Medication for Pelvic Pain

NYU Langone doctors may prescribe antibiotics to treat women with urinary tract infections or a sexually transmitted infection that’s causing PID. The medication is taken by mouth, by injection, or by intravenous (IV) infusion for days or weeks, depending on the medication. Additional courses of a different type of antibiotic may be necessary if the infection is resistant to certain antibiotics.

Some antibiotics can make your skin more sensitive to the sun, so your doctor may recommend that you wear a hat and sunscreen or avoid the sun while taking them.

Depending on your diagnosis, your doctor may prescribe hormonal medications to help relieve pelvic pain.

Oral Contraceptives

Doctors may prescribe oral contraceptives, or birth control pills, for women diagnosed with endometriosis, fibroids, menstrual cramps, or ovarian cysts. When oral contraceptives are taken continuously, without a break for menstruation, the lining of the uterus thins and both ovulation and periods stop.

This often lessens or eliminates pain associated with these conditions. In some women, spotting or breakthrough bleeding occurs during the first six months of use but subsides over time.

No risks have been associated with suppressing menstrual cycles. Some women can’t tolerate birth control pills and may be prescribed other kinds of medication.

Gonadotropin-Releasing Hormone Agonists

Commonly called GnRH therapy, gonadotropin-releasing hormone agonists suppress ovulation and put the body in a temporary and reversible menopause that lasts only as long as the medication is taken.

GnRH therapy shrinks fibroids and endometrial implants—endometrial cells that appear outside the uterus and attach to other organs, a sign of endometriosis. GnRH therapy can reduce or eliminate pain for some women who do not experience relief with oral contraceptives. Some GnRH medications are injected; others are sprayed into the nose.

These medications are prescribed for one, three, or six months at a time. Side effects can include hot flashes and mood changes, and the therapy can lead to bone loss that may not be reversible. Your doctor can help you manage this condition with calcium supplements and, if needed, medication.

Progestin

Progestin, a synthetic version of the hormone progesterone, shrinks endometrial implants, thereby reducing or eliminating pain caused by endometriosis. These medications can be taken by mouth, by injection, or through an intrauterine device.

Progestins are taken daily by mouth, or by injection every 90 days in your doctor’s office. Alternately, a progestin-containing intrauterine device (IUD) called Mirena^® can be inserted into the uterus during an office visit, and it can remain there for up to five years. It can be removed if you want to get pregnant.

Side effects of progestins can include spotting or vaginal bleeding, breast tenderness, and weight gain, though the likelihood of these side effects varies with the dose of medication.

Danazol

This synthetic form of the male hormone testosterone lowers estrogen levels and increases levels of androgens, or male sex hormones, and is given to reduce or eliminate pain caused by endometriosis. Taking danazol causes a temporary, reversible menopause.

Given as a vaginal suppository, the medication shrinks endometrial implants and stops periods. After treatments, your menstrual cycle typically returns if you’re not naturally past menopause.

Danazol can cause side effects that include unnatural hair growth, such as on the face, and a deepening of the voice. Therefore it is usually considered a last-resort therapy before surgery for women who have severe endometriosis and aren’t getting relief from other treatments.

Your doctor may recommend an over-the-counter pain relief medication, such as ibuprofen or naproxen, called a nonsteroidal anti-inflammatory drug (NSAID). Taken by mouth, NSAIDs help to relieve mild pain caused by adenomyosis, endometriosis, fibroids, interstitial cystitis, ovarian cysts, pelvic organ prolapse, or pelvic inflammatory disease.

Avoid taking these medications for longer than 90 days, as they can lead to the erosion of the stomach lining and ulcers in some women. Talk to your doctor if you are still feeling pain after 90 days, and he or she can help you explore alternatives.

Constipation can cause women to strain during a bowel movement, which can aggravate pelvic pain, particularly in women with pelvic organ prolapse. To prevent or treat constipation, your doctor may recommend over-the-counter fiber supplements or stool-softening medications.