The short answer: long-lasting pelvic pain usually starts with a few simple tests — an examination, an internal ultrasound, swabs and blood tests. If these are normal but the pain continues, a keyhole operation to look inside (diagnostic laparoscopy) may be advised; endometriosis or scar tissue (adhesions) is often found and can be treated at the same time. A normal ultrasound does not mean the pain is imaginary — some common causes simply do not show on a scan. For the different patterns of pelvic pain, start there.
On this page
- Investigating Chronic Pelvic Pain: What to Expect
- Initial Investigations
- When Laparoscopy Is Needed
- When Does Pelvic Pain Need Oncological Assessment?
Investigating Chronic Pelvic Pain: What to Expect
Chronic pelvic pain — defined as pain of at least 6 months duration, bad enough to stop you doing daily things or to need medical care — demands a structured diagnostic approach. The challenge is that pelvic pain can originate from gynaecological, urological, gastrointestinal, musculoskeletal, or psychological sources, and these often coexist. A systematic workup is essential to avoid years of under-diagnosis.
Initial Investigations
- Detailed history — whether the pain follows your periods or not, its link with passing urine or stools, pain after sex, previous surgeries, family history of endometriosis or cancer
- Pelvic examination — the size of the womb and whether it is tender, any lumps near the womb such as on the ovaries or tubes (adnexal masses), and pain when the cervix is gently moved (cervical motion tenderness, a sign of infection)
- Transvaginal ultrasound — ovarian cysts, fibroids or other changes in the womb, and fluid in the pelvis; an MRI gives more detail if the ultrasound is unclear
- Swabs — to exclude pelvic inflammatory disease
- Bloods — FBC (for anaemia), CA-125 (a blood marker, checked in selected cases when there is an ovarian concern), thyroid function
Endometriosis often does not show on a routine ultrasound, so a normal scan does not rule it out. Read about endometriosis assessment and care.
When Laparoscopy Is Needed
If the first tests do not find the cause and symptoms persist, diagnostic laparoscopy is the next step. It remains the only way to definitively diagnose endometriosis, scar tissue (pelvic adhesions), or problems on the lining of the tummy (peritoneal pathology). Approximately 30–35% of women undergoing laparoscopy for chronic pelvic pain are found to have endometriosis. In experienced hands, the diagnostic procedure becomes a treatment: endometriosis patches are cut out and scar tissue is released in the same operation.
What a diagnostic laparoscopy involves
It is done under general anaesthetic through two or three small cuts in the tummy, using a thin camera. Most women go home the same day or the next day and return to light activities in about one to two weeks — longer if a lot of endometriosis has been removed. The cost depends on the hospital and on whether treatment is done during the same operation; our care team can give you an estimate — message the care team on WhatsApp.
When Does Pelvic Pain Need Oncological Assessment?
Any of the following should prompt referral to a gynaecological oncologist alongside or instead of general gynaecology:
- Pelvic mass on imaging with any complex features
- Elevated CA-125 in a woman with pelvic pain and a complex cyst
- New pelvic pain in a woman over 55
- Pain alongside postmenopausal or abnormal vaginal bleeding
- Rapidly progressive pain with weight loss or bloating
- Pelvic pain following treatment for a previous malignancy
Contact Dr. Nishtha Tripathi Patel at +91 76988 00333 for specialist pelvic pain assessment in Ahmedabad.