Pelvic pain is a symptom that many women experience at some point in their lives. While mild cramps around menstruation are often harmless, persistent or recurring pelvic pain can sometimes point to a deeper issue — one that may even affect fertility.

In women of reproductive age, chronic pelvic pain is often linked to gynaecological conditions that can interfere with ovulation, implantation, or the health of the reproductive organs. Understanding how these conditions impact fertility is the first step in getting the right treatment and improving your chances of conception.

If you’ve noticed pelvic discomfort that lingers beyond your period, you may find our article on why pelvic pain occurs after menstruation helpful. It explores the most common underlying causes, including endometriosis, ovarian cysts, and fibroids. In this post, we’ll take a closer look at how these same conditions can also affect fertility — and what you can do about it.

Understanding Pelvic Pain and the Reproductive System

The pelvis is home to several key reproductive organs — the uterus, ovaries, fallopian tubes, cervix, and vagina. When pain occurs in this region, it could stem from any of these structures, or from surrounding tissues such as the bladder or bowel.

Pelvic pain can appear in several forms:

• Cyclical pain that coincides with your menstrual cycle
• Non-cyclical pain that persists throughout the month
• Acute pain caused by infection or sudden complications (like a ruptured cyst)
• Chronic pain lasting more than six months

Chronic pelvic pain is often multifactorial, meaning more than one cause may be contributing — such as inflammation, hormonal imbalance, or scar tissue from previous infections. Many of these factors can also have an effect on reproductive function.

Common Gynaecological Conditions That Cause Both Pain and Fertility Problems

1. Endometriosis

Endometriosis is one of the most significant causes of both pelvic pain and fertility difficulties. It occurs when tissue similar to the uterine lining grows outside the womb — often on the ovaries, fallopian tubes, or the pelvic wall.

This tissue responds to hormonal changes each month, leading to inflammation, scarring, and adhesions that can distort reproductive anatomy.

How endometriosis affects fertility:

• The fallopian tubes can become blocked or twisted.
• Inflammation may interfere with egg quality or implantation.
• Painful intercourse can make conception more challenging.

Treatment options:

Hormonal medication can help suppress symptoms, while laparoscopic surgery may be recommended to remove endometriotic lesions and restore normal pelvic anatomy. Many women see improved fertility following surgical treatment.

2. Pelvic Inflammatory Disease (PID)

PID is an infection of the upper reproductive tract, often caused by bacteria that spread from the vagina or cervix to the uterus, fallopian tubes, or ovaries. Chlamydia and gonorrhoea are the most common triggers.

How PID affects fertility: If left untreated, PID can lead to scarring of the fallopian tubes, making it harder for eggs to travel to the uterus. This increases the risk of infertility or ectopic pregnancy (when a fertilised egg implants outside the womb).

Warning signs include:

• Persistent pelvic pain
• Unusual vaginal discharge
• Fever or flu-like symptoms
• Pain during intercourse or urination

Early diagnosis and antibiotics can usually treat the infection effectively. However, once scarring has occurred, it may be permanent — which is why early testing and treatment are crucial.

3. Fibroids

Uterine fibroids are non-cancerous growths that can develop within or on the uterus. While not all fibroids cause pain, larger or multiple fibroids can create pressure in the pelvis and contribute to heavy or prolonged periods.

How fibroids affect fertility:

• Distortion of the uterine cavity can make it difficult for an embryo to implant.
• Fibroids near the fallopian tube openings can block passage of the egg.
• Large fibroids can interfere with blood supply to the uterine lining.

Treatment options:
Medication, hormonal therapy, or surgical procedures like myomectomy can remove fibroids while preserving fertility.

4. Adenomyosis

Adenomyosis occurs when the uterine lining grows into the muscular wall of the uterus. It can cause severe menstrual cramps, heavy bleeding, and a feeling of pelvic fullness or tenderness.

Although adenomyosis is more common in women who have already had children, it can also affect those trying to conceive. The condition may alter the shape and function of the uterus, reducing the likelihood of successful implantation.

5. Ovarian Cysts and Ovulatory Disorders

Functional ovarian cysts are usually harmless and disappear on their own. However, if cysts persist or are caused by conditions such as polycystic ovary syndrome (PCOS), they may contribute to both pelvic pain and infertility.

PCOS is a hormonal imbalance that affects ovulation. Women with PCOS may have irregular cycles, difficulty conceiving, acne, or excessive hair growth. Managing PCOS through lifestyle changes, medication, and hormonal therapy can help restore ovulation and improve fertility outcomes.

When Pelvic Pain is a Sign to See a Fertility Specialist

If you experience pelvic pain along with any of the following, it’s important to seek medical advice:

• Irregular or heavy menstrual cycles
• Pain during intercourse or ovulation
• Difficulty conceiving after 6–12 months of trying
• History of PID, endometriosis, or fibroids

A gynaecology consultation can help identify underlying conditions early. Investigations may include:

• Pelvic ultrasound scan – to visualise cysts, fibroids, or adenomyosis
• Blood tests – to check hormone levels and ovulatory function
• Cervical or vaginal swabs – to rule out infection
• Laparoscopy – for direct examination and treatment of pelvic abnormalities

Managing Pelvic Pain and Improving Fertility

The good news is that most causes of pelvic pain can be treated — and many women go on to conceive naturally after receiving proper medical care. The key is early diagnosis and an individualised treatment plan.

Treatment options may include:

• Medication: To manage pain or balance hormones.
• Surgery: To remove fibroids, endometriosis lesions, or scar tissue.
• Fertility treatments: Such as ovulation induction or IVF, if natural conception is difficult.
• Lifestyle support: Maintaining a healthy weight, reducing stress, and avoiding smoking or alcohol can improve reproductive outcomes.

Emotional Impact of Pelvic Pain and Infertility

Beyond the physical symptoms, living with chronic pelvic pain or fertility struggles can be emotionally challenging. Many women experience anxiety, frustration, or isolation. It’s important to seek emotional support — whether through counselling, support groups, or open communication with your healthcare team.

Understanding that you are not alone, and that effective treatment options exist, can help you feel empowered and in control of your health journey.

When to Take Action

If you’ve been living with pelvic pain — particularly if it occurs after your period or interferes with your daily life — don’t ignore it. Persistent pain can be a warning sign of conditions that may affect your reproductive health.

You can read more about the causes of post-period discomfort in our detailed article, Why am I Experiencing Pelvic Pain After My Period? It explains when to seek help and what tests might be necessary to uncover the root cause.

Booking a private gynaecology consultation is often the fastest way to get a diagnosis and a personalised treatment plan — helping you find relief, protect your fertility, and restore your wellbeing.

Final Thoughts

Pelvic pain and fertility are closely linked, and understanding this relationship can help you take proactive steps toward better reproductive health. Whether caused by endometriosis, fibroids, infections, or hormonal imbalances, early intervention offers the best chance of successful treatment.

If pain persists beyond your period or you’ve been trying to conceive without success, don’t delay seeking professional advice. With expert assessment and modern treatment options, most women can regain comfort and confidence — and achieve their fertility goals.