Do not ignore that pain in your pelvis

All women should have a yearly visit to their gynaecologist to discuss any other concerns about their gynaecological health as well receive a full pelvic exam. STOCK PHOTOS

What you need to know:

There are several other conditions that can cause pelvic pain in women, some of which are serious if left untreated. It is always a good idea to pay attention to your body and report anything new and different to your healthcare provider.

Aside from producing ova, ovaries produce hormones such as oestrogen and progesterone that trigger menstruation. Since they are located in the lower abdomen (pelvis), if one has pain resulting from ovaries, it will most certainly be in the lower abdomen. This pain may be caused by a number of factors.

Ovarian cysts and tumours
Dr Junior Ndozire, a gynaecologist at Mildmay, says in this case, fluid-filled sacs form within the ovaries during the process of ovulation and this condition is common among women of child bearing age (15-49yrs). “Cysts rarely cause any symptoms and dissolve on their own. However, they can enlarge and twist, rupture or get infected thereby causing pelvic pain,” he says.
Rowena Laker knew something was wrong when whenever she walked, she would get pain in her lower right abdomen. She says it was a sudden pain that felt like menstrual cramps but after a few minutes of rest, it would subside.

When Laker visited a gynaecologist, she was asked to undergo an ultrasound. “The results showed I had a nine centimetre cyst on my ovaries,” she says. For confirmation, another scan was done coupled with a blood test and results showed that she had a pelvic mass which had increased in size with features that indicated presence of cancer. Laker was then referred to the cancer ward to prepare for surgery to remove the cyst.
“However, before the surgery, another scan was done and it was discovered that it was a cystic mass hence easily confused for a cancerous mass. The surgery was done and a month later, the pain subsided,” says Laker.

Treatment
Dr Ndozire says treatment for cysts involves conservative or watchful waiting since the cysts sometimes resolve spontaneously. He adds that sometimes, the woman is prescribed birth control pills, which prevent ovulation and in the long run prevent formation of cysts.
Also, a laparoscopy can be performed. Dr Ndozire says this is a form of surgery that uses small incisions and a tiny, lit camera on the end of a metal tube that is inserted into the abdomen to remove small cysts. However, for larger cysts, he says, someone might require open surgery. In regards to tumours, he says, they can also be benign or cancerous and in this case a laparotomy coupled with cancer treatment is recommended.

Endometriosis
This is the presence of endometrial tissues in other places apart from the endometrium. Dr Omanwa Kireki, a consultant obstetrician and gynaecologist, says: “When endometriosis involves the ovaries, cysts called endometriomas may form.” He adds that the most prominent and common symptom of this condition is period pain.
“It usually starts a few days to about one week before the period starts. The pain usually continues until the flow ends and then it disappears.” He adds that the pain is cyclical. Other symptoms can be pain during intercourse, especially during deep penetration.

“There can also be pain when passing stool and can sometimes be accompanied by blood stained stool. Apart from that, there can also be generalised pain, and in some patients, nausea and vomiting,” he says.
That has been Fatima Bakireke’s life for the last 12 years. “Every day is a nightmare because bowel movement is so painful. I have also heard of others that face difficulty while urinating.” While some women only experience this pain during menstruation, Bakireke faces this pain everyday unless she is on hormonal medication or pain killers.
Dr Kireki also says that sometimes, these signs or symptoms may not be so clear cut so the clinician has to be very keen on medical history to differentiate them from other possible diseases.

An ovarian cyst happens when fluid accumulates within a thin membrane inside the ovary.

Treatment
It is generally conservative (medical), surgical or both. “In the medical management medications such as oral contraceptive pills, progesterone, injections which stop the ovaries from working (GnRH analogues) can be used. Apart from that, other additional medications which are analgesics can be used to compliment the hormonal treatment,” Dr Kireki says. Surgical treatment is either laparoscopically or open laparotomy where the abdomen is cut open.

Pelvic Inflammatory disease
Dr Ndozire says this is an infection that affects the female reproductive organs such as ovaries, uterus and fallopian tubes. It is usually caused by sexually transmitted infections (STIs) such as chlamydia and gonorrhoea because the bacteria spreads from one’s vagina to the uterus, fallopian tubes or ovaries.
He adds that pelvic inflammatory disease (PID) often has no signs or symptoms so one might not realise they have it, hence never seek treatment. However, it could be detected later if one experiences fertility issues or develops chronic pelvic pain.

Samantha Musoke, after a visit to her gynaecologist, had received a PID diagnosis though it was yet to be confirmed. “I had just become sexually active again and had developed vaginal thrush, a small lump on her vagina and was also feeling sick. Though I was not worried about the lump because I had had one before, I just needed to check since I was sexually active again.”

She was, however, told that the lump was infected hence the need for antibiotics and was given cream to deal with the thrush. “But little did I know that my major problem was in one of my ovaries and the antibiotics only put the PID symptoms at bay without dealing with them. More to that, the lump turned into a benign cyst.” I started feeling ill a month later to the extent of vomiting all the time,” she says.
Tests showed an infection hence more antibiotics. However, a couple of weeks later, all the symptoms returned with a bang and I could barely eat. “I chose to go to another doctor. A llaparoscopy showed adhesions, which the doctor explained were from recurrent infections.
At last, I knew what it was, but wondered how to tell my boyfriend who I was certain gave it to me.” Musoke was glad that he listened and willingly went for treatment with her.

Eating for healthy ovaries
A healthy diet can go a long way to helping your body produce healthy eggs. Choose foods that are low in fats, sugar and salt. Processed foods, such as those that are smoked, salted or otherwise preserved, should be avoided, as they tend to be high in salt content. Avoid binge drinking or binge eating. Binge drinking has been found to affect the regular menstrual cycle, and can also affect the health of the baby in early pregnancy.

How do I know if my ovaries are healthy?
If you are below the age of 30, and have been experiencing regular menstrual periods, there is a good chance that your ovaries are healthy. Regardless of age or menstrual regularity, if you have difficulty getting pregnant while having unprotected intercourse for a year, you should consult a fertility specialist.