular bone density scans can help monitor her condition.

5. Lifestyle Modifications: Encourage her to engage in low-impact exercises, such as walking or swimming, which can help maintain mobility without putting excessive strain on her bones. Additionally, a balanced diet rich in calcium and vitamin D is essential for bone health.

6. Multidisciplinary Approach: Given the complexity of her case, a multidisciplinary team involving her primary care physician, endocrinologist, urologist, and pain management specialist may provide the best comprehensive care.

In conclusion, the persistent lower body pain your mother is experiencing is likely multifactorial, stemming from her medical history and current health status. A thorough evaluation by specialists and a coordinated care plan will be essential in addressing her symptoms and improving her quality of life. It is important to remain persistent in seeking answers and advocating for her health, as chronic pain can significantly impact overall well-being.

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