Chronic Pelvic Pain Causes & Treatment

By TMoM Team Member Suzy Fielders

Do you suffer from chronic pelvic pain? Are you struggling with endometriosis or uterine fibroids? You aren’t alone, about 1 in 10 women are impacted by it. Furthermore, despite all the recent advocacy efforts many women still suffer for 7 to 10 years before reaching a diagnosis. The thought of having surgery might seem scary or unnecessary, but did you know that Atrium Health Wake Forest Baptist offers a minimally invasive gynecologic surgery program? The treatments they offer might be the answer to provide you with relief from the constant pain. Don’t live in pain any longer! Get the help you need! Visit WakeHealth.edu/MIGS or call 336-716-6476 to schedule your appointment today.

Dr. Eva Reina is a fellowship trained gynecologic surgeon at Atrium Health Wake Forest Baptist. She specializes in chronic pelvic pain and minimally invasive gynecologic surgery. Her surgery experience includes the Sonata procedure, which is an incisionless procedure to treat uterine fibroids. “At the beginning of my OB-GYN residency, I enjoyed delivering babies, but what I really enjoyed was hearing patient stories, getting to know them, following them over a long period of time and helping them in some of their most challenging moments,” she says. In the Q&A session below, Dr. Reina shares more on her background and experience, chronic pelvic pain, gynecologic surgeries, and more.

Meet Dr. Reina

What led you to become a doctor?

“I’ve wanted to be a teacher ever since I can remember. In college I had an ‘Aha!’ moment – Who better to teach than people about their own bodies? To doctor is to teach.”

How did you determine chronic pelvic pain was your niche?

“I enjoy long-term relationships with my patients — listening, understanding their unique goals, and helping people regain a meaningful quality of life is what brought me to care for those suffering from chronic pelvic pain.”

Chronic Pelvic Pain & Pain Management

What are some common causes of chronic pelvic pain?

“One of the reasons chronic pelvic pain is so complex, is that most individuals have more than one pain generator. The body’s nervous system has intricate connections allowing different organ systems to talk to each other, which can lead the body to sound the alarm in neighboring areas even without tissue damage. This is called pelvic organ “cross-talk.” The most common combination of this I see in my practice is endometriosis, pelvic floor muscle spasm, and bladder pain conditions.”

What ways do you support your patients through their unique journey?

“By the time many patients reach a subspecialist, they have seen upwards of 5 doctors for their pain. Many people feel exhausted, dismissed, and uncertain of where to go from here. Acknowledging the validity and working to gain an understanding of their journey is critically important to paving a path towards healing.”

How do you and a patient set a plan and determine what is best for them?

“I start every visit by identifying the patient’s goals. What is your most important “must not miss” item that we cover today? Which of these symptoms are most impacting your quality of life? As pelvic pain typically develops over several years, we often need to work together to prioritize which aspect would be most meaningful to tackle first, and that pathway is different for every individual.”

Gynecologic Surgery

What reasons deem gynecologic surgery necessary?

“In the case of pelvic pain, the most common reasons we do gynecologic surgery are structural conditions like endometriosis, adenomyosis, and fibroids. These structural conditions cause pain in many ways, but one of these ways is by distorting the normal pelvic anatomy. Most individuals with these conditions will require both surgical and non-surgical interventions such as medications and/or physical therapy to adequately address their pain and improve quality of life.”

What are some minimally invasive gynecologic surgeries and how does each help a person?

“Minimally invasive gynecologic surgery takes many forms. The most common surgeries I perform are laparoscopic excision of endometriosis with preservation of the ovaries, laparoscopic or hysteroscopic myomectomy to remove fibroids, and laparoscopic hysterectomy to remove the uterus. Sometimes we utilize the surgical robot during these procedures depending on the patient’s individual needs. Some examples of these surgical needs include:

Endometriosis may manifest in the tissue lining the abdomen and pelvis, the ovaries, or deep nodules infiltrating the bowel or bladder. Removing endometriosis can help to improve painful periods, and in certain cases address related bladder and bowel dysfunction.
In the case of uterine fibroids, we have the option to preserve the uterus via myomectomy either with an incision-less vaginal approach (hysteroscopy) or via small incisions on the abdomen depending on where the fibroids are located.
A hysterectomy is most commonly done if the patient is having heavy menstrual bleeding, fibroids, or in certain cases pelvic pain and does not wish to preserve their uterus for childbearing or other cultural reasons. Performing hysterectomy via small incisions allows patients to go home the same day and return more quickly to their everyday activities.”

What is the Sonata procedure and when should someone ultimately choose this procedure?

“Sonata is an incision-less procedural intervention used to shrink uterine fibroids to improve symptoms such as heavy menstrual bleeding and pelvic pressure. Fibroids may be inside the lining of the uterus, in the muscle, or on the outside of the uterus. We have safe, effective, minimally invasive surgical techniques to remove fibroids on the outside and the lining of the uterus. However, those smaller fibroids buried deep in the muscle are harder to get to with those techniques. Sonata provides a less invasive option (typical return to work within 48 hours) as compared to myomectomy or hysterectomy.”

How Can Someone with Chronic Pelvic Pain Seek Relief? Get Pain Relief Today with Atrium Health Wake Forest Baptist.

You do not have to keep living in pain and feel unheard in your concerns. To schedule an appointment or learn more, visit WakeHealth.edu/MIGS or call 336-716-6476 to get the pain relief you are looking for and have a medical team that is with you every step of the way during treatment.