Could my pelvic pain be caused by PCOS?
Experiencing any sort of pelvic pain, especially if you suspect it’s tied to your reproductive health, can be a huge cause for concern. Often, the pain is simply period pain, or even a stomach upset, but there are certain conditions affecting the reproductive organs that also have pelvic pain as a symptom. If you are experiencing regular or chronic pelvic pain, you may be wondering if one of these conditions affects you.
Pelvic pain is a commonly reported symptom of polycystic ovary syndrome, or PCOS. The condition, which affects one in five women in the UK,1 is an endocrine disorder caused by irregularities in hormone levels. Symptoms include undeveloped follicles, known as ‘cysts’, on the ovaries that haven’t developed into eggs, acne or oily skin, excess body hair (hirsutism), irregular or no periods, higher than normal levels of ‘male’ hormones, and infertility.
These irregular hormone levels can disrupt the entire cycle of hormonal changes needed to bring about a regular menstrual cycle, hence women with PCOS may not ovulate regularly.
Why does PCOS cause pelvic pain?
It is important to be aware that in many women, their PCOS won’t cause them pelvic pain. Diagnosis is made if a woman displays at least two of the three main symptoms of the condition: high levels of male hormones (androgens), irregular periods, and ‘cysts’. Pelvic pain is not considered a primary identifying symptom of PCOS.
Nonetheless, there are lots of reasons why you may still experience pain alongside your other PCOS symptoms, and while some claim that pelvic pain is unrelated to PCOS, anecdotal evidence of women experiencing pain alongside their symptoms cannot and should not be ignored. Studies have highlighted anecdotal evidence of women with PCOS experiencing severe cramping and/or pelvic pain,2 but little research has been done into why this occurs.
Studies have highlighted anecdotal evidence of women with PCOS experiencing severe cramping and/or pelvic pain, but little research has been done into why this occurs.
One particular study has highlighted that women with PCOS who do experience cramping don’t necessarily experience this is in conjunction with their period.3 The study concluded that more research was necessary in this area given the sudden nature and intensity of the cramping, particularly when it occurred without a period. Another study found that women with PCOS reported pain, particularly after exercise, suggesting the immature follicles on the ovaries could be causing the pain.4
Bloating and pelvic pain
Many women with PCOS report bloating as one of their symptoms, suggesting that having small cysts, increased insulin resistance (common with PCOS), or even simply having hormones that aren’t working as they should, could contribute to bloating.
Another potential cause could be the anxiety brought on by having PCOS, and studies have shown psychological disorders in women with PCOS are much higher than in the general population.5 The link between anxiety and IBS (of which bloating is a symptom) has been reported.6 As well as general discomfort, bloating can cause pelvic pain, and irritable bowel syndrome is indeed one of the most common causes of pelvic pain.7
Painful periods (dysmenorrhea)
There is a chance that your pelvic pain could be caused by particularly painful periods (dysmenorrhea). An estimated 25% of women experience dysmenorrhea, and, in many women, it can affect their day-to-day life.8 Some conditions can cause painful periods, including endometriosis, discussed in depth below. PCOS, too, can cause painful periods. This is because you may not be ovulating frequently so when you do finally have a period, it is heavy and painful, as the endometrium has had more time to build up.
There is a lot of confusion around PCOS due to the name, but ironically, having ovarian cysts isn’t necessarily a symptom of PCOS. The ‘cysts’ caused by PCOS are actually undeveloped egg follicles that start developing but never mature to release an egg, forming little nodules on the ovaries. It is possible to have lots of little cysts like these on your ovaries and not have PCOS – they can occur if you are not ovulating for another reason, and often occur with no symptoms.
If you have PCOS, you can also develop large ovarian cysts, so if you do feel sudden or dull pain when you didn’t have it previously, you should visit a doctor to rule out anything serious.
Larger ovarian cysts, which can occur with or without PCOS, are fluid-filled sacs that develop on a woman’s ovary. They are very common and rarely cause pain, or any symptoms at all, and often simply disappear of their own accord after a few months. However, symptoms can occur if a cysts ruptures, grows very large, or blocks blood supply to the ovaries, and in this case you may have severe pelvic pain — either dull and heavy or severe and sharp — and pain during sex. Ovarian cysts can also cause you to have irregular periods, so while there is some overlap in symptoms between PCOS and ovarian cysts, they are often unrelated conditions.9
If you have PCOS, you can also develop large ovarian cysts, so if you do feel sudden or dull pain when you didn’t have it previously, you should visit a doctor to rule out anything serious, as very occasionally ovarian cysts can be cancerous. If an ovarian cyst is persistent and causing symptoms it may require surgical removal.
Ovarian hyperstimulation syndrome
There is a “significant and consistent” relationship between PCOS and ovarian hyperstimulation syndrome (OHSS).10 OHSS affects women taking fertility treatment in order to conceive during IVF, and occurs when overstimulated ovaries enlarge and release chemicals into the bloodstream. It can cause abdominal pain and vomiting, so if you are having IVF and have been diagnosed with PCOS, it is important to be aware of this condition.11
Other conditions causing pelvic pain
Endometriosis is one condition that can cause intense pelvic pain, and not just around the time of menstruation. If you have PCOS but are experiencing a lot of pelvic pain and heavy periods, it could well be that you have endometriosis too: endometriosis has been found to be the cause in 25-40% of women with pelvic pain, and one study specifically looking at the endometriosis and PCOS relationship found endometriotic lesions in 72% of women with PCOS.12
Although the pathology of each condition is different, there are overlaps in a way that makes endometriosis more likely – for example, as women with PCOS have a progesterone deficiency and unopposed oestrogen, this can promote endometrial growth, as well as ectopic endometrial cell growth.
If you have PCOS but are experiencing a lot of pelvic pain and heavy periods, it could well be that you have endometriosis too: endometriosis has been found to be the cause in 25-40% of women with pelvic pain.
If you have not been diagnosed with PCOS and have no other symptoms other than pelvic pain, endometriosis could be the cause. Other symptoms to look out for with endometriosis include extremely heavy periods, fatigue, bloating, and painful periods.
Fibroids are non-cancerous growths that can develop in or around the womb. They are made of muscle and fibrous tissue, and many women will have fibroids without being aware as they can often cause no symptoms. The one in three women who do have symptoms may experience tummy pain, and other symptoms include heavy or painful periods, pain during sex, constipation, and the need to urinate frequently.13
A way of differentiating this pain from pain caused by PCOS is the absence of any other PCOS symptoms, such as hirsutism, acne, and irregular periods. While it is possible to have fibroids and PCOS, generally women with PCOS are less likely to have fibroids than women without PCOS.14
Pelvic inflammatory disease
Pelvic inflammatory disease (PID) is an infection of the female upper genital tract, including the womb, fallopian tubes and ovaries, and it is a common condition mainly affecting sexually active women aged 15-24. It doesn’t always cause symptoms but when it does these can include pelvic pain and pain during sex, as well as bleeding between periods and after sex. It is often caused by a bacterial infection in the vagina or cervix that has spread to the other reproductive organs. One in four cases of PID are caused by STIs such as chlamydia or gonorrhoea.15
If you are having pelvic pain and any of the above symptoms, it is important to go and get checked out by a doctor, and it is possible to have pelvic pain caused by PID as well as having PCOS.16
What will help treat my pelvic pain if it is related to PCOS?
If your pelvic pain is caused by PCOS, it stands to reason that the best way of treating the pain would be to tackle your PCOS directly. It is important you visit your doctor to rule out the presence of any other conditions that could be causing the pelvic pain. It may be that a diagnosis of PCOS is obtained, especially if you present with symptoms, but have not had a formal diagnosis.
Certain lifestyle factors can bring about an improvement in PCOS symptoms. For some women, going on a combined oral contraceptive pill can drastically reduce symptoms, and losing weight if you are overweight has been proven to be effective in many cases.
Your doctor may prescribe certain medications to treat PCOS and some women may choose to take specific supplements to help manage some of the symptoms. There is evidence to suggest that taking myo-inositol, a type of B vitamin, combined with folic acid can increase your chances of regular ovulation, reducing your chances of period pain when your period does arrive. It has also been proven to help with many other symptoms of PCOS, including acne, hirsutism, and fertility, by regulating your hormone levels in general.
- NHS Choices Health A-Z, ‘Polycystic ovary syndrome’, [website], 2016, https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/, (accessed 14 August 2018).
- M. L. Martin et al., ‘Understanding polycystic ovary syndrome from the patient perspective: a concept elicitation patient interview study’, Health Qual Life Outcomes, Vol. 15, 2017, p. 162.
- F. N. Amiri et al., ‘The Experience of Women Affected by Polycystic Ovary Syndrome: A Qualitative Study From Iran’, Int J Endocrinol Metab., Vol 12, No. 2, 2014, p. e13612.
- Columbia University School of Nursing, ‘Psychiatric Complications in Women with Polycystic Ovary Syndrome Most Often Linked to Menstrual Irregularities’, [available online],http://nursing.columbia.edu/psychiatric-complications-women-polycystic-ovary-syndrome-most-often-linked-menstrual-irregularities, (accessed 14 August 2018).
- Anxiety and Depression Association of America, ‘Understand the Facts: Irritable Bowel Syndrome (IBS)’, [available online], https://adaa.org/understanding-anxiety/related-illnesses/irritable-bowel-syndrome-ibs, (accessed 14 August 2018).
- NHS Choices Health A-Z, ‘Pelvic pain’, [website], 2016, https://www.nhs.uk/conditions/pelvic-pain/, (accessed 14 August 2018).
- K. A. Calls, ‘Dysmenorrhea’, Medscape, [website], 2017, https://emedicine.medscape.com/article/253812-overview, (accessed 14 August 2018).
- NHS Choices Health A-Z, ‘Ovarian cyst’, [website], 2016, https://www.nhs.uk/conditions/ovarian-cyst/, (accessed 14 August 2018).
- I. Tummon et al., ‘Polycystic ovaries and ovarian hyperstimulation syndrome: a systematic review’, Acta Obstet Gynecol Scand., Vol. 84, No. 7, 2005, pp. 611-6.
- Royal College of Obstetricians & Gynaecologists, ‘Ovarian hyperstimulation syndrome’, Patient Information Leaflet, [available online], 2016, https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/gynaecology/pi_ohss.pdf, (accessed 14 August 2018).
- K. J. Holoch et al., ‘Coexistence of polycystic ovary syndrome and endomeriosis in women with infertility’, Journal of Endometriosis and Pelvic Pain Disorders, Vol. 6, No. 2, 2014, pp. 78-83.
- NHS Choices Health A-Z, ‘Fibroids’, [website], 2015, https://www.nhs.uk/conditions/fibroids/, (accessed 14 August 2018).
- A. Abdel-Gadir et al., ‘Coexistence of polycystic ovaries and uterine fibroids and their combined effect on the uterine artery blood flow in relation to age and parity’, J Reprod Med., Vol. 54, No. 6, 2009, pp. 347-52.
- NHS Choices Health A-Z, ‘Pelvic inflammatory disease’, [website], 2018, https://www.nhs.uk/conditions/pelvic-inflammatory-disease-pid/, (accessed 14 August 2018)