1 in 5 Australian women live with pelvic pain. Many have been told their scans are clear, that period pain is just part of being a woman, or that they've had the surgery so they should be fine now. If that's you, this episode is for you.
Dr Kafa Lee is joined by Dr Marilla Druitt, obstetrician and gynaecologist at the Avonlea Clinic in Geelong, President of Pelvic Pain Victoria, and the gynaecologist on the Victorian Inquiry into Women's Pain. Together they unpack why pelvic pain is so often dismissed, how the brain shapes pain, and the wide range of treatments most women have never been offered.
In This Episode
· Why women today have up to 500 periods in a lifetime
· What almost 13,000 Victorians told the women's pain inquiry
· The ultrasound rebate gap that shows how medicine is gendered
· How stress, injustice and the brain shape pain
· The words that help, and the words that harm
· What to bring to your GP about pelvic pain
· Hormonal and non-hormonal treatment options
· Pelvic floor physio, gut health, sleep and pain psychology
· Myth or fact: the biggest beliefs about pelvic pain
Why We Have More Pain Than Ever
Marilla shares the work of anthropologist Beverly Strassmann, who lived with a farming community in Mali in the 1990s. With an average of nine babies and years of breastfeeding each, women there had around 100 periods in their lifetime. Today, many teenagers have had about 150 periods by age 20, and women may have around 500 by menopause.
Period pain is normal and common, but that number of periods is new for humans. Each period is an inflammatory event, and over time the brain learns pain. None of this means women are imagining it. It means modern bodies are carrying a load our ancestors didn't.
What the Women's Pain Inquiry Heard
The Victorian Inquiry into Women's Pain received almost 13,000 submissions, more than any Australian inquiry before it. The stories confirmed what research had shown for years: women's pain is too often dismissed.
Clinicians told the inquiry they lacked time, knowledge and training. Marilla believes real change needs both better education and changes to how care is funded and measured, and she's optimistic, because care has improved enormously over the past 20 years.
One striking example of gendered medicine: a scrotal ultrasound attracts a higher Medicare rebate than a pelvic ultrasound, even though the pelvic scan takes longer and looks at more organs. Around 95% of pelvic ultrasounds in Australia are done for women.
Your Brain Makes Pain
Pain is made in the brain and felt in the body, and the brain makes pain when it senses danger. That's why ongoing stress, conflict or a sense of injustice, such as a family law case or a toxic workplace, can keep pain going even after the physical causes have been treated.
It's also why the amount of endometriosis on a scan or at surgery doesn't match how much pain someone feels. Pain is real, and it has many contributors, not one single cause.
The Words That Help
The phrase "I believe you and your pain is real" comes from patient advocate Kat Stanley, and saying it out loud makes a measurable difference.
Marilla also encourages clinicians to "be a placebo, not a nocebo": avoid frightening language like "that's the worst endo I've ever seen", because fear signals danger, and danger turns up pain.
What to Bring to Your GP
· Book a longer appointment. Pelvic pain can't be sorted in a short visit.
· Write your symptoms down, or use a symptom tool that prints a report.
· Set goals beyond "no pain": what would you love to be able to do again?
· Expect a broad approach covering uterus, ovaries, gut, bladder, muscles, brain and sleep.
· Talk about mental health early. Pain and mental health affect each other.
Treatment Options
Hormonal options are chosen by goal: less bleeding, less pain, contraception, or all of them. A hormonal IUD can take around six months to settle.
Non-hormonal options discussed include tranexamic acid and anti-inflammatories for heavy or painful periods, TENS machines, acupuncture, exercise, and zinc sulfate, which trials suggest may ease period pain in teenagers after about three cycles. Talk to your doctor before starting any supplement or medicine.
Marilla also covers pelvic floor physiotherapy ("all good pelvic pain care starts with a good pelvic health physio"), gut care including checks for coeliac disease and evidence-based gut hypnotherapy for IBS, improving sleep, and pain psychology such as CBT for pain.
The best approach is a menu: you choose what you want to try, and your clinician helps you find the right combination.
Join the CODEENDO Trial
Are you over 18, living in Australia, with diagnosed endometriosis? CODEENDO lets you choose from nine modules, including diet, physio, mindfulness, yoga, CBT and hormone treatment.
Learn more about CODEENDO
Myth or Fact
Period pain is normal, so just put up with it.
Period pain is common. Putting up with it isn't necessary.
If the scan is clear, there's nothing wrong.
If you have a symptom you don't like, that matters, whatever the scan shows.
Surgery to remove endometriosis will fix the pain.
Sometimes it does, but it isn't a guaranteed fix.
How much it hurts shows how much damage there is.
No. The brain decides how much pain to make based on danger, not damage alone.
Pelvic pain stops at menopause.
Not necessarily, though painful periods will.
About Our Guest
Dr Marilla Druitt is an obstetrician and gynaecologist at the Avonlea Clinic in Geelong and President of Pelvic Pain Victoria. She was the gynaecologist on the Victorian Inquiry into Women's Pain, researches pelvic pain, and is a Clinical Senior Lecturer at Deakin University.
Frequently Asked Questions
Is period pain normal?
Period pain is common, but pain that stops you living your life isn't something you have to put up with. Speak with your GP about options.
Why does my pelvic pain continue when my scan is clear?
Pain has many contributors, including muscles, gut, bladder, sleep, stress and how the brain processes danger. A clear scan doesn't mean your pain isn't real.
Will surgery for endometriosis fix my pain?
Sometimes, but not always. The amount of endometriosis doesn't match how much pain someone feels, and the best results usually come from a broader treatment plan.
What non-hormonal treatments help pelvic pain?
Options discussed include anti-inflammatories, tranexamic acid, TENS, exercise, pelvic floor physio, gut hypnotherapy for IBS, better sleep and pain psychology.
What should I bring to my GP for pelvic pain?
A written record of your symptoms, your goals, and enough time. Book a longer appointment if you can.
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