PELVIC PAIN & ENDOMETRIOSIS

Evidence-based nutrition and exercise strategies for perimenopause and menopause. Learn how hormonal changes affect metabolism, manage weight, optimize protein and fiber intake, and build a workout plan backed by NAMS, ACOG, and the Endocrine Society.

Explore the latest hormone replacement therapy guidelines in 2026, including benefits, risks, safety updates, and menopause symptom relief.

Learn the clinical difference between perimenopause and menopause, latest FDA hormone therapy updates, symptoms, diagnosis & treatment. Reviewed by Dr. Hema Jonnalagadda, FACOG.

May is Pelvic Health Awareness Month , a time to shine a light on the vital role the pelvis and pelvic floor play in women’s overall well-being. Pelvic health involves taking care of the muscles and organs in the lower belly so they function properly and feel good. Yet many women don’t realize how important pelvic health is until problems arise. In fact, about one in three women will experience a pelvic health condition at some point in their lives, and these conditions can significantly impact daily comfort and quality of life. This month (and every month), we aim to raise awareness, educate, and encourage open conversation about pelvic health Common Pelvic Health Concerns Women’s pelvic health can be affected by several common conditions. Here is a brief overview: ● Pelvic Organ Prolapse : This occurs when the muscles and tissues that support pelvic organs (like the uterus, bladder, or rectum) weaken or loosen. As a result, an organ can “drop” or press into the vaginal canal. Women with prolapse may feel a bulge or heaviness in the pelvis, especially during activities or lifting, and sometimes experience bladder or bowel changes. Many women are embarrassed to discuss these symptoms, but prolapse is treatable with options like pelvic floor therapy, pessary devices, or surgery ● Urinary Incontinence: Incontinence is the involuntary leakage of urine, ranging from occasional drips (for example, when coughing or sneezing) to a sudden strong urge that can’t be controlled. It affects about one in three women worldwide, often related to pregnancy, childbirth, or menopause. Importantly, urinary incontinence is not a normal part of aging and is treatable Treatments include pelvic floor muscle exercises and other therapies. Early help can prevent it from seriously affecting daily life. ● Endometriosis: Endometriosis happens when tissue like the uterine lining grows outside the uterus, on ovaries, fallopian tubes, or other pelvic sites This condition affects roughly 10% of women of reproductive ageIt often causes severe pelvic pain (especially with periods or intercourse), heavy menstrual bleeding, and sometimes infertility Endometriosis can lead to chronic inflammation, scar tissue, and painful adhesions, so early diagnosis and management are crucial. ● Chronic Pelvic Pain: Chronic pelvic pain is ongoing, non-cyclic pain in the pelvis lasting six months or longer. It can have many causes (or even none clearly identified) and often coexists with other issues like endometriosis, irritable bowel syndrome, or interstitial cystitis Studies estimate that 6–27% of women worldwide suffer from chronic pelvic pain. Because it can be complex, successful management usually involves a multidisciplinary approach (medication, therapy, physical therapy, etc.) tailored to each woman. ● Uterine Fibroids: Fibroids are benign (non-cancerous) tumors that grow in the wall of the uterusThey are very common – up to 80% of women have fibroids by menopause – though many have no symptoms. When fibroids do cause problems, women may experience heavy menstrual bleeding, pelvic pain or pressure. Large fibroids can press on the bladder or bowel, leading to urinary frequency or constipationTreatments range from medication to minimally invasive procedures, depending on symptoms and goals. Each of the above issues is common in women’s health and highlights why paying attention to pelvic symptoms is so important. Future posts in this series will explore these topics in depth, but first it’s key to recognize them and know that effective care is available. Early Detection and Open Conversation Early diagnosis and regular gynecologic care are vital for pelvic health. Women’s health providers are trained to evaluate pelvic concerns. During a routine exam, your provider can check for issues or recommend tests (like pelvic ultrasound) and treatments (such as pelvic floor physical therapy) if needed If you notice any changes – for example, new pelvic pain, unusual pressure, or bladder/bowel leaks – do not hesitate to mention them. Many women feel embarrassed to bring up pelvic symptoms or think they are “just normal,” but that silence can delay help Remember that urinary incontinence and pelvic pressure are not “normal” parts of aging, and there is nothing shameful about seeking help. Talking openly with your doctor can lead to earlier, less invasive treatments. In fact, learning about the pelvic floor can help you spot problems early. Being informed makes you an active partner in your care. Regular checkups also allow your provider to address other aspects of pelvic health (for example, discussing pelvic floor exercises, lifestyle changes, or preventive screenings). In short, don’t wait to speak up – early action can make pelvic conditions much easier to manage. Ready to Take the Next Step? Dr. Hema Jonnalagadda and the team at Advocare Montgomery Gynecology are committed to providing compassionate, expert care for all aspects of women’s pelvic health. If you’re experiencing symptoms or simply want to stay proactive, we’re here to help. 👉 Visit our practice page to learn more or book an appointment today. Your pelvic health matters—and you don’t have to navigate it alone.

Menopause is a transformative phase in a woman’s life, marked by profound hormonal changes that affect nearly every system in the body. While often discussed in general terms, its complexities require a more advanced understanding, especially for those experiencing disruptive symptoms or seeking expert care. As a menopause specialist, Dr. Hema Jonnalagadda, M.D., at Advocare Montgomery Gynecology, provides cutting-edge, personalized treatment options to help women navigate this transition with confidence and optimal health. Understanding Menopause at a Deeper Level Menopause officially begins when a woman has gone 12 consecutive months without a menstrual period, typically occurring between ages 45 and 55. However, the biological shifts start years earlier during perimenopause, a phase characterized by erratic hormone fluctuations, particularly in estrogen and progesterone. The Endocrinology of Menopause Estrogen, a key hormone for reproductive health, also regulates cardiovascular, cognitive, and skeletal systems. As ovarian function declines, so does estrogen production, leading to widespread physiological changes: Cardiovascular: Increased risk of hypertension, atherosclerosis, and altered lipid profiles. Cognitive: Brain fog, memory challenges, and potential links to neurodegenerative diseases. Skeletal: Accelerated bone loss leading to osteopenia or osteoporosis. Metabolic: Insulin resistance, changes in fat distribution, and increased risk of type 2 diabetes. Symptoms Beyond Hot Flashes While vasomotor symptoms (hot flashes and night sweats) are commonly discussed, menopause presents an array of other challenges: Genitourinary Syndrome of Menopause (GSM): Vaginal atrophy, dryness, painful intercourse, and increased UTIs. Sleep Disturbances: Declining melatonin and progesterone levels affect sleep architecture. Mood & Mental Health: Fluctuating neurotransmitter activity can increase susceptibility to depression and anxiety. Joint & Muscle Pain: Estrogen’s anti-inflammatory role means that its decline can exacerbate musculoskeletal pain. Hair & Skin Changes: Collagen loss results in skin thinning, dryness, and increased wrinkling. Advanced Treatment Options Addressing menopause requires a multifaceted approach, combining medical expertise, lifestyle modifications, and innovative therapies tailored to each patient. Hormone Replacement Therapy (HRT) HRT remains the gold standard for managing moderate to severe menopausal symptoms. However, not all formulations are equal. Dr. Jonnalagadda customizes HRT based on: Bioidentical vs. Synthetic Hormones: Assessing patient suitability for bioidentical estrogen and progesterone. Route of Administration: Pills, patches, gels, and vaginal preparations tailored to individual needs. Risk Stratification: Evaluating personal and family history for cardiovascular disease, breast cancer, and thrombotic risk. Non-Hormonal Therapies For women who cannot or choose not to take HRT, effective alternatives include: Selective Estrogen Receptor Modulators (SERMs): Addressing bone density and vasomotor symptoms. Antidepressants (SSRIs/SNRIs): Mitigating mood disturbances and hot flashes. Neurokinin 3 Receptor Antagonists: Newer options targeting hot flashes via central nervous system pathways. Vaginal Estrogen & DHEA: Localized treatments for GSM without systemic effects. Cutting-Edge Therapies & Integrative Medicine Low-Dose Laser Therapy (MonaLisa Touch): Enhancing vaginal health by stimulating collagen regeneration. Nutraceuticals: Phytoestrogens (soy, flaxseed), omega-3 fatty acids, and vitamin D for bone and heart health. Lifestyle Optimization: Personalized nutrition, intermittent fasting, strength training, and sleep optimization strategies. When to Seek Expert Care Menopause is highly individualized, and unmanaged symptoms can severely impact quality of life. Dr. Jonnalagadda specializes in evidence-based, patient-centered care, ensuring that women receive the best possible guidance and treatment. You Should Consult a Menopause Specialist If You: Experience persistent or debilitating symptoms affecting daily life. Have a history of early menopause, surgical menopause, or complex hormonal conditions. Are concerned about osteoporosis, heart disease, or cognitive decline. Need guidance on safe, effective treatment options tailored to your medical history. Take Control of Your Menopause Journey Menopause doesn’t have to mean discomfort or diminished well-being. With the right expertise, women can thrive during this phase. If you're struggling with symptoms or want proactive care, schedule a consultation with Dr. Hema Jonnalagadda at Advocare Montgomery Gynecology today. Let’s work together to create a personalized plan for your health and longevity.

Understanding a Normal Menstrual Cycle A healthy menstrual cycle typically lasts between 21 and 35 days, with bleeding occurring for 3 to 7 days. The amount of blood loss is usually between 30–80 mL per cycle. A normal period should: ● Be fairly predictable each month. ● Not be excessively heavy or painful. ● Not interfere with daily activities. When bleeding patterns change—becoming too frequent, too heavy, or happening outside of your usual cycle—it may be time to seek medical advice. When Bleeding Becomes a Concern Abnormal uterine bleeding (AUB) refers to any bleeding that is outside of the normal menstrual pattern. It can be due to structural issues, hormonal imbalances, or other medical conditions. The PALM-COEIN classification system helps doctors determine the cause: Common Causes of Abnormal Bleeding Structural Causes (PALM) Polyps: Small tissue growths in the uterus or cervix that can cause irregular bleeding. Adenomyosis: When the uterine lining grows into the muscle, leading to heavy and painful periods. Fibroids: Non-cancerous growths in the uterus that can increase bleeding. Endometrial Hyperplasia or Cancer: Abnormal thickening of the uterine lining, which may cause postmenopausal bleeding Non-Structural Causes (COEIN) Hormonal Imbalances (Ovulatory Dysfunction): Conditions like PCOS, thyroid disorders, or perimenopause can lead to irregular cycles. Blood Clotting Disorders: Conditions such as von Willebrand disease may cause excessive menstrual bleeding. Medications: Certain birth control methods, anticoagulants, and hormone therapy can impact bleeding patterns. Other Causes: Sometimes, the exact cause remains unknown but can still be managed effectively. Types of Abnormal Bleeding Heavy Periods (Menorrhagia) Bleeding that lasts longer than 7 days or soaks through multiple pads/tampons per hour. Common causes: Fibroids, adenomyosis, blood clotting disorders. Irregular or Unpredictable Bleeding Bleeding between periods (Metrorrhagia) or very light, inconsistent cycles (Oligomenorrhea). Common causes: Hormonal imbalances, polyps, perimenopause. Bleeding After Menopause Any bleeding after 12 months of no periods is considered abnormal. Requires immediate evaluation for possible underlying conditions, including cancer. Diagnosis: What to Expect at Your Doctor’s Visit To determine the cause of abnormal bleeding, your doctor may recommend: Blood tests to check hormone levels and rule out clotting disorders. Ultrasound to evaluate the uterus and ovaries. Endometrial biopsy to check for abnormal tissue growth. Hysteroscopy to directly examine the inside of the uterus. Treatment Options Treatment depends on the cause of the bleeding, your overall health, and whether you are planning future pregnancies. Options include: Medication-Based Treatments Hormonal Therapy: Birth control pills, IUDs, or progesterone therapy to regulate cycles. Tranexamic Acid & NSAIDs: Reduce heavy bleeding without hormones. Iron Supplements: Help prevent anemia due to heavy bleeding. Minimally Invasive Procedures Endometrial Ablation: A procedure to reduce or stop bleeding by thinning the uterine lining. Hysteroscopy: To remove polyps or fibroids inside the uterus. Uterine Artery Embolization: A non-surgical option to shrink fibroids. Surgical Options (If Needed) Myomectomy: Removes fibroids while preserving the uterus. Hysterectomy: A last-resort option for severe cases where other treatments fail. When to See a Specialist If you are experiencing any of the following, it’s time to schedule an appointment: Bleeding that lasts longer than a week or is unusually heavy. Bleeding between periods or after menopause. Severe cramping or pain that disrupts your daily activities. Signs of anemia, such as fatigue, dizziness, or shortness of breath. Take Control of Your Health Abnormal bleeding doesn’t have to control your life. Dr. Hema Jonnalagadda, M.D., at Advocare Montgomery Gynecology, is dedicated to providing expert, personalized care to help you find relief. If you have concerns about your menstrual health, don’t wait—schedule a consultation today to get answers and the best treatment options available.

Understanding Vulvodynia: A Comprehensive Guide to Chronic Vulvar Pain