What could be the reason of the back pain and pain radiating from the pelvis to the hips?

Hi doctor,

My girlfriend is 29. She is 5 feet tall and weighs 121 pounds. She is generally active, does not smoke and is non-alcoholic. Her family has a history of breast cancer, and all women are in their 70s. She had rare but painful ovarian cysts before six years. Eight months ago, she was diagnosed with mild arthritis between L5 and S1. She was experiencing severe back pain and mild pelvic pain. The doctor said the pelvic pain was referred due to potential nerve impingement. My girlfriend had strained her back severely, which was why she originally presented at the clinic. She underwent an ultrasound for the pelvis, which was unremarkable, with no fluid and no masses. She had taken an MRI of the lower spine for arthritis diagnosis, and potential nerve impingement was seen. She began chiropractic therapy and physical therapy. However, her back pain went away, but the pelvic pain hung around. But the pain was very mild. Over the last month, pelvic pain has increased, resulting in an ER presentation where the doctor could not find pelvic or abdominal tenderness. The blood test and urine test came back clear. She has no constipation, diarrhea, abnormal urine frequency, or blockage. Also, no feeling full or pressure in the stomach and no reflux. A week prior, we did a full STI and HPV screen, which was also clear. We are awaiting the results of the FBE test and another ultrasound. Her current symptoms are very mild intermittent pelvic pain, which is not noticeable most of the time. The pain spreads from her pelvis to the left and right side of the hip. The back pain is present only when sitting for long periods or at awkward angles. She has mild bloating that comes and goes. Also, she has minor fatigue, which we assume is more of a lifestyle than a symptom. She rarely gets a whole night's sleep due to commitments. I am concerned about whether it could be ovarian cancer, a tumor, or a cyst. This inquiry is mostly to get an idea of the chances of an ovarian complication and also to understand her chances of it being benign. Also, suggestions of alternative potential diagnoses. Kindly suggest.

Hi doctor,

I cannot get a photo of the tongue, and her oral health is generally good. There are no signs of geographic tongue or candidiasis. Also, I am unable to get a picture of the conjunctiva, and her eye health is also fine, though she does get dry eyes staring at screens. Her period is light. The most recent period was heavy for the first few days after her cervical swab. The period ended five days ago. Also, she had peak pelvic pain lined up with the egg release window during ovulation. She usually does pilates. However, she stopped last month due to shifting house and her busy schedule. Also, she experienced chest pain during pilates after having COVID in May this year. We are awaiting echocardiography stress cardiogram results. Kindly give your opinion.