Urogynecology Expert Forum
Persistent Pelvic Pain Post-Menopausal
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Questions in the Urogynecology forum are answered by Bruce Crawford, MD, J. Kyle Mathews, MD, and other medical professionals and experts. Topics covered include overactive bladders, bladder pain, fallen/drooping bladder, bowel urgency, bowel prolapse, cystitis, incontinence, pain with intercourse, rectal prolapse, surgery, urinary urgency, and uterine prolapse.

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Persistent Pelvic Pain Post-Menopausal

I'm 60 years of age. I had a abdominal partial hysterectomy 20 years ago.  Afterwards I would occasionally have a day or two pelvic cramps.  And also had some endometriosis.  About 6 years ago I started HRT and was taken off it 1 year ago.  I had hot flashes for several months & still avg one/day.  8 weeks ago I started having pelvic cramping.  My physician decided it could be a UTI and gave me antibiotics - I still have the pain.  I'm now on Naprosyn - still experience pain.  The pain lessens when laying down at night.  I had a pelvic ultrasound 2 weeks ago and it shows clear.  I'm scheduled to have a pelvic exam and pap with the same physician this coming week.  I have located a highly recommended gynecologist in my area and have also scheduled an appointment with him for 2 weeks in the future.
A couple of days ago I attempted to examine my vagina before a shower.  I discovered a bump - it felt like a golf ball size - barely inside the entrance to the vagina, and the pain worsened significantly after I poked at it.  I'm not having any problems urinating or defacating.  I've read a lot about prolapsed bladder.  But I'm wondering what else could be causing the pain.  Can cramping like menstrual pain be associated with a prolapsed bladder?  Could scar tissue from the hysterectomy cause this?  Could I still have endometriosis post-menopause?  Should a prolapsed bladder have shown up on a pelvic ultrasound?  Am I missing something to help diagnose this?
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Endometriosis is supposed to not be a problem after menopause. The bulge you feel may be a partial prolapse of the vaginal wall, but this should not be painful if you poke at it. Prolapse is usually not a life threatening situation, and does not cause sharp pain.
I would recommend you get the pelvic exam, and a full evaluation by your gynecologist. If this is completely normal and you do not get any useful answers, vonsider visiting with a qualified pelvic floor physical therapist who can tell if your pain is being caused by painful trigger points in the pelvic floor muscles.
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J. Kyle Mathews, MD, DVMBlank
Plano Urogynecology Associates
Plano, TX
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