Pelvic Pain After Menopause: Causes and Solutions

Lower abdominal issues?

Hello Doctor: Several years ago, I began experiencing lower abdominal pain during my monthly ovulation, which extended to a feeling of heaviness in the rectal area.
After a gynecological examination, I was diagnosed with adenomyosis.
Since I was in my 50s at the time, the doctor believed I would soon reach menopause and recommended treatment with leuprolide until menopause was achieved.
Before the treatment, my menstrual cycle was normal, the blood flow was also normal, and there were no signs of menopause; my hormone levels were normal with no indications of decline.
I received injections for two years until last year when my menstruation stopped.
I thought everything would be fine from then on, but after menopause, I started experiencing pain not during ovulation but rather a dull ache in the lower right abdomen after standing for long periods or after bowel movements, which sometimes extends to the right posterior pelvis and occasionally presents as a heaviness in the rectal area.
Each time after a bowel movement, I experience soreness that requires me to lie down for 1 to 2 hours for relief.
Upon returning to the gynecologist, the doctor suspected pelvic congestion and prescribed medication, but there has been no improvement.
I would like to ask if you have any different opinions or suggestions? Thank you.

Ms. Chen, 60~69 year old female. Ask Date: 2022/04/22

Dr. Zhang Kunmin reply Obstetrics and Gynecology

Hello, the reason for abdominal pain can be quite varied, making it difficult to diagnose based on your description.
I recommend consulting a gynecologist to evaluate for adenomyosis or any changes in the pelvis.
Additionally, you may want to see a gastroenterologist or a colorectal specialist for further examination.
Thank you! Wishing you peace and good health.
Dr.
Chang

Reply Date: 2022/04/22

More Info

Pelvic pain after menopause can be a complex issue, often stemming from a variety of causes. In your case, the history of adenomyosis and the subsequent hormonal treatment you received may have contributed to the development of pelvic pain symptoms post-menopause. Understanding the potential causes and exploring solutions is essential for managing your discomfort.

Causes of Pelvic Pain After Menopause
1. Hormonal Changes: After menopause, the body experiences a significant drop in estrogen levels, which can lead to various symptoms, including pelvic pain. Estrogen plays a crucial role in maintaining the health of pelvic tissues, and its deficiency can lead to atrophy of the vaginal and pelvic tissues, causing discomfort.

2. Adenomyosis: Given your previous diagnosis of adenomyosis, it's possible that remnants of this condition could still be causing pain. Adenomyosis involves the presence of endometrial tissue within the uterine muscle, which can lead to chronic pain, especially during certain activities like standing for long periods or during bowel movements.

3. Pelvic Floor Dysfunction: After menopause, pelvic floor muscles may weaken, leading to dysfunction. This can manifest as pain during activities that put pressure on the pelvic area, such as standing or straining during bowel movements.

4. Pelvic Congestion Syndrome: This condition involves chronic pelvic pain due to varicose veins in the pelvic region. It can cause pain that worsens with prolonged standing and may be associated with a feeling of heaviness or aching in the pelvic area.

5. Gastrointestinal Issues: Sometimes, pelvic pain can be referred from gastrointestinal problems, such as constipation or irritable bowel syndrome (IBS). The pain you experience after bowel movements could be related to these conditions.

6. Other Gynecological Conditions: Conditions such as ovarian cysts, fibroids, or even pelvic inflammatory disease (PID) can also cause pelvic pain. Although these are less common post-menopause, they should not be ruled out.

Solutions and Management Strategies
1. Consultation with a Specialist: Since your gynecologist has already prescribed medication without improvement, it may be beneficial to seek a second opinion from a pelvic pain specialist or a gastroenterologist. They can provide a comprehensive evaluation and explore other potential causes of your pain.

2. Physical Therapy: Pelvic floor physical therapy can be highly effective for managing pelvic pain. A trained therapist can help strengthen pelvic floor muscles, improve flexibility, and teach relaxation techniques that may alleviate pain.

3. Pain Management Techniques: Non-steroidal anti-inflammatory drugs (NSAIDs) can help manage pain. Additionally, alternative therapies such as acupuncture or mindfulness-based stress reduction may provide relief.

4. Hormonal Treatments: If hormonal changes are contributing to your pain, discussing the possibility of low-dose hormone replacement therapy (HRT) with your healthcare provider may be beneficial. HRT can help alleviate some of the symptoms associated with estrogen deficiency.

5. Dietary Adjustments: If gastrointestinal issues are suspected, dietary changes, such as increasing fiber intake or avoiding trigger foods, may help alleviate symptoms. Keeping a food diary can help identify any correlations between diet and pain.

6. Lifestyle Modifications: Incorporating regular exercise, maintaining a healthy weight, and practicing good bowel habits can also contribute to overall pelvic health and may reduce pain.

7. Mind-Body Approaches: Techniques such as yoga, meditation, and deep breathing exercises can help manage chronic pain by reducing stress and promoting relaxation.

Conclusion
Pelvic pain after menopause can arise from various factors, including hormonal changes, previous gynecological conditions, and pelvic floor dysfunction. A multidisciplinary approach involving specialists, physical therapy, pain management, and lifestyle modifications can provide relief. It’s essential to communicate openly with your healthcare providers about your symptoms and treatment preferences to find the most effective management plan for your situation.

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