Pelvic Pain

Pelvic pain is pain felt anywhere in the lower abdomen/pelvis—often described as aching, cramping, pressure, stabbing, or burning. In people with suspected or known endometriosis, pelvic pain may be cyclical (worse around periods or ovulation) or persistent throughout the month. With adenomyosis, pain is commonly strongest during menstruation and may occur alongside heavy bleeding and a “boggy” or enlarged uterus.

In endometriosis, endometrial-like tissue can grow outside the uterus (for example on the ovaries, pelvic sidewalls, bowel, bladder, or behind the uterus). These implants can trigger inflammation, scarring, and adhesions that restrict normal organ movement and irritate nearby nerves—creating pain that can flare with hormonal shifts and sometimes persist even between cycles. In adenomyosis, endometrial tissue grows into the uterine muscle, which can cause the uterus to contract more painfully and contribute to deep, heavy cramping and pelvic pressure.

Pelvic pain can overlap with other conditions, which is one reason endometriosis often takes years to diagnose. Symptoms may mimic IBS, bladder pain syndrome/interstitial cystitis, pelvic floor dysfunction, fibroids, or musculoskeletal issues. A key clue is a pattern of cyclical flares, pain with sex, bowel movements, urination, or worsening pain despite “normal” routine testing—but any pattern deserves a thoughtful evaluation. A specialist-led workup through an experienced team can help identify endometriosis and common look‑alikes or coexisting issues (see Evaluation & Diagnosis and Related Conditions).

Living with chronic pelvic pain can be isolating and exhausting. It may affect concentration, physical activity, intimacy, mood, and confidence in your body—especially when pain is minimized or mislabeled as “normal period pain.” You deserve to be taken seriously, and effective care is possible with a plan that addresses both symptom relief and root causes.

Pelvic pain can feel different from person to person—even among people with the same diagnosis. Many describe a deep, low ache or heaviness in the pelvis, cramping that feels “labor-like,” sharp stabbing pains, or a pulling sensation that worsens with movement, bowel movements, urination, or intercourse. Some people notice pressure in the rectum or vagina, or pain that radiates into the lower back, hips, or thighs.

A common endometriosis pattern is flares that intensify in the days leading up to a period and during bleeding, but pain can also spike mid‑cycle (around ovulation) or after physical activity. With adenomyosis, pain is often centered in the uterus—deep, intense menstrual cramps and pelvic tenderness—and may be accompanied by a feeling of pelvic fullness or bloating.

Over time, persistent inflammation and nerve sensitization can make pain less tied to the cycle and more constant. Some people develop “good days and bad days,” where stress, sleep loss, certain foods, or pelvic floor muscle tension amplify symptoms. If your pain is escalating, spreading, or becoming less predictable, that’s a sign you may need a more comprehensive evaluation and a multi‑layer treatment approach.

Pelvic pain is one of the most common reasons people seek evaluation for endometriosis. Endometriosis affects about 10% of women of reproductive age, and chronic pelvic pain is a frequent presenting complaint—though the exact proportion varies by study and by how pelvic pain is defined.

In adenomyosis, pelvic pain—especially severe period pain—is also common, often alongside heavy menstrual bleeding. Many people have both adenomyosis and endometriosis, which can intensify pain and broaden symptom patterns (uterine cramping plus pain from lesions/adhesions elsewhere in the pelvis).

Importantly, pain severity does not reliably match “stage” or how much disease is seen on imaging or at surgery. Some people have extensive disease with modest pain, while others have severe pain with minimal visible lesions—especially when deep disease, adhesions, pelvic floor dysfunction, or nerve involvement are present.

In endometriosis, pelvic pain is driven by a combination of inflammation, scarring, and nerve involvement. Endometrial-like tissue outside the uterus can bleed and inflame surrounding structures, releasing inflammatory chemicals that irritate nerves and increase pain sensitivity. Over time, the body may form adhesions (scar tissue bands) that tether organs, making normal movement—like bowel filling, bladder emptying, or intercourse—painful.

Deep infiltrating endometriosis can involve tissues rich in nerves and create pain with specific functions (for example, bowel movements or urination). Endometriomas (ovarian cysts associated with endometriosis) can contribute to aching or sharp pain, especially with activity or around the cycle.

In adenomyosis, endometrial glands within the uterine muscle can lead to thicker, more reactive uterine tissue and stronger uterine contractions during menstruation. This can cause intense cramping, pelvic pressure, and tenderness. Adenomyosis-related inflammation may also amplify pain signaling and contribute to fatigue.

Other factors can worsen pelvic pain even when the underlying disease is stable: pelvic floor muscle spasm/guarding, central sensitization (a “wound-up” nervous system), coexisting bladder or bowel conditions, and stress-related changes in pain processing. That’s why many patients benefit most from a plan that addresses both the disease and the pain system (see Pain Management).

Treatment for pelvic pain usually works best when it targets both symptom control now and long-term drivers (endometriosis lesions, adenomyosis, adhesions, and nervous system sensitization). Options are individualized based on your goals (pain relief, fertility, avoiding hormones, avoiding hysterectomy), severity, and whether adenomyosis and endometriosis coexist.

Medical options may include anti-inflammatory medications (like NSAIDs), nerve-pain–targeted medications for neuropathic components, and hormonal suppression to reduce cyclical inflammation and bleeding. Hormonal approaches (such as continuous birth control, progestins, or other suppressive therapies) can reduce flares for some patients, though they don’t remove endometriosis tissue and may not be tolerated by everyone. Learn more about medication approaches in Hormonal Therapy and symptom-focused care in Pain Management.

Surgical treatment is often considered when pain is persistent, progressive, or not responding to medical management—or when imaging/exam suggests deep disease, endometriomas, or significant adhesions. For endometriosis, excision surgery (removing lesions at the root) is widely regarded as the gold standard because it aims to remove disease rather than burn the surface. At Lotus, advanced minimally invasive approaches are central to care; explore Surgery & Advanced Excision and learn about surgeon expertise with Dr. Steven Vasilev. Adenomyosis treatment may range from hormonal therapy and uterine-sparing options to hysterectomy in select cases, depending on symptoms and fertility goals (see adenomyosis).

Pelvic floor physical therapy can be a game-changer when muscles tighten in response to chronic pain (a common, treatable pain amplifier). Therapy may focus on down-training/relaxation, trigger point release, breathing mechanics, and gentle strengthening—often improving pain with sex, bowel movements, and daily activity (see Pelvic Floor PT and Pelvic Floor Dysfunction).

Lifestyle and integrative supports can complement medical/surgical care: heat, TENS, pacing and flare plans, anti-inflammatory nutrition strategies, sleep support, stress reduction, and selected supplements when appropriate. These tools won’t “cure” endometriosis or adenomyosis, but they can reduce suffering and improve function while you pursue definitive diagnosis and treatment (see Integrative Medicine & Lifestyle Care and At-Home Remedies). What to expect: meaningful improvement is possible, but it may take a layered plan and time—especially if pain has been present for years.

Seek urgent care immediately if pelvic pain is sudden and severe (especially one-sided), accompanied by fainting, shoulder pain with dizziness, fever, persistent vomiting, heavy bleeding soaking pads hourly, black/tarry stools, blood in urine, or if you could be pregnant (to rule out ectopic pregnancy or other emergencies). Also seek urgent evaluation for new neurologic symptoms (leg weakness/numbness) or inability to pass urine.

Schedule a specialist evaluation if pelvic pain is chronic (most days for 3+ months), repeatedly causes missed school/work, worsens around your period, or occurs with sex, bowel movements, urination, or infertility concerns. If you’ve been told imaging is “normal” but your symptoms persist, that does not rule out endometriosis—many cases require expert assessment and, when appropriate, surgical diagnosis.

To make your visit more effective, bring a symptom timeline (cycle days, triggers, bowel/bladder symptoms, medications tried, and functional impact). If you’re ready for a deeper evaluation and a clear plan, you can schedule a consultation with Lotus. Our team focuses on thoughtful diagnosis and individualized care for both endometriosis and adenomyosis (see Evaluation & Diagnosis).