Chronic Female Pelvic Pain
Is this topic for you?
This topic focuses on pelvic pain that has lasted longer than 6 months. If you have new, sudden pelvic pain, see your doctor as soon as you can. To learn more about new pelvic pain, see the topic Abdominal Pain, Age 12 and Older.
What is chronic female pelvic pain?
Female pelvic pain is pain below a woman’s belly button. It is considered chronic, which means long-lasting, if you have had it for at least 6 months. The type of pain varies from woman to woman. In some women, it is a mild ache that comes and goes. In others, the pain is so steady and severe that it’s hard to sleep, work, or enjoy life.
If your doctor can find what’s causing the pain, treating the cause may make the pain go away. If no cause is found, your doctor can help you find ways to ease the pain and get your life back.
What causes chronic female pelvic pain?
Some common causes include:
- Problems of the reproductive system, such as endometriosis, adenomyosis, and uterine fibroids.
- Scar tissue (adhesions) in the pelvic area after a pelvic infection or surgery.
- Diseases of the urinary tract or bowel, such as irritable bowel syndrome or chronic bladder irritation.
- Physical or sexual abuse. Experts are not sure why this is so, but about half of women with chronic pelvic pain have a history of abuse.1
Doctors don't really understand all the things that can cause chronic pelvic pain. So sometimes, even with a lot of testing, the cause remains a mystery. This doesn't mean that there isn't a cause or that your pain isn't real.
Sometimes, after a disease has been treated or an injury has healed, the affected nerves keep sending pain signals. This is called neuropathic pain. It may help explain why it can be so hard to find the cause of chronic pelvic pain.
What are the symptoms?
The type of pain can vary widely. Chronic pelvic pain can include:
- Pain that ranges from mild to severe.
- Pain that ranges from dull to sharp.
- Severe cramping during periods.
- Pain during sex.
- Pain when you urinate or have a bowel movement.
Chronic pain can lead to depression. Depression can cause you to feel sad and hopeless, eat and sleep poorly, and move slowly.
How is chronic female pelvic pain diagnosed?
At your first visit, your doctor will do a complete pelvic exam to look for problems with your reproductive system. The doctor will also ask questions about your past and present health and about your symptoms. You may have some tests, such as:
- A Pap test to look for cervical cancer or cell changes called dysplasia.
- Blood and urine tests to look for signs of infection.
- A pregnancy test.
- Tests for sexually transmitted diseases.
Emotional issues can play a big role in chronic pain. Your doctor may ask questions to find out if depression or stress is adding to your problem. You may also be asked about any past or current sexual or physical abuse. It can be hard to talk about these things, but it’s important to do it so you can get the right treatment.
If the first tests don't find a cause, you may have other tests that show pictures of the organs in your belly. These may include a transvaginal ultrasound and an MRI or CT scan of the pelvis. You may also have a type of minor surgery called laparoscopy (say “lap-uh-ROS-kuh-pee”). In this surgery, the doctor puts a thin, lighted tube with a tiny camera through a small cut in your belly. This lets the doctor look for problems like growths or scar tissue inside your belly.
Finding the cause of pelvic pain can be a long and frustrating process. You can help by keeping notes about the type of pain you have, when it happens, and what seems to bring it on. Show these notes to your doctor. They may give clues about what is causing the problem or the best way to treat it.
How is it treated?
If your doctor found a problem that could be causing your pelvic pain, you will be treated for that problem. Some common treatments include:
- Birth control pills or hormone treatment for problems related to your periods.
- Surgery to remove a growth, cyst, or tumor.
- Medicine to treat the problem, such as an antibiotic for infection or medicine for irritable bowel syndrome.
Chronic pain can become a medical problem in itself. Whether or not a cause is found, your doctor can suggest treatments to help you manage the pain. You may get the best results from a combination of treatments such as:
- Pain relievers called NSAIDs, like ibuprofen (such as Advil or Motrin) or naproxen (such as Aleve). You can buy these over the counter, or your doctor may prescribe stronger ones. These medicines work best if you take them on a regular schedule, not just when you have pain. Your doctor can tell you how much to take and how often.
- Tricyclic antidepressant medicine, which can help with pain as well as depression.
- Cognitive-behavioral therapy or biofeedback, to help you change the way you think about or react to pain.
- Counseling , to give you emotional support and reduce stress.
You may need to try many treatments before you find the ones that help you the most. If the things you're using aren't working well, ask your doctor what else you can try. Taking an active role in your treatment may help you feel more hopeful.
Frequently Asked Questions
Learning about chronic female pelvic pain:
If you have pelvic pain, your health professional will consider a broad range of possible causes. Female pelvic pain is typically caused by a medical condition involving the reproductive organs, muscles of the abdominal wall, urinary tract, or lower gastrointestinal tract. Some causes are always short-term (acute), and others can become long-lasting (chronic) unless successfully treated.
Female pelvic pain can be a difficult-to-solve medical mystery. Experts have yet to understand all possible causes of pelvic pain, particularly when it has become chronic. For this reason, some women have chronic female pelvic pain with no known cause, even after a lot of testing. This does not mean, however, that there isn't a cause behind the pain nor that there is no possible treatment.1
Chronic pain with no diagnosable cause can occur in any part of the body. Long after a disease or injury has healed, nerves can continue firing pain signals (neuropathic pain). This is thought to be caused by an overloading of the nervous system by extreme or long-lasting pain. It also helps explain why it's fairly common for chronic pelvic pain to have no obvious cause.
Conditions that can cause acute pelvic pain include:
- Normal ovulation, which can cause brief ovary pain, or "mittelschmerz." This pain is cyclic, meaning that it happens once during each normal menstrual cycle.
- Ectopic pregnancy , which requires emergency treatment. For more information, see the topic Ectopic Pregnancy.
- Kidney stones , which can become chronic. For more information, see the topic Kidney Stones.
- Appendicitis , which requires immediate medical care. For more information, see the topic Appendicitis.
- Functional ovarian cysts , which can become chronic. For more information, see the topic Functional Ovarian Cysts.
- Urinary tract infection . For more information, see the topic Urinary Tract Infections in Teens and Adults.
- Pelvic inflammatory disease (PID) or tubo-ovarian abscess, which requires medical treatment. For more information, see the topic Pelvic Inflammatory Disease.
- Sexually transmitted diseases , which occasionally become chronic. For more information, see the topic Exposure to Sexually Transmitted Diseases.
Conditions that can cause chronic pelvic pain include:
- Endometriosis , the growth of uterine lining (endometrial) tissue outside of the uterus, which often causes cyclic pain and bleeding. For more information, see the topic Endometriosis.
- Adenomyosis, the growth of endometrial tissue into the uterine muscle, which can cause cyclic pain and bleeding.
- Noncancerous (benign) tumors of the uterus, such as:
- Scar tissue (adhesions) in the abdomen and pelvis, typically caused by pelvic inflammatory disease, radiation treatment of the pelvis, or pelvic or abdominal surgery. For more information, see the topic Pelvic Inflammatory Disease.
- Bowel problems, such as irritable bowel syndrome. For more information, see the topics Abdominal Pain, Age 12 and Older and Irritable Bowel Syndrome.
- Physical or sexual abuse in the recent or distant past. (Though poorly understood, combined emotional and physical trauma are thought to cause chronic pain or make it worse.1) For more information, see the topics Domestic Violence and Child Abuse and Neglect.
- Urinary tract problems, such as bladder inflammation (chronic interstitial cystitis).
- Pelvic organ cancers. For more information, see the topics Endometrial (Uterine) Cancer, Ovarian Cancer, and Cervical Cancer.
- Structural problems with the uterus.
- Muscle spasm or pain in the lower abdominal wall muscles ("trigger points"). This is sometimes linked to past surgery in that area.
Female pelvic pain symptoms can include:
- Severe to mild pain.
- Vague to sharp pain.
- Severe menstrual cramps (dysmenorrhea).
- Low backache 1 or 2 days before the start of the menstrual period (or earlier), subsiding during the period.
- Pain during sexual intercourse (dyspareunia).
- Painful urination.
- Rectal pain.
- Pain during bowel movements.
Symptoms that can accompany pelvic pain, depending on the cause, include:
- Blood in the urine or stool.
- Vaginal bleeding after intercourse.
- Heavy or irregular vaginal bleeding.
Depression symptoms are commonly linked to chronic pain. Signs of depression include sleep problems, appetite changes, feelings of emptiness and sadness, and slowed body movements and reactions. If you have depression symptoms, see your health professional. For the best chance of recovery from pain, depression must be treated along with any known physical cause(s) of pain.
Experts have yet to understand all possible causes of female pelvic pain, particularly when it has become chronic. For this reason, the cause of pelvic pain sometimes remains unknown, even after a lot of testing. This does not mean that there is no cause behind the pain.1 Fortunately, even without knowing the cause, there is available treatment for relieving the pain.
Because female pelvic pain can be caused by one or more conditions, its course can have just as many variations.
- When a cause is readily diagnosed and treated, such as an ovarian cyst, pain is most likely to be reversed.
- For pain that is difficult to diagnose, your health professional can do a number of tests to rule out various medical conditions. Your health professional may also try certain treatments to see whether they work, which can also help with diagnosis.
- When a diagnosed cause is difficult to treat, such as endometriosis, your pain may have an unpredictable course.
- For pain that is undiagnosed after a lot of testing, you and your health professional can consider several types of pain relief options that are known to help relieve chronic pain.
In some cases, pain that lasts 4 to 6 months can become chronic pain, which is a medical condition in itself.2 Even after the cause of pain has been treated, the affected nerves don't stop transmitting pain signals. This is called neuropathic pain, a type of chronic pain. When chronic pain has set in, it's possible that treatment will manage the pain yet not cure it.2 Experts continue to research the causes and best treatments for chronic pelvic pain.
About half of women with chronic pelvic pain report a history of sexual or physical abuse.1 Although it is not well understood, past or current abuse is strongly linked to chronic pelvic pain. If you have a history of abuse, counseling is recommended as part of your pain treatment plan.
What Increases Your Risk
Factors that increase a woman's risk of developing female pelvic pain that becomes chronic include:
- Pregnancy and childbirth that have stressed the back and pelvis, including delivery of a large baby, a difficult delivery, or a forceps or vacuum delivery.
- A history of childhood or adult physical or sexual abuse. About half of women with chronic female pelvic pain report abuse in their past.1
- A history of pelvic inflammatory disease (PID).
- A history of radiation therapy or surgery of the abdomen or pelvis. (This includes some surgeries for urinary incontinence.2)
- Past or current diagnosis of depression. Pain sensation and depression seem to be interrelated.
- Alcohol or drug abuse.
- Something abnormal in the structure of the uterus, cervix, or vagina.
When To Call a Doctor
If you have chronic female pelvic pain that has not yet been evaluated, call your health professional for an appointment.
If you have chronic pelvic pain that has already been evaluated, call a health professional for immediate care if sudden, severe pelvic pain occurs with or without vaginal bleeding.
Call a health professional if:
- Your periods have changed from relatively pain-free to painful.
- Pain interferes with your daily activities.
- You begin to have pain during intercourse.
- You have painful urination, blood in your urine, or an inability to control the flow of urine.
- You have blood in the stool or a significant, unexplained change in your bowel movements.
Even if you have existing pain or other symptoms, call your health professional if you notice new pelvic symptoms.
Watchful waiting is a period of time during which you and your health professional observe your pelvic pain symptoms without using additional medical treatment. During this period, you can keep a daily record of your symptoms, menstrual cycle, and any other life events that you consider important. A watchful waiting period may vary from a few days to weeks or possibly months.
Who To See
The following primary health professionals can generally evaluate and help you manage the symptoms of female pelvic pain:
If chronic pelvic pain is to be formally diagnosed or treated with advanced methods, consult with a gynecologist or a urologist who specializes in female pelvic disorders.
Experts have noted a link between abuse and chronic pelvic pain.1 If you have ever been physically or sexually abused, the physical and psychological trauma you have suffered may be playing a part in your pain. For this reason, it's important that you have a health professional with whom you are comfortable discussing any past or current abuse, as well as your current symptoms.
If you have had long-lasting (chronic) pelvic pain that hasn't responded to treatment or seems to have no physical cause, you may have developed neuropathic pain, which means your nerves continue to fire pain signals long after an original injury or disease has healed. If your health professional suspects that you have neuropathic pain, he or she may refer you to a pain management clinic for evaluation and treatment.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Exams and Tests
There are many possible causes of female pelvic pain, so it is important to see your health professional for a thorough evaluation. Although your condition may be easily diagnosed during your first exam, expect that you might have a series of medical appointments and tests. For many women with pelvic pain, diagnosing the cause is a process of elimination that takes a while to complete.
Initial exam for a cause of female pelvic pain
If possible, bring with you a calendar or diary of your symptoms, menstrual cycle, sexual activity, physical exertion, and any other factors that you consider important, such as stressful events or illnesses. To begin narrowing down the list of possible causes of your pain, your health professional will review your symptom diary and:
- Ask about your health history, including the history of your menstrual cycle as well as any pelvic surgery, radiation treatment, sexually transmitted disease, pregnancy, or childbirth.
- Perform a pelvic exam to look for signs of abnormalities in your reproductive tract. You may also have a digital rectal exam. Your health professional may conduct this exam in a slower, more thorough manner than a routine pelvic exam, carefully checking for tender areas.
You may also have additional tests, depending on whether you've recently had a Pap test or are sexually active. These may include:
- A Pap test, which detects cervical cancer and cervical precancer (dysplasia).
- A pregnancy test (human chorionic gonadotropin, or hCG). If you test positive for pregnancy, you will also have an ultrasound to check for signs of a tubal (ectopic) pregnancy.
- A complete blood count (CBC), which can detect signs of infection, anemia, and blood cell abnormalities.
- An erythrocyte sedimentation rate (ESR), which can indicate infection if elevated.
- Tests for sexually transmitted diseases, such as chlamydia, gonorrhea, and genital herpes.
- Urinalysis and urine culture, which can detect signs of infection and kidney stones.
- Stool analysis, to check for signs of blood.
Experts have noted a link between abuse and chronic pelvic pain.1 If you have ever been physically or sexually abused, your pelvic pain may be made worse by physical and psychological trauma. For this reason, it's important that you choose a health professional with whom you are comfortable discussing any past or current abuse as well as your current symptoms.
Further testing for a cause of female pelvic pain
If your initial exam hasn't detected a cause of your pain, or if your results suggest a specific condition, your health professional will recommend further testing. Commonly used tests for further diagnosis of pelvic pain include:
- Abdominal ultrasound and/or transvaginal ultrasound of the pelvic area using a small ultrasound device (transducer) inserted into the vagina. Ultrasound plays a major role in looking for causes of pelvic pain. It is useful for detecting endometrial hyperplasia; pelvic inflammatory disease; and cancerous or noncancerous (benign) growths such as fibroids, cysts, and tumors on the ovaries, uterus, cervix, or fallopian tubes.
- Intravenous pyelogram (IVP), which uses an injected dye combined with X-rays to create pictures of the kidneys, bladder, ureters, and urethra.
- Computed tomography (CT) urogram, which uses X-rays to create pictures of the kidneys and urinary tract.
- Laparoscopy, a surgical procedure that uses a thin, lighted viewing instrument (laparoscope) inserted through a small abdominal incision. This allows a doctor to look inside the pelvis for causes of pain, including scar tissue (adhesions), abnormal growths, cysts, tumors, and pelvic inflammatory disease. Laparoscopy is the only way to confirm the presence of endometriosis. If needed, a growth or adhesion can also be removed during the procedure.
- Computed tomography (CT) scan of the pelvis, which uses X-rays to create pictures of organs and bones.
- Magnetic resonance imaging (MRI) of the pelvis, which uses a magnetic field and pulses of radio wave energy to create pictures of organs and bones.
- Cystoscopy, which uses a viewing instrument inserted through the urethra into the bladder. This allows a doctor to see signs of inflammation, growths, or kidney stones in the bladder.
- Urodynamic studies, which test bladder function and whether bladder spasms are causing pelvic pain.
- Evaluation for irritable bowel syndrome.
- Evaluation of abdominal wall for “trigger points."
Chronic pain testing
Chronic pain can have a wearing effect on the mind and emotions, which can in turn make pain management more difficult. Your health professional may recommend a mental health assessment. You will be asked questions to determine whether such conditions as depression, insomnia, or stress are contributing to or being caused by your chronic pain. For the best chance of recovering from pain, these conditions must be treated along with any known physical cause(s) of pain.
What to think about
A laparoscopy or other test that reveals no apparent problems (negative test result) does not necessarily mean that no physical cause is present. Exams and tests for causes of female pelvic pain are not yet able to detect all causes.2
Treatment for chronic female pelvic pain can be approached in two ways: treating a known, specific cause of the pain or treating the pain itself as a medical condition. If possible, your health professional will combine the two approaches.2
Treatment of a known or suspected cause of pelvic pain
Based on your history, pelvic exam, and testing results, your health professional may find one or more conditions that could be causing your pelvic pain or making it worse, such as endometriosis, irritable bowel syndrome, or uterine fibroids. Depending on the cause, your treatment may include:
- Medication to control or stop the ovulation cycle, if cyclic hormonal changes seem to make your symptoms worse.
- Other disease-specific medication, such as an antibiotic for infection or medication for irritable bowel syndrome.
- Cognitive-behavioral therapy , counseling, or biofeedback.
- Surgery to remove painful growths, cysts, or tumors. (However, studies have shown that surgery to remove scar tissue, or adhesions, does not relieve pain unless the adhesions are severe, referred to as stage IV adhesions.2)
- Healthy lifestyle choices, such as regular exercise to manage stress and improve strength, mood, and general health, along with dietary changes, such as those recommended to manage irritable bowel syndrome.
For both new (acute) and chronic pelvic pain, nonsteroidal anti-inflammatory drugs (NSAIDs) are the first-choice treatment for relieving pain and inflammation. NSAIDs are also highly effective for relieving menstrual pain because they block production of prostaglandin, which is responsible for cramping pain. Your health professional may recommend a nonprescription NSAID, such as ibuprofen, taken on a regular schedule. Different types of NSAIDs work for some people but not others. If your first trial doesn't work, your health professional will recommend a different type, possibly a prescription NSAID.
For cyclic pain that seems to be caused or made worse by menstruation, stopping ovulation and controlling hormone levels is commonly recommended and sometimes effective.
- Birth control pills (oral contraceptives) or high-dose progestin are commonly prescribed to reduce painful menstruation. Oral contraceptives are often prescribed for endometriosis-related pain, though there is little research that shows them to be effective.1 However, when the risk of using an oral contraceptive is low, it is typically worth trying for several months.
- Gonadotropin-releasing hormone agonists (GnRH-As) can relieve endometriosis-related pain by stopping production of the hormones that make endometriosis worse. GnRH-A treatment may also relieve cyclic pelvic pain not related to endometriosis, as well as pelvic pain related to irritable bowel syndrome.1 However, this short-term treatment induces menopause for as long as you take it, with side effects such as hot flashes and loss of bone density. For more information, see the topic Endometriosis.
For chronic pelvic pain, combining medical and psychological treatment increases your chances of treatment success. Medications that may help manage your chronic pelvic pain include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs), taken on a regular schedule to relieve pain caused by inflammation or menstruation. If one type doesn't work for you, your health professional may recommend trying another before discontinuing NSAID therapy. Talk to your health professional about whether NSAID therapy is safe for you, how much to take, and what type of schedule to follow.
- Tricyclic antidepressant medications (TCAs), which are used to treat chronic pain in other areas of the body as well. Limited research suggests that TCA therapy decreases chronic pelvic pain intensity for some women.1
- Narcotic pain medication, which is only recommended as a last-resort, short-term treatment for severe pelvic pain because of the risk of addiction.
Counseling and mental skills training help you learn the mental and emotional tools for managing chronic pain and the stress that makes it worse. Commonly recommended approaches include:
- Cognitive-behavioral therapy focused on changing both the way you think about pain and your ability to mentally influence how pain affects you.
- Biofeedback, which is the conscious control of body function that is normally unconsciously controlled.
- Interpersonal counseling focused on best managing your life events, stressors, and relationships.
Alternative pain treatments such as acupuncture, transcutaneous nerve stimulation (TENS), hypnosis, guided imagery, aromatherapy, meditation, and yoga are low-risk pain treatments that many people use to manage pain. Acupuncture and TENS have shown some success in relieving painful menstrual periods. Acupuncture has also been used as a treatment for nonmenstrual chronic pelvic pain but has not been well studied.1
Surgical treatment for chronic pelvic pain should be limited to the treatment of surgically correctable problems. Surgery is most useful for treatment of a specific cause of pelvic pain, such as fibroids or endometriosis.
There is no evidence that surgical removal of the reproductive organs relieves chronic pelvic pain when the cause of pain cannot be found.3 When surgery is done for pain with no known cause (hysterectomy or cutting of specific pelvic-area nerves), there is a risk of persistent or worsened pain after surgery as well as surgery-related side effects.
What To Think About
After 4 to 6 months of pain, some people develop chronic pain, which is a medical disorder that is separate from the original pain-causing condition. Because chronic pain and female pelvic pain have yet to be fully understood, treatment can be a trial-and-error process. It is common for women with chronic female pelvic pain to try many treatments before finding one or more that are helpful.
Decisions are complicated when considering treatment for chronic pelvic pain. Evaluate the following:
- Are the symptoms bothersome enough to require treatment?
- Do you want to have a child or more children?
- Has a specific cause of the pain been discovered, or is the cause unclear?
- Is menopause, which may stop symptoms, going to occur soon?
- Would an opinion from another health professional be helpful?
- Would an opinion from a physician who specializes in chronic pain be valuable?
- Have you tried cognitive-behavioral therapy?
Early diagnosis and treatment of pelvic pain may help prevent chronic female pelvic pain from developing.
One cause of chronic pelvic pain is pelvic inflammatory disease (PID). You can greatly reduce your risk of PID by protecting yourself from sexually transmitted diseases (STDs).
Practice safe sex or abstinence
Preventing an STD is easier than treating an infection after it occurs.
- Talk with your partner about STDs before beginning a sexual relationship. Find out whether he or she is at risk for an STD. Remember that it is quite possible to be infected with an STD without knowing it. Some STDs, such as HIV, can take up to 6 months before they can be detected in the blood.
- Be responsible.
- Avoid sexual contact if you have symptoms of an STD or are being treated for an STD.
- Avoid all sexual contact with anyone who has symptoms of an STD or who may have been exposed to an STD.
- Don't have more than one sex partner at a time. Your risk for an STD increases if you have several sex partners at the same time.
Condom use reduces the risk of becoming infected with an STD, especially gonorrhea, chlamydia, and HIV. Condoms must be in place before beginning any sexual contact. Use condoms with a new partner every time you have sex, until you know from test results that he or she does not have an STD.
Abstaining from sexual contact is the only certain way to avoid exposure to STDs.
Home treatment may help ease female pelvic pain and can be used along with your medical treatment plan.
To relieve your pain:
nonprescription medicine, such as ibuprofen (for
example, Advil or Motrin) or acetaminophen (for example, Tylenol).
- Start taking the recommended dose of pain medicine as soon as you feel uncomfortable. If you have painful periods, start taking the medicine one day before your menstrual period is scheduled to start.
- Take the medicine in regularly scheduled doses to keep the pain under control. Pain medicine works better if you take it at regularly scheduled times.
- Before you take any nonprescription medicine for the first time, be sure to carefully read the information on the package. It is important to understand how much of the medicine you should take and when you should take it as well as reasons not to take the medicine.
- Do not take more than the recommended dose.
- Do not take aspirin if you are younger than 20 unless your doctor tells you to.
- If you are or could be pregnant, call your doctor before using any medicine.
- Apply a heating pad, hot water bottle, or warm compress to your lower belly, or take a warm bath. Heat improves blood flow and may relieve pain.
- To relieve back pain, lie down and elevate your legs by placing a pillow under your knees. When lying on your side, bring your knees up to your chest.
- Try relaxation techniques, such as meditation, yoga, breathing exercises, and progressive muscle relaxation.
- Exercise regularly. It improves blood flow, increases pain-relieving endorphins naturally made by the body, and reduces pain.
- Try sexual activity, which may relieve pelvic cramping and backache. If your pain is related to endometriosis, however, sex may make it worse.
Treatment with medication does not cure female pelvic pain. However, controlling pain can help prevent it from getting worse or becoming chronic.
The following may help relieve symptoms:
- Prescription nonsteroidal anti-inflammatory drugs (NSAIDs), taken on a regular schedule, help relieve pain caused by inflammation or menstruation. If one type doesn't work for you, your health professional may recommend that you try at least one other before stopping NSAID therapy.
- Birth control pills (oral contraceptives) are commonly prescribed to reduce painful menstruation. Oral contraceptives are often prescribed for endometriosis-related pain, though there is little research that shows them to be effective.1
- High-dose progestin is sometimes prescribed to relieve pain related to endometriosis.1
- Gonadotropin-releasing hormone agonists (GnRH-As) can relieve endometriosis-related pain by stopping production of the hormones that make endometriosis worse. GnRH-A treatment may also relieve cyclic pelvic pain not related to endometriosis, as well as pelvic pain related to irritable bowel syndrome.1 However, this short-term treatment induces menopause, with side effects such as hot flashes and loss of bone density, for as long as you take it. For more information, see the topic Endometriosis.
- Tricyclic antidepressant medications (TCAs) are sometimes used to treat chronic pain in other areas of the body. Limited research suggests that TCA therapy decreases chronic pelvic pain intensity for some women.1
- Narcotic pain medication is only recommended as a last-resort treatment for severe pelvic pain because of the risk of addiction.
What To Think About
No single medication successfully treats chronic pelvic pain in all women.
Treating chronic pelvic pain with medication is usually preferable to using a surgical option. Surgery is only recommended when a correctable cause of pain is clearly known. Even in these cases, there are no guarantees that surgery will relieve pain or that it will not cause further problems.
Chronic pelvic pain symptoms sometimes stop naturally when menopause occurs. If you are close to menopausal age (usually around age 50) and your symptoms are likely related to hormones, your best option may be home treatment and medication until menopause occurs.
There is no evidence that surgical removal of the reproductive organs relieves chronic pelvic pain.3 When surgery, such as hysterectomy or cutting of specific pelvic-area nerves, is done for pain with no known cause, there is a risk of persistent pain or pain that is worse after surgery as well as surgery-related side effects.
- Hysterectomy, the surgical removal of the uterus, is sometimes used as a last-resort treatment for chronic, severe pelvic pain. Depending on the cause, hysterectomy may relieve pain for some women.
- Studies have shown that surgery to remove scar tissue adhesions from previous surgery or from pelvic inflammatory disease does not relieve pain unless the adhesions are severe (referred to as stage IV adhesions).2
What To Think About
Laparoscopy to diagnose chronic pelvic pain may be done before treatment with medications (other than birth control pills) or surgery. Sites of endometriosis (implants) or scar tissue (adhesions) may be removed or destroyed during the laparoscopy.4
Hysterectomy is only a good treatment choice for chronic pelvic pain when a documented disease or surgically correctable condition of the pelvic organs is present. When hysterectomy is performed solely for relief of pelvic pain, the results may be disappointing.
Surgery may lead to complications that cause added pain, discomfort, or other problems such as infection or scar tissue.
Symptoms caused by chronic pelvic pain often go away without treatment when menopause occurs and hormone fluctuations settle down. Controlling symptoms with home treatment or medications until menopause may be an option. Symptoms of chronic pelvic pain may return if you decide to use hormone replacement therapy for perimenopausal symptoms. Discuss your options with your health professional if you are nearing menopause.
Female pelvic pain treatment can be enhanced with counseling, mental skills training, relaxation, and physical therapy treatment.
Other Treatment Choices
Counseling and mental skills training help you learn the mental and emotional tools for managing chronic pain and the stress that makes it worse. Commonly recommended approaches include:
- Cognitive-behavioral therapy focused on changing the way you think about and mentally manage pain. See a psychologist, licensed counselor, or clinical social worker who specializes in pain management skills.
- Biofeedback, which is the conscious control of body function that is normally unconsciously controlled.
- Interpersonal counseling , focused on best managing your life events, stressors, and relationships.
Physical therapy can help you learn specific exercises to stretch and strengthen certain muscle groups. Physical therapy helps you to improve posture, gait, and muscle tone.
Alternative pain treatments for chronic female pelvic pain are not well studied but are considered helpful for managing stress and building mental mastery over pain. Acupuncture and transcutaneous nerve stimulation (TENS) have shown some success in relieving painful menstrual periods. Acupuncture has also been used as a treatment for nonmenstrual chronic pelvic pain but is not yet well studied.1
Other low-risk alternative pain treatments that many people use to help manage pain include:
- Relaxation and breathing exercises.
- Guided imagery.
- Massage therapy.
What To Think About
Chronic pelvic pain takes time to develop and can take a long time to treat. Take charge of how you cope with pain by using one or more of the treatment choices above. Combine your treatment with the practices you prefer for keeping a positive state of mind. For more information, see the topic Stress Management.
Other Places To Get Help
|International Pelvic Pain Society|
|1111 North Plaza Drive|
|Schaumburg, IL 60173-4950|
Chronic pelvic pain affects millions of women. However, new surgical and medical therapies are available that may offer hope for women suffering from chronic pelvic pain. The International Pelvic Pain Society brings physicians, psychologists, physical therapists, and basic scientists together to coordinate, collect, and apply this growing body of information, and the organization serves as a forum for professional and public education.
|National Women's Health Information Center|
|8270 Willow Oaks Corporate Drive|
|Fairfax, VA 22031|
The National Women's Health Information Center (NWHIC) is a service of the U.S. Department of Health and Human Services Office on Women's Health. NWHIC provides women's health information to a variety of audiences, including consumers, health professionals, and researchers.
- American College of Obstetricians and Gynecologists (2004, reaffirmed 2008). Chronic pelvic pain. ACOG Practice Bulletin No. 51. Obstetrics and Gynecology, 103(3): 589–605.
- Howard FM (2003). Chronic pelvic pain. Obstetrics and Gynecology, 101(3): 594–611.
- Lentz GM (2007). Pelvic pain section of Differential diagnosis of major gynecologic problems by age groups. In VL Katz et al., eds., Comprehensive Gynecology, 5th ed., pp. 158–164. Philadelphia: Mosby Elsevier.
- Lobo RA (2007). Endometriosis. In VL Katz et al., eds., Comprehensive Gynecology, 5th ed., pp. 473–499. Philadelphia: Mosby Elsevier.
|Author||Sandy Jocoy, RN|
|Editor||Kathleen M. Ariss, MS|
|Associate Editor||Denele Ivins|
|Primary Medical Reviewer||Joy Melnikow, MD, MPH - Family Medicine|
|Specialist Medical Reviewer||R. Hugh Gorwill, MD - Obstetrics and Gynecology|
|Last Updated||January 28, 2009|
Last Updated: January 28, 2009