Pelvic Pain Evaluation — Identifying What Is Actually Causing Your Pain
Pelvic pain is one of the most common and most underdiagnosed gynecologic complaints. It affects women of all ages and presents in many forms — cramping that arrives with your period, constant pressure in the lower abdomen, pain with intercourse, pain with urination or bowel movements, or unpredictable sharp pain that disrupts daily life. Each pattern points toward a different set of potential causes, and identifying the right one requires a systematic evaluation.
At Lapeer Women’s Health, Dr. Andrei approaches pelvic pain as a diagnostic problem requiring a structured workup — not a symptom to be managed indefinitely without explanation. The evaluation begins with a thorough history that establishes the pain’s character, location, timing, and relationship to your cycle. It continues with a focused physical exam, targeted imaging, and laboratory testing when indicated.
Chronic pelvic pain lasting three or more months is particularly important to evaluate thoroughly. Many women with chronic pelvic pain have endometriosis, adenomyosis, pelvic floor dysfunction, or a combination of overlapping causes that require individualized management. Dr. Andrei will not send you home with pain medication and a follow-up in six months. The goal is an answer.
Common Causes of Pelvic Pain Dr. Andrei Evaluates
Pelvic pain has a wide differential. These are the conditions most commonly identified during the structured evaluation at Lapeer Women’s Health.
Endometriosis
Tissue similar to the uterine lining grows outside the uterus, causing cyclical pain, pain with intercourse, and sometimes chronic daily pain. Endometriosis is frequently underdiagnosed — Dr. Andrei evaluates clinical features carefully and does not dismiss pain as “normal periods.”
Uterine fibroids
Intramural and subserosal fibroids cause pelvic pressure, heaviness, and pain — particularly around menstruation. Large or multiple fibroids create a constant sense of fullness in the lower abdomen. Identified by bimanual exam and confirmed on ultrasound.
Ovarian cysts
Functional, endometriotic, or complex ovarian cysts cause unilateral pelvic pain that may be sharp, constant, or positional. Rupture or torsion causes acute severe pain requiring urgent evaluation.
Adenomyosis
Uterine lining tissue growing into the uterine muscle wall causes progressively worsening menstrual cramps, a tender enlarged uterus, and heavy periods. Often coexists with fibroids or endometriosis.
Pelvic floor dysfunction
Hypertonic or dyssynergic pelvic floor muscles cause chronic pelvic pain, painful intercourse, urinary urgency, and painful bowel movements — without a structural abnormality on imaging. Identified by pelvic floor examination.
Pelvic adhesions
Scar tissue from prior surgery, infection, or endometriosis creates tethering between pelvic organs that causes positional or activity-related pain. Suspected clinically and confirmed at the time of laparoscopy when surgery is indicated.
How Dr. Andrei Evaluates Pelvic Pain
Pelvic pain evaluation at Lapeer Women’s Health follows a structured clinical approach. The goal is a working diagnosis — not a referral to another provider to repeat the same tests.
- Pain history: location, character, severity, timing, relationship to cycle, aggravating and relieving factors
- Menstrual and sexual history: cycle regularity, dysmenorrhea, dyspareunia, contraception
- Surgical and obstetric history: prior pelvic procedures that may have introduced adhesions
- Pelvic examination: uterine size and tenderness, adnexal assessment, cervical motion tenderness, pelvic floor tone
- Transvaginal ultrasound when indicated: fibroids, cysts, endometriomas, structural abnormalities
- Laboratory testing: STI screening, CBC, and inflammatory markers when infection or systemic cause is suspected
“Pelvic pain is not something women should learn to live with. Every pain pattern has a physiologic explanation. My job is to find it — and that starts with actually listening to what the pain is doing, when it happens, and how it has changed over time.”
- When imaging is normal and pain persists, pelvic floor dysfunction and endometriosis remain leading diagnoses
- Laparoscopy is the only definitive diagnostic tool for endometriosis — discussed when clinical picture warrants
- Overlapping causes are common — the evaluation accounts for multiple contributing conditions
- Referral to pelvic floor physical therapy coordinated when pelvic floor dysfunction is identified
- Pain management discussed as part of the treatment plan — not as a substitute for diagnosis
- Surgical options at McLaren Lapeer, McLaren Flint, and Henry Ford Rochester when operative intervention is indicated
Questions About the Pelvic Pain Evaluation
Pelvic Pain Has a Cause.
Find It.
Dr. Andrei performs structured in-office pelvic pain evaluations at both the Lapeer and Rochester Hills offices. History, exam, imaging, and labs coordinated in one place — with a working diagnosis as the goal.
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 — Rochester Hills
2710 S Rochester Rd, Suite 2
Rochester Hills, MI 48307
Serving patients in Lapeer, Rochester Hills, and surrounding communities throughout Southeast Michigan.