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Case Study: Long-Term Pelvic Pain in Women


A 32-year-old woman from Scotland presented to her primary care provider, reporting severe pelvic pain that started in her teenage years. For nearly 10 years, she had endured painful periods, daily cramps, nausea, bloating, and pain during or after sex. She often told herself that her symptoms were just “normal period pain” and did not seek medical help until her symptoms began to interfere with her daily life and activities.


Over time, her menstrual cramps became so intense that she became housebound on some days and had to withdraw from her postgraduate studies due to pain and fatigue. She experienced fluctuations in her weight, including rapid weight changes that were unrelated to her dieting efforts.


Medical History & Timeline

  • Age: 32

  • Presenting complaints:

    • Severe menstrual cramps for over a decade

    • Daily pelvic pain

    • Bloating

    • Nausea

    • Pain during or after intercourse

  • Diagnostic testing: Ultrasound and scans revealed multiple large endometriomas (cysts typically associated with Endometriosis), a twisted fallopian tube, and evidence that parts of the bowel had adhered to the uterus.


Possible Diagnoses


1. Chronic Pelvic Inflammatory Disease (PID)

An infection of the female reproductive organs that can cause persistent pelvic pain and sometimes infertility.


2. Irritable Bowel Syndrome (IBS)

A gastrointestinal disorder that causes bloating, pain, and changes in bowel habits.


3. Endometriosis

A condition in which tissue similar to the lining of the uterus grows outside the uterus, causing chronic pelvic pain, painful periods, and sometimes infertility.


4. Ovarian Cysts from Functional Menstrual Changes

Non-endometriosis cysts that can form during menstrual cycles.


Thank you for reading, 

Ashira Agarwal


Sources: 


Answer:

The correct diagnosis was Endometriosis, a chronic gynecological condition where tissue similar to the uterine lining grows outside the uterus, often leading to severe pain, adhesions, and long diagnostic delays.

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