Lapeer · Rochester Hills · Telehealth

Chronic
Pelvic Pain
Persistent Pelvic Pain in Women — Finding the Cause and a Path Forward

Chronic pelvic pain — pain lasting three months or more — affects a significant number of women and is among the most undertreated conditions in gynecology. It is not a diagnosis in itself but a symptom that reflects one or more underlying causes, most of which are identifiable and treatable. If you have been managing pelvic pain for months or years without a satisfying explanation, that situation can change.

Dr. Ramona D. Andrei, MD, PhD, FACOG provides comprehensive chronic pelvic pain evaluation and treatment at both our Lapeer and Rochester Hills offices — with a commitment to finding the source, not simply managing the symptom.

Schedule a Gynecologic Visit

Board-certified gynecology & minimally invasive surgery  ·  Most major insurances accepted
Serving Lapeer County & Oakland County

Chronic Pelvic Pain — What It Is and Why It Persists

Chronic pelvic pain is defined clinically as pelvic pain lasting three months or more. By the time most women seek evaluation for it, they have been living with it considerably longer — often years — and have received either no diagnosis or a diagnosis that has not led to effective treatment. The gap between symptom onset and accurate diagnosis for chronic pelvic pain is among the longest of any common gynecologic condition.

Chronic pelvic pain is not a disease. It is a symptom — one that can arise from a range of gynecologic conditions, each of which has its own mechanism, its own clinical pattern, and its own optimal treatment approach. Endometriosis, adenomyosis, uterine fibroids, ovarian cysts, pelvic adhesions, and pelvic inflammatory disease are among the most common gynecologic causes. Pelvic floor dysfunction, interstitial cystitis, and irritable bowel syndrome frequently coexist with gynecologic causes and contribute to the overall pain burden. In many women with chronic pelvic pain, multiple contributing factors are present simultaneously.

This page covers the most common causes of chronic pelvic pain, what a thorough evaluation involves, and what the full range of treatment options looks like when the source of pain is identified. If you have been living with chronic pelvic pain and have not received a satisfying explanation or adequate treatment, this page is a starting point for understanding what a comprehensive evaluation can offer.

Schedule a Gynecologic Visit
How Chronic Pelvic Pain Presents — Recognizing the Patterns

Chronic pelvic pain presents differently depending on its underlying cause. The following patterns reflect the range of ways persistent pelvic pain manifests in women — none of which should be accepted as simply normal or untreatable.

  • A persistent dull aching or pressure in the lower abdomen or pelvis that is present most days regardless of activity
  • Pain that is consistently worse in the days before and during the menstrual period and somewhat better between cycles
  • Pain that is relatively constant throughout the cycle with cyclical worsening at menstruation
  • Deep pelvic pain during or after sexual intercourse that may persist for hours afterward
  • Pain that radiates into the lower back, hips, or upper thighs
  • A sense of pelvic heaviness or fullness that is present throughout the day
  • Pain that worsens with prolonged sitting, standing, or specific physical activities
  • Painful bowel movements or urination that follow a cyclical pattern or are present consistently
  • Pain accompanied by heavy or abnormal menstrual bleeding
  • Pain that has been progressively worsening over months or years
  • Pain that has significantly affected your ability to work, exercise, maintain relationships, or enjoy daily life
  • Pain that has been attributed to stress, anxiety, or normal variation without a diagnostic workup that specifically looked for structural or hormonal causes

Chronic pelvic pain that has been present for months or years and has not been adequately evaluated or treated is not something to simply accept. It has a cause — often more than one — and those causes are identifiable with a thorough clinical evaluation.

Schedule a Gynecologic Visit
Common Causes of Chronic Pelvic Pain in Women

The following are the most common gynecologic and related causes of chronic pelvic pain evaluated at Lapeer Women’s Health. Because these conditions frequently coexist and share overlapping symptom profiles, a thorough evaluation that considers the full differential — rather than stopping at the first plausible explanation — is essential to accurate diagnosis.

Endometriosis

Endometriosis is identified in a substantial proportion of women evaluated for chronic pelvic pain and is one of the conditions most likely to be missed or delayed in diagnosis. It produces chronic pelvic pain through the cyclical bleeding and inflammatory activity of endometrial-like tissue outside the uterus — which over time leads to adhesion formation, sensitization of pelvic nerve fibers, and a pain experience that becomes progressively less confined to the menstrual period and more constant. A normal pelvic ultrasound does not rule out endometriosis. Clinical history and focused examination are essential diagnostic components that imaging alone cannot replace. Learn more about endometriosis →

Adenomyosis

Adenomyosis — the growth of endometrial glands into the uterine muscle wall — produces a characteristically deep, diffuse pelvic aching that is most intense during menstruation but often present to some degree throughout the cycle. It is associated with a uniformly enlarged, tender uterus and frequently coexists with endometriosis, compounding the overall pain burden when both are present. Adenomyosis is underdiagnosed partly because its imaging findings on standard ultrasound are subtler than those of fibroids or ovarian cysts, and partly because its pain is so commonly normalized as part of having difficult periods. Learn more about adenomyosis symptoms →

Uterine Fibroids

Fibroids produce pelvic pain through their mechanical bulk — pressure on surrounding structures, particularly with subserosal or large intramural fibroids — and through their effect on uterine function during menstruation. The pain of fibroids is often described as pressure, heaviness, or deep aching rather than sharp or cramping pain. It tends to be fairly constant, with worsening during menstruation. Fibroids are reliably identified on pelvic ultrasound, making imaging an important early step in chronic pelvic pain evaluation. Learn more about uterine fibroids →

Pelvic Adhesions

Fibrous scar tissue from prior surgery, prior pelvic infection, or endometriosis-related inflammation can bind pelvic organs together and restrict their normal movement, producing a characteristic pain with positional or activity-related features. Adhesion-related pain is often described as pulling, tearing, or pressure with specific movements — and may be particularly noticeable during intercourse, bowel movements, or physical activity. Adhesions are not visible on standard ultrasound and require laparoscopy for definitive identification and treatment.

Ovarian Cysts and Ovarian Remnant Syndrome

Persistent or recurrent ovarian cysts — including endometriomas — produce chronic pelvic pain that is often lateralized and associated with a sense of adnexal fullness or pressure. Women who have had prior oophorectomy and continue to have pelvic pain may have ovarian remnant syndrome — a condition in which a small amount of ovarian tissue left behind at surgery continues to produce hormones and develop cysts. Ovarian remnant syndrome is specifically worth considering in women with post-surgical chronic pelvic pain that was expected to resolve after oophorectomy.

Pelvic Floor Dysfunction

Hypertonic pelvic floor dysfunction — chronic excessive tension in the pelvic floor musculature — is a significant contributor to chronic pelvic pain, dyspareunia, and urinary and bowel symptoms. It frequently develops as a protective response to underlying gynecologic pain and can perpetuate pain independently even after the primary gynecologic cause has been treated. Pelvic floor dysfunction is identified on focused pelvic examination and is addressed through pelvic floor physical therapy as part of a comprehensive treatment plan.

Central Sensitization

In women with long-standing, inadequately treated pelvic pain, the central nervous system can undergo a process of sensitization in which pain thresholds are lowered and pain signals are amplified. The result is a pain experience that is disproportionate to the current level of peripheral input — and one that responds less predictably to treatments directed solely at the peripheral source. Central sensitization does not mean pain is “in your head” — it is a real, documented neurophysiological process that develops in response to sustained pain exposure. It is one of the primary reasons that earlier diagnosis and treatment of the underlying cause produces better outcomes than later intervention after years of inadequate management.

Because multiple causes frequently coexist in women with chronic pelvic pain, a comprehensive evaluation that does not stop at the first identified diagnosis is essential. An endometriosis diagnosis does not preclude adenomyosis. A fibroid finding does not explain all pelvic floor dysfunction. The complete picture requires looking for all contributing factors.

What a Chronic Pelvic Pain Evaluation Looks Like at Lapeer Women’s Health

Chronic pelvic pain evaluation at Lapeer Women’s Health is led by Dr. Ramona D. Andrei, MD, PhD, FACOG — with a commitment to thoroughness, a willingness to reconsider prior diagnoses, and a focus on identifying every contributing factor rather than stopping at the most obvious one.

Step 1 — Complete Pain and Clinical History

Dr. Andrei takes a thorough history of your pain — its character, location, timing, relationship to the menstrual cycle and specific activities, how it has changed over time, prior diagnoses and treatments, and its impact on daily functioning. Prior records, operative reports, and imaging are reviewed when available. The history frequently reveals patterns that point toward specific diagnoses that prior evaluations did not consider.

Step 2 — Focused Examination and Imaging

A pelvic examination is performed with specific attention to the findings most relevant to chronic pelvic pain — including uterosacral tenderness, pelvic floor tone, uterine mobility and contour, and adnexal findings. Transvaginal ultrasound evaluates for structural causes. MRI is recommended when endometriosis, adenomyosis, or complex anatomy requires greater anatomical detail.

Step 3 — A Comprehensive Treatment Plan

The treatment plan addresses every identified contributing factor — not simply the most prominent one. When multiple causes are present, the plan reflects that complexity. Options range from medical management through minimally invasive surgery, and may include coordination with pelvic floor physical therapy for women with a significant pelvic floor component.

Treatment Options for Chronic Pelvic Pain

Treatment for chronic pelvic pain is always diagnosis-driven. The approaches below represent the range of options available at Lapeer Women’s Health — matched to the specific causes identified in each patient’s evaluation.

Medical Management
Hormonal Therapy, Targeted Medications, and Supportive Care

For chronic pelvic pain driven by endometriosis, adenomyosis, or hormonal dysregulation, hormonal suppression is an effective first-line approach that reduces cyclical inflammatory activity and provides meaningful symptom relief. NSAIDs address the prostaglandin-driven component of pain. Targeted medications for specific conditions — including antibiotics for infectious causes — address their respective mechanisms. Pelvic floor physical therapy is an important adjunct for women with a significant pelvic floor dysfunction component.

GnRH antagonists (Oriahnn / Myfembree) Combined oral contraceptives Progestin therapy Hormonal IUD (Mirena / Liletta) NSAIDs for pain and inflammation Pelvic floor physical therapy referral
Minimally Invasive Surgery
Diagnostic and Therapeutic Laparoscopy

For women whose chronic pelvic pain has not been adequately explained by imaging or whose symptoms are sufficiently consistent with endometriosis or adhesion disease to warrant surgical evaluation, diagnostic and therapeutic laparoscopy provides both definitive diagnosis and treatment in a single minimally invasive procedure. Endometriosis excision, adhesiolysis, ovarian cystectomy, and myomectomy each address specific structural sources of chronic pain directly. Robotic assistance is used when the complexity of disease warrants it.

Diagnostic laparoscopy with treatment Endometriosis excision Robotic-assisted excision Adhesiolysis Ovarian cystectomy Laparoscopic myomectomy
Definitive Treatment
Hysterectomy for Refractory Disease

For women with severe chronic pelvic pain from endometriosis, adenomyosis, or combined conditions who have completed childbearing and for whom other treatments have not provided adequate relief, minimally invasive hysterectomy with concurrent excision of all endometriosis provides the most complete resolution. The decision to pursue hysterectomy is made collaboratively after thorough discussion of alternatives, expected outcomes, and the patient’s specific goals.

Laparoscopic hysterectomy Robotic-assisted hysterectomy Concurrent endometriosis excision
Chronic Pelvic Pain Is Not Normal. It Is Not Untreatable. And You Are Not Alone.

The experience of living with chronic pelvic pain that has not been adequately explained or treated is one of the most isolating in women’s health. The pain is real. The impact on daily life is real. And the frustration of having it normalized, minimized, or attributed to stress rather than investigated is also real — and common.

What is equally real is that chronic pelvic pain, in the vast majority of cases, has an identifiable cause. Finding that cause requires a thorough evaluation with a provider who takes the clinical history seriously, understands the limitations of standard imaging, and is willing to look beyond the first plausible explanation. That is what the evaluation at Lapeer Women’s Health is designed to provide.

Dr. Ramona D. Andrei and the team at Lapeer Women’s Health are here for that evaluation — at both our Lapeer and Rochester Hills offices, without a referral required.

Schedule a Gynecologic Visit
Frequently Asked Questions About
Chronic Pelvic Pain
Endometriosis is one of the most commonly identified causes of chronic pelvic pain in women of reproductive age, found in a substantial proportion of women who undergo laparoscopic evaluation for this complaint. Adenomyosis, uterine fibroids, pelvic adhesions, and pelvic floor dysfunction are also frequent contributors — and they frequently coexist. The most important thing to understand about chronic pelvic pain is that a single cause is often not the complete answer. A thorough evaluation that considers all contributing factors — rather than stopping at the first identified diagnosis — is the basis of effective treatment.
Several factors contribute to the diagnostic difficulty of chronic pelvic pain. The most common cause — endometriosis — is not visible on standard pelvic ultrasound in its most common form, meaning a normal imaging result is frequently and incorrectly used to exclude it. Symptoms overlap substantially between multiple conditions, making pattern-matching unreliable without a thorough clinical evaluation. Pain in women is more likely than in men to be attributed to psychological causes rather than investigated for physical sources. And the conditions most responsible for chronic pelvic pain — endometriosis, adenomyosis — carry long diagnostic delays that have been documented across the medical literature for decades. None of these factors reflect anything about the legitimacy of your pain. They reflect systematic gaps in how chronic pelvic pain in women has historically been evaluated.
Not necessarily. A clinical diagnosis based on thorough history, physical examination, and imaging can identify many causes of chronic pelvic pain without requiring surgery. Fibroids, ovarian cysts, and adenomyosis (in many cases) are identifiable on imaging. Endometriosis can often be diagnosed clinically when the symptom pattern is sufficiently characteristic, and empirical medical treatment can be initiated on the basis of a clinical diagnosis. Diagnostic laparoscopy is most appropriate when the clinical picture is uncertain, when imaging has not provided a clear explanation, when surgical treatment is being considered, or when it is important to confirm the diagnosis before committing to long-term management. Dr. Andrei discusses the appropriate diagnostic pathway for your specific situation at your evaluation.
Yes — for many patients and many causes. Hormonal management for endometriosis and adenomyosis provides effective symptom control for a significant proportion of women without requiring surgery. Medical treatment for fibroids can reduce pain meaningfully. Pelvic floor physical therapy addresses pelvic floor dysfunction effectively without surgical intervention. The appropriate treatment depends entirely on the identified cause or causes — and for many women with chronic pelvic pain, non-surgical approaches provide sufficient relief. Surgery is recommended when non-surgical approaches have not provided adequate control, when structural conditions require it, or when a patient’s goals are best served by surgical treatment.
No. Treatment that has not provided adequate relief is most commonly an indication that the diagnosis was incomplete, that the treatment was directed at the wrong target, or that a contributing cause was not identified or addressed. Women whose chronic pelvic pain has not responded to prior medical management may have endometriosis that was not identified because of imaging limitations. Women whose prior surgery did not provide lasting relief may have had ablation rather than excision, or may have had adenomyosis or adhesion disease that was not addressed. A re-evaluation that specifically reviews what was previously found, what was treated, and what may have been missed is often the most productive next step when prior treatment has been inadequate.
Yes. Chronic pelvic pain evaluations are available at both the Lapeer office (1245 N Main St, Lapeer, MI — (810) 969-4670) and the Rochester Hills office (2710 S Rochester Rd, Suite 2, Rochester Hills, MI — (248) 923-3522). No referral is required to schedule. Our team will help you choose the location and appointment time that works best for you.
Schedule a Gynecologic Visit
Related Pages

Explore related pages on specific types of pelvic pain and the conditions that most commonly cause them — or return to the main hub for a complete overview.

Board-certified gynecology & minimally invasive surgery  ·  Most major insurances accepted  ·  Convenient locations in Lapeer & Rochester Hills
Chronic Pelvic Pain Has a Cause. Let’s Find It.

If you have been living with pelvic pain without adequate answers, a thorough evaluation at Lapeer Women’s Health is the starting point for a different outcome. Both our Lapeer and Rochester Hills offices are available — no referral required.

Schedule a Gynecologic Visit

The information on this page is intended for educational purposes only and does not constitute medical advice. Individual symptoms, diagnoses, and treatment options vary significantly. Reading this content does not establish a physician-patient relationship with Dr. Ramona D. Andrei or Lapeer Women’s Health. If you are experiencing a medical emergency, call 911 or go to the nearest emergency room immediately. Please consult a qualified healthcare provider for advice specific to your situation. Content reviewed by Dr. Ramona D. Andrei, MD PhD FACOG.

Gynecologic care for women of every age

Lapeer Women’s Health — Lapeer
1245 N Main St
Lapeer, MI 48446
Lapeer: (810) 969-4670
Rochester Hills: (248) 923-3522

Lapeer Women’s Health — Rochester Hills
2710 S Rochester Rd, Suite 2
Rochester Hills, MI 48307

Serving patients in Lapeer, Rochester Hills, and surrounding communities throughout Southeast Michigan.