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Chronic Female Pelvic Pain - Topic Overview

This topic focuses on pelvic pain that has lasted longer than 6 months. If you have new, sudden pelvic pain, see your doctor as soon as you can. To learn more about new pelvic pain, see the topic Abdominal Pain, Age 12 and Older.
What is chronic female pelvic pain?

Female pelvic pain is pain below a woman’s belly button. It is considered chronic, which means long-lasting, if you have had it for at least 6 months. The type of pain varies from woman to woman. In some women, it is a mild ache that comes and goes. In others, the pain is so steady and severe that it’s hard to sleep, work, or enjoy life.

If your doctor can find what’s causing the pain, treating the cause may make the pain go away. If no cause is found, your doctor can help you find ways to ease the pain and get your life back.
What causes chronic female pelvic pain?

Some common causes include:

* Problems of the reproductive system, such as endometriosis, adenomyosis, and uterine fibroids.
* Scar tissue (adhesions) in the pelvic area after a pelvic infection or surgery.
* Diseases of the urinary tract or bowel, such as irritable bowel syndrome or chronic bladder irritation.
* Physical or sexual abuse. Experts are not sure why this is so, but about half of women with chronic pelvic pain have a history of abuse.1

Doctors don’t really understand all the things that can cause chronic pelvic pain. So sometimes, even with a lot of testing, the cause remains a mystery. This doesn’t mean that there isn’t a cause or that your pain isn’t real.

Sometimes, after a disease has been treated or an injury has healed, the affected nerves keep sending pain signals. This is called neuropathic pain. It may help explain why it can be so hard to find the cause of chronic pelvic pain.
What are the symptoms?

The type of pain can vary widely. Chronic pelvic pain can include:

* Pain that ranges from mild to severe.
* Pain that ranges from dull to sharp.
* Severe cramping during periods.
* Pain during sex.
* Pain when you urinate or have a bowel movement.

Chronic pain can lead to depression. Depression can cause you to feel sad and hopeless, eat and sleep poorly, and move slowly.
How is chronic female pelvic pain diagnosed?

At your first visit, your doctor will do a complete pelvic exam to look for problems with your reproductive system. The doctor will also ask questions about your past and present health and about your symptoms. You may have some tests, such as:

* A Pap test to look for cervical cancer or cell changes called dysplasia.
* Blood and urine tests to look for signs of infection.
* A pregnancy test.
* Tests for sexually transmitted diseases.

Emotional issues can play a big role in chronic pain. Your doctor may ask questions to find out if depression or stress is adding to your problem. You may also be asked about any past or current sexual or physical abuse. It can be hard to talk about these things, but it’s important to do it so you can get the right treatment.

If the first tests don’t find a cause, you may have other tests that show pictures of the organs in your belly. These may include a transvaginal ultrasound and an MRI or CT scan of the pelvis. You may also have a type of minor surgery called laparoscopy (say “lap-uh-ROS-kuh-pee”). In this surgery, the doctor puts a thin, lighted tube with a tiny camera through a small cut in your belly. This lets the doctor look for problems like growths or scar tissue inside your belly.

Finding the cause of pelvic pain can be a long and frustrating process. You can help by keeping notes about the type of pain you have, when it happens, and what seems to bring it on. Show these notes to your doctor. They may give clues about what is causing the problem or the best way to treat it.
How is it treated?

If your doctor found a problem that could be causing your pelvic pain, you will be treated for that problem. Some common treatments include:

* Birth control pills or hormone treatment for problems related to your periods.
* Surgery to remove a growth, cyst, or tumor.
* Medicine to treat the problem, such as an antibiotic for infection or medicine for irritable bowel syndrome.

Chronic pain can become a medical problem in itself. Whether or not a cause is found, your doctor can suggest treatments to help you manage the pain. You may get the best results from a combination of treatments such as:

* Pain relievers called NSAIDs, like ibuprofen (such as Advil or Motrin) or naproxen (such as Aleve). You can buy these over the counter, or your doctor may prescribe stronger ones. These medicines work best if you take them on a regular schedule, not just when you have pain. Your doctor can tell you how much to take and how often.
* Tricyclic antidepressant medicine, which can help with pain as well as depression.
* Cognitive-behavioral therapy or biofeedback, to help you change the way you think about or react to pain.
* Counseling, to give you emotional support and reduce stress.

You may need to try many treatments before you find the ones that help you the most. If the things you’re using aren’t working well, ask your doctor what else you can try. Taking an active role in your treatment may help you feel more hopeful.

A Daily Skin Care Routine

People often ask me which skin care products I use… so here they are! As you’ll see, most of my favorite products are inexpensive and widely available.

Whatever your skin type, the brands you find at your local drugstore are typically your best bet. Larger skin care companies have the biggest budgets for research and development, and can sell highly effective products at affordable prices. There are a couple of products I recommend splurging on if you can - keep reading to find out which ones.

Remember, though, that skin care is not one-size-fits-all. It’s important to choose products that are tailored to your particular skin needs. If you’re familiar with my book The Skin Type Solution and the 16 skin types it describes, you know that I define skin according to four different parameters.

I’m a DSNW, for example: That means my skin is dry, sensitive, non-pigmented (not prone to hyperpigmentation), and “wrinkled” (more susceptible to aging than “tight” skin types).

If your skin sounds similar to mine, check out these excellent products - they’ve all served me well!

Morning:

1. I begin by washing with Dove Energy Glow Facial Cleanser
   , a moisturizing cleanser that’s great for my dry skin.
2. Then I apply SkinCeuticals C E Ferulic serum for a boost of antioxidants. If you’re going to splurge on any product in your arsenal, this is one of two places to do it - good facial serums deliver highly concentrated antioxidants and other beneficial ingredients, giving you a lot of bang for your buck.
3. To sufficiently moisturize my skin, I then apply ATOPALM MLE Face Cream, followed by Purpose Dual Treatment Moisture Lotion with SPF 15. Again, my skin is quite dry - if yours is less dry, the Purpose product can do double-duty as your sole daytime moisturizer and a sunscreen.
4. If I’m going to spend any significant time in the sun, though, a moisturizer with SPF is not enough. I add a chemical sunscreen like La Roche-Posay Anthelios SPF 15 (if I’m lucky, I might even have some of the SPF 50+ version that’s only available abroad!), followed by Blue Lizard Australian Suncream for sensitive skin
   . (The Blue Lizard is a physical sunscreen - that is, it contains zinc oxide and titanium dioxide to reflect light - and may appear white for the first few minutes after it’s applied.) Using both a chemical and a physical sunscreen might seem like overkill, but it’s absolutely the best way to protect skin in sunny environments.

Evening:

1. Again, I start by washing my face with Dove Energy Glow Cleanser.
2. One of the products I use most religiously is my prescription-strength retinoid of choice, Tazorac. This is the only other place I recommend splurging on a skin care product - after the initial visit to the dermatologist, a month’s supply of most retinoids cost around $30, and it is not covered by insurance for anti-aging purposes. (I am assuming one tube lasts three months). It’s worth it: This is the only ingredient proven to not only prevent new lines and wrinkles, but also minimize the existing ones.
3. Next I apply an antioxidant-rich product like Topix Replenix Cream CF.
4. Finally, I apply ATOPALM MLE Face Cream to nourish my skin while I sleep.

Remember that every good skin care regimen should also include a full range of skin-friendly nutrients. In addition to eating a healthy diet, rich in fruits, vegetables, and omega-3 fatty acids, I take coenzyme Q₁₀ supplements - 200mg every morning is a great way to fight aging. Enjoying several cups of green tea a day and a dark chocolate treat from time to time are my other favorite ways to ensure that I’m getting plenty of antioxidants.

Cardiovascular disease 101: Understanding heart and blood vessel conditions

Cardiovascular disease is a broad term used to describe a range of diseases that affect your heart or blood vessels. The various diseases that fall under the umbrella of cardiovascular disease include coronary artery disease, heart attack, heart failure, high blood pressure and stroke.

The term “cardiovascular disease” is often used interchangeably with heart disease because both terms refer to diseases of the heart or arteries. By whatever name you call it — cardiovascular disease or heart disease - it’s clear that diseases of the heart and blood vessels are serious problems. Cardiovascular disease is the No. 1 worldwide killer of men and women, including in the United States. For example, cardiovascular disease is responsible for 40 percent of all the deaths in the United States, more than all forms of cancer combined.

Brushing up on some basic terminology about cardiovascular disease can help you stay more informed, which pays off whether you’re watching the news or meeting with your doctor.

Feeling Depressed

Life is full of changes. Everyday events and our reactions to them sometimes interfere with our sense of well-being and peace of mind. It is common to get the blues or become sad when disappointed. Symptoms of depression are the most common medical problems seen by health professionals. It is estimated that feelings of depression will affect about one-third of all adults in the United States at some time in their lives.

Most people experience feelings of sadness over such losses as divorce or separation, the death of a friend or loved one, or a job change or layoff. These feelings are an expected reaction to a “triggering event,” and most people get over them in time.

Several factors increase your risk of developing feelings of depression, such as:

* Female sex. Women are twice as likely as men to experience feelings of depression. Hormonal changes may play a role in these feelings, which may be more evident during pregnancy, especially shortly after the birth of a baby (postpartum depression) or shortly before or during menopause. Some women experience feelings of sadness or depression shortly before the start of menstruation (premenstrual syndrome, or PMS).
* Age older than 60. Feelings of depression in this age group are frequently overlooked because the symptoms are similar to other diseases and problems experienced by older adults. Adults in this age group are more likely to experience social isolation. Feelings of sadness may accompany other life events, such as retirement, death of a spouse or child, or declining physical abilities.
* Personal or family history. You are more likely to experience feelings of depression if you have a history of previous depression, an anxiety disorder, or another mental illness. You are also 2 to 3 times more likely to experience feelings of depression if one or both of your parents were diagnosed with depression.
* Medical problems—such as cancer, kidney disease, heart disease, or Parkinson’s disease—or alcohol or substance abuse or withdrawal.
* Stressful life events, such as changing jobs, the loss of a job, or children leaving home.
* Lack of family or social support.
* Having less than a high school education.

Symptoms of depression that may indicate a need for treatment vary from person to person. If you experience feelings of sadness or loss of interest in pleasurable activities plus 4 or more of the following symptoms for 2 weeks or longer, you may be depressed.

* Changes in appetite or weight
* Restlessness or decreased activity that is noticed by others
* Feeling tired or sleepy all of the time
* Trouble sleeping or sleeping more than usual
* Inability to concentrate or make decisions
* Feelings of hopelessness
* Feelings of worthlessness or guilt
* Preoccupation with death or recurrent thoughts of suicide

Because “mood swings” and other emotional changes are considered a normal part of growing up, depression in children and teens often goes unrecognized. Children and teens do develop depression, and it can affect a child’s quality of life. If prolonged or severe depression is left untreated, it can lead to serious outcomes, including suicide attempts and even completed suicide.

Depression is the most important risk factor for suicide. For more information, see the topic Depression.

Review the Emergencies and Check Your Symptoms sections to determine if and when you need to see a health professional.
Emergencies

Do you have any of the following symptoms that require emergency treatment? Call 911 or other emergency services immediately.

* Seriously considering suicide with a plan that includes:
o Having the means, such as weapons or medicines, available to commit suicide or do harm to another person
o Having set a time and place to commit suicide
o Thinking there is no other way to solve your problem or end your pain

Check Your Symptoms

If you answer yes to any of the following questions, click on the “Yes” in front of the question for information about how soon to see a health professional.

Review health risks that may increase the seriousness of your symptoms.

If you have any of the following symptoms, evaluate those symptoms first.

* Thoughts of suicide: Go to the topic Suicidal Thoughts or Threats.
* Feelings of extreme sadness after having a baby: Go to the topic Problems After Delivery of Your Baby.

Yes

Do you feel sad or blue?

See significance of feeling sad or blue if you need information to help you answer the questions below.

Review health risks that may increase the seriousness of your symptoms.

Call your health professional immediately if you answer “Yes” to the following question.
Yes

Do you have frequent thoughts of death or suicide?

Call your health professional today if you answer “Yes” to any of the following questions.
Yes

Are you no longer interested in activities that you once enjoyed?
Yes

Have you had feelings of unusual sadness for 2 weeks or longer?
Yes

Do you find it difficult to concentrate?
Yes

Do you often feel restless or anxious?
Yes

Are you troubled with feelings of worthlessness or guilt?
Yes

Have you had a change in your sleep pattern, either an inability to sleep or wanting to sleep all the time?
Yes

Have you had a recent change in your appetite?
Yes

Have you gained or lost 10 lb (4.5 kg) or more in the past 6 weeks without trying?

If you have answered “No” to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
close
Yes

Are you being treated for depression, but you are not getting better?

See significance of not getting better with treatment for depression if you need information to help you answer the questions below.

Review health risks that may increase the seriousness of your symptoms.
Note:

* Be sure to follow your doctor’s instructions about when to call if you are not feeling better.
* It may take several weeks before you notice much of a change, especially if you have been depressed for a long time. But you should start to feel better in 2 to 3 weeks and see the full effects in 12 weeks.

Call your health professional immediately if you answer “Yes” to the following question.
Yes

Do you have frequent thoughts of death or suicide?

Call your health professional today if you answer “Yes” to any of the following questions.
Yes

Have your symptoms of depression gotten worse since starting treatment or a medicine for depression?
Yes

Have your symptoms of depression not gotten better as expected?
Yes

Have your symptoms of depression not gotten better after starting treatment or medicine for depression, but you are not sure about when you should start to feel better?

If you have answered “No” to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
close
Yes

Do you think that your feelings of sadness may be caused by a medicine?

See significance of a medicine causing feelings of depression if you need information to help you answer the question below.

Review health risks that may increase the seriousness of your symptoms.

Call your health professional today if you answer “Yes” to the following question.
Yes

Do you think that your feelings of sadness may be caused by a medicine?
Note: If you answered “Yes“:

* Call the health professional who prescribed the medicine to determine whether you should stop taking the medicine or take a different one. An appointment may not be necessary.
* If you are taking a nonprescription medicine, stop taking it. Call your health professional if you feel you need to continue taking the medicine.

If you have answered “No” to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
close
Other Symptoms to Watch For

Do you have any of the following symptoms?

* Feelings of anxiety: Go to the topic Anxiety.
* Inability to sleep or early waking: Go to the topic Sleep Problems, Age 12 and Older.
* Feelings of profound weakness or fatigue: Go to the topic Weakness and Fatigue.
* Problems with alcohol or substance abuse: Go to the topic Alcohol and Drug Problems.

If a visit to a health professional is not needed immediately, see the Home Treatment section for self-care information.
Home Treatment

Positive actions and feelings can help lift your spirits. Although thinking positively may be very difficult when you are feeling depressed, try to consider the positive side of situations and events in your life.

Appreciate any moments when you have positive thoughts. The following tips may help.

* Practice positive thinking. Make statements that promote good thoughts. Replace negative self-talk with positive comments.
* Take action to put more fun into your life:
o Exercise. Running, brisk walking, and other forms of aerobic exercise improve symptoms of mild to moderate depression.
o Work in the garden or play with a pet. Plants and pets can be very therapeutic. When you pet an animal, your blood pressure goes down and your heart rate slows. Filling the needs of animals and plants can help you feel useful.
o Visit a friend. Spending time with a good friend may help you forget about your problems for a while and help you see the brighter side of life.
o Have a massage or a manicure, or get your hair cut.
o Rearrange your furniture.
* Talk with your health professional about nonprescription medicines, such as St. John’s wort or SAM-e.
o Talk to your health professional or pharmacist before taking St. John’s wort if you are taking any other medicines. St. John’s wort may change the way other medicines work. In some cases, it may decrease how well medicines work. In other cases, it may make medicines poisonous.
o Do not use alcohol or other mood-altering drugs while you are taking a nonprescription medicine.
o Follow the directions on the label. Do not exceed the recommended dose.
o If you are or could be pregnant, talk with your health professional before taking any medicine or supplement.
o For more information on dietary supplements, visit the Web site of the Office of Dietary Supplements, within the National Institutes of Health, at http://ods.od.nih.gov/index.aspx.
* Take a class or go to a free lecture at the public library or local hospital.
* Take a vacation. Sometimes just getting away for the afternoon will brighten your mood.
* Go to the movies or rent a funny movie.
* If nothing feels fun, try doing something that you used to enjoy.

Symptoms to Watch For During Home Treatment

Use the Check Your Symptoms section to evaluate your symptoms if any of the following occur during home treatment.

* You feel sad, lonely, or unhappy for weeks or months.
* Your symptoms become more severe or frequent.
* You are not getting better as expected after starting treatment for depression.

Prevention

Life is full of changes. Everyday events and our reactions to them sometimes interfere with our sense of well-being and peace of mind. While it is common to get the “blues” or to feel sad occasionally, you may be able to prevent feelings of depression.

* Have a regular checkup with your health professional. Your health professional may evaluate your thyroid function and other factors. Many other diseases, such as coronary artery disease and diabetes, can increase your risk of feeling depressed.
* Talk to your health professional about light therapy if you think that you feel worse during the winter months. Just 30 minutes of light therapy each day improves mood in many people with seasonal affective disorder (SAD).
* Maintain regular sleep and eating patterns. Do not skip meals.
* Try to get some exercise every day. Walking is a good way to start.
* Get involved in social groups or volunteer to help others. Being alone makes things seem worse than they are.
* Do not use alcohol or illegal drugs, such as cocaine, amphetamines, or heroin, to “self-treat” your symptoms. A treatment plan that includes prescription medicine and regular visits to a health professional is much safer and more effective.
* Do not smoke or use other tobacco products. Smoking increases your risk of developing coronary artery disease. The use of smokeless (spit) tobacco increases your risk of developing cancer of the mouth, neck, throat, and digestive tract. Your risk of developing depression increases if you have coronary artery disease or cancer.

Tips to Transform Your Body Faster

There are a few things that you can do besides eating well and exercising that will expedite your physical transformation:

1. Stay positive
Believe that transformation is possible even when you haven’t seen the changes that you want yet. I am sure that you can site many examples in your life where you didn’t expect something to happen and then whoa, there it was. If you don’t have enough evidence of your own, look around you. Do you know someone who thought they’d never get the job, meet that special person, or lose the weight, and then they did? Haven’t you read amazing stories about people overcoming obstacles and creating tremendous transformation in their lives, many against great odds? These are just people too, like you and me; anyone can overcome.

There is one thing that you can be sure of in life, and that is change. Make sure yours happens quickly, and in the way you want, by staying positive and then taking the steps that you know you should take.

2. Stay in the moment
If you think about your end results, the work becomes overwhelming. Just do what you know you can do today, and when tomorrow becomes today, you’ll deal with that.

3. Keep your expectations low
Don’t expect too much too soon, you’ll only get discouraged. Aiming high is nice to say but truly it is easier to stay positive if you set your sites on realistic, smaller goals.

4. Eliminate temptation
Remove distractions like foods that you don’t want to eat and people who have habits that you are trying to break. Surround yourself with people and materials that mirror the changes that you want for yourself. Hang out with happy, healthy people, read inspiring books, and listen to some great music that motivates you to get moving and take action.

5. Stop using excuses
There are always excuses; I am sure you have heard, or used, them all. When your desire to change becomes greater than your fear of changing, the excuses will go away – nothing will stop you from becoming the new you. Even though you may not be able to change the underlying reasons why you haven’t yet accomplished your goals, you can start by removing some of the actions and thought processes that encourage you to stay stuck. Enough with the excuses!

How To Find the Motivation to Exercise

Summer is gone and so goes play time, summer fun, vacations and the free-feeling attitude that comes with summer. It’s back to school (good news for moms, not so much for students), full workweeks with heavier workloads, traffic as usual, and a more regimented schedule all around.

So maybe you’re not the “bikini time - get into shape” type. Maybe you are more of a regimented work schedule type, and the end of summer is just what you need to get yourself back to exercise, eating well and more invested in your own health and fitness.

Training is essential to your mental and physical wellbeing – you know that. And with real life back in session, you are going to have to find added inspiration to manage a regular exercise regimen into your already busy schedule.

So let’s find some fall inspiration. How, even though you have been thinking about getting into better shape ‘forever’, do you finally make it happen?

1. Schedule in your workouts and let everyone who could throw off that schedule know your plan. Then get yourself committed by setting up training dates. I do this. I schedule in my workouts at the beginning of the week for the entire week and make dates with running/walking partners.

I book exercise classes, and make sure that I am committed to a minimum amount of training each week. Everyone is busy. So I make sure to get my training dates with others set ahead of time. And wherever possible I have regularly scheduled dates, which really works out well because I can schedule other things around it, knowing ahead of time that it’s there and I have someone else who is committed, too. And believe me, anyone who could get in the way of my training – whether I live or work with them – get’s the heads up.

2. Think outside the gym to make it work in your schedule. You already know that you can get up 45 minutes earlier than before and get a really fabulous workout in. But if that’s truly asking too much of yourself, do half of your training before work and the rest when you get home. I made a workout video called AM/PM walking that is very popular. There are so many benefits to exercising morning and evening, and I highly recommend this at least once a week.

3. Tell yourself the truth - If you know that you won’t feel like working out after a full day of whatever you do all day, here’s another option: Do a really tough 20 - 25 minutes of training (intervals would be great) before you start your day and then do a strong, but not too intense, 20 – 25 minute walk at lunch time. There – you’re done for the day.

4. Get started and don’t look back. Don’t evaluate or judge your workouts (or even your missed workouts). Keep moving forward, keep the momentum going, and know that soon you, too, will be looking back only to see how far you have come, and how much you have changed.

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