How To Effectively Manage Pelvic Pain | with Dr Hazel Batten

I have been following the fantastic work of gynaecologist Dr Peta Wright for some time now. Dr Peta works at Vera Women’s Wellness Clinic in Queensland. She has an innovative approach to managing pelvic pain and has shared her knowledge in her latest book “Healing Pelvic Pain”. This article will summarise some of her incredible insights into the causes of chronic pelvic pain.

As a society we are conditioned into thinking that all pelvic pain is abnormal. However, this is largely incorrect. Up to 93% of women will experience some degree of period pain. Menstruation is an inflammatory process involving the release of inflammatory chemicals called prostaglandins that cause the uterus muscle to contract and the lining to shed. Ovulation pain can also be a normal experience around mid-cycle. Prostaglandins stimulate the release of an egg. This can release a small amount of fluid into the pelvis which can trigger pain receptors.

Period pain is acute pain (nociceptive). Nociceptive pain is a vital survival mechanism for keeping us safe, but if it becomes severe, for reasons such as increased inflammation, this pain can convert to chronic (neuroplastic) pain. Neuroplastic pain is pain that has altered the nervous system that results in amplification of the pain signal transmitted to the brain and the misinterpretation of safe sensations to dangerous ones. Painful periods that remain unmanaged can be commonly associated with the development of chronic pain. The longer pain persists untreated, the deeper these neural pathways are carved.

Endometriosis is now the main cause of pelvic pain in women. It is the presence of endometrial-like tissue which is deposited outside of the uterus. Endometriosis is thought to be caused by retrograde flow of blood. It is also a result of underlying immune dysregulation and inflammation. People are fearful that endometriosis can progress and cause issues with fertility; however, this is rarely the case. Most lesions that are found during surgery are superficial and likely to represent part of the normal menstruation process, they do not progress further.

Endometriosis alone is not the complete picture when it comes to pelvic pain. Other factors that impact on the body’s immune system play a role. These include:

The gut microbiome plays an important role in controlling the body’s immune system. Women with endometriosis often have lower levels of beneficial bacteria and are more likely to have dysbiosis (bad bacteria), which may lead to higher levels of a chemical known as lipopolysaccharide (LPS). LPS can damage the gut lining leading to increased permeability ‘leaky gut’. This allows the immune cells to encounter toxins from the gut. LPS is also prevalent in the outer wall of certain bacteria like E.Coli. It binds to immune cells, activating them to produce inflammatory cytokines, which leads to inflammation around the body, for example in the brain, which can contribute to chronic pain. This mechanism is present in all causes of pelvic pain. Immune dysfunction can also mean that endometriosis deposits throughout the body are not properly cleared away.

Trauma is a very common cause of chronic pelvic pain. The human body cannot separate the mind and body. Those people who start off with acute pain and then develop chronic pain are more likely to have had an underlying trauma or be perfectionist personality type, which can lead to their body’s getting stuck in the sympathetic nervous system (‘fight or flight’ mode). We start to see the world as a threat. Our brain may even misinterpret normal safe signals as dangerous and produce pain.

Being in a chronic state of stress has been linked to disruption of the microbiome, leaky gut and immune dysregulation. It can also lead to contraction of the pelvic floor muscles. When these are in a constant state of contraction, they can become tense and more likely to spasm and cause pain.

Often people get validation from being told their pain has a physical cause. However, unresolved trauma is something to consider if conventional treatment for endometriosis has not helped. Becoming aware of our nervous systems and recognising when they are in different states is key in managing the pain. As well as learning strategies to move back into a place of safety when the parasympathetic nervous system can take over again.

If you would like to book an appointment with Dr Hazel, you can book here

Dr Hazel Batten is an Integrative Doctor with over a decade of clinical experience and a keen interest in women's hormones, PCOS, thyroid conditions and post-partum depletion.