Spotting. Itching. Tenderness. When below-the-belt symptoms crop up, your first impulse is probably to slip into a pair of pajamas and curl up on the couch. Holing away for a night or two is fine, but what if your symptoms last for weeks or even months?

"When it comes to gynecological issues, many women adopt a grin-and- bear-it mentality," says Fred M. Howard, M.D., chief gynecologist at the Rochester Endometriosis and Pelvic Pain Center in Rochester, New York. Often they're simply too embarrassed to tell anyone-even their doctors-about their problems. "But left untreated, some can lead to more serious illnesses," he says. Even when you do fess up, receiving the proper care can be tricky: Many of the symptoms are often vague and can be easily confused with other conditions. In fact, research reveals that it can take years for physicians to arrive at an accurate diagnosis.

But the sooner you take charge of your health, the sooner you'll feel better. That's why we've asked experts to decipher some down-there symptoms and treatments-so you can get off that couch already!


Heavy and/or painful periods that last for at least seven days; abdominal pain or fullness

Ask your doctor about uterine fibroids

You may be one of the 40 percent of women with fibroids, or noncancerous growths that are usually found on the uterine wall. "Most people think of it as a condition that affects older women," says Bruce McLucas, M.D., founder of the Fibroid Treatment Collective at the University of California, Los Angeles. "But the truth is that fibroids are most common among women in their 30s and 40s." The majority of these tissue masses measure about 4 centimeters in diameter (picture a golf ball), but some can balloon to the size of a grapefruit.

About 75 percent of women with fibroids don't experience any problems and, in most cases, won't need treatment. But when symptoms show up, they can be very uncomfortable and affect the quality of your life. "Heavy bleeding may occur because fibroids distort the uterine wall, causing more of the lining to shed," says McLucas. In serious cases, this bleeding can lead to anemia. Fibroids that block the fallopian tubes, womb, or birth canal may lead to infertility, miscarriages, and premature birth.


The most common treatment for fibroids used to be hysterectomy, a surgery to remove the uterus. But today there are noninvasive options better suited to your lifestyle and needs.

For example, if you still want to get pregnant, your best choice is myomectomy. This surgical removal of the fibroids is the only treatment that's known to preserve fertility. Don't want more kids? Consider uterine artery embolization, or UAE. Doctors inject particles into the arteries leading to the fibroids, blocking blood flow and shrinking them.

For symptomatic women who have a few larger (rather than smaller) fibroids, a newer treatment called magnetic resonance imaging ultrasound may be in order. During the procedure, an M.D. zaps growths with a high-intensity ultrasound beam. Fibroids are broken down and reabsorbed by the body; most patients can return to work in a day or two.


Painful intercourse; severe cramps starting a week or two before menstruation; bloating

Ask your doctor about endometriosis

"There's a misconception among women, and even some doctors, that it's normal to have extreme discomfort during your period," says Howard. But severe cramps may signal endometriosis, a condition in which the endometrium, or tissue that lines the uterus, grows outside of the uterine walls. Although there's no definitive cause, some experts believe that menstrual blood may carry endometrial cells to other sites in the body-most commonly, the ovaries, fallopian tubes, or the lining of your pelvis.

During your monthly cycle, hormone fluctuations cause the endometrium to thicken, break down, and bleed. But since there's no place for the blood to drain, it becomes trapped, irritating the surrounding tissue. Over time, it can lead to cysts, scarring, and infertility.


Taking oral contraceptives continuously (skipping the placebo pills) to stop your period can relieve symptoms, so ask your gynecologist about taking an extended-cycle brand. Progesterone-only pills are another option, as are prescription drugs called gonadotropin analogs. Both stop the ovaries from producing estrogen, causing temporary menopause.

If you're trying to have a baby, ask your doctor about surgical removal of the errant tissue; studies show that this procedure decreases pain while increasing your odds of conceiving. "Schedule the surgery about six months before you want to become pregnant," says Howard.


A frequent need to urinate; pelvic pain

Ask your doctor about interstitial cystitis (IC)

You have the telltale signs of a urinary tract infection, yet no amount of antibiotics seems to do any good. Sound familiar? You may be one of the million Americans suffering from IC (also called painful bladder syndrome). "This condition may be caused by a small hole in the protective lining of the bladder that allows toxic substances in urine to seep out and irritate the outside of the bladder," says Kristene Whitmore, M.D., chief of urology at the Drexel College of Medicine. A urologist can perform a cytoscopy, a procedure that uses a tiny camera to examine the inside of your bladder for IC-related hemorrhages.


Unfortunately, there's no simple cure for IC; most sufferers try a combination of treatments. Antidepressants can soothe the inflamed bladder wall, while Elmiron-the only oral pill approved for IC-can help it heal. And the latest research shows that the anti-wrinkle treatment Botox is also effective: Two studies found that an injection of this muscle-relaxing filler in the bladder reduced pain and urinary frequency for up to six months.

Physical therapy and biofeedback, in which a computer monitors your vaginal contractions, can help you learn how to relax your vaginal muscles during spasms.


Vaginal itching; milky discharge; a fishy odor

Ask your about doctor bacterial vaginosis (BV)

One in five women who purchased an over-the-counter yeast infection remedy actually had BV, finds a study from the Medical College of Georgia. Caused by an overgrowth of anaerobic bacteria in the vagina, this condition strikes 3 million women a year. "Having the infection, which weakens your vagina's natural protective barrier, can raise your risk of contracting sexually transmitted diseases, such as HIV, chlamydia, and gonorrhea," says Jeanne Marrazzo, M.D., an associate professor of medicine at the University of Washington.


See your gynecologist, who may prescribe a course of antibiotics.