Chronic pelvic pain (CPP) is one of the most common reasons women see their physician, affecting 15 percent of 18 to 50 year old American women.   The condition is characterized by pain in the lower abdomen and pelvic area that has been present for at least six months.  The pain may radiate down into the legs or around the back.  The pain may be constant or it may come and go, perhaps recurring or intensifying with a woman's menstrual cycle.  The severity of pain can also vary greatly.  It may range from mild and tolerable at times to so severe it interferes with normal activities.

Women with CPP usually have one of the or more of the following associated symptoms:

§         Abnormal menstrual periods

§         Severe cramps

§         Prolonged periods

§         Heavy periods

§         Premenstrual spotting

§         Pain

§         Constant or intermittent pelvic pain

§         Low backache for several days before period

§         Pain during intercourse and possible bleeding after intercourse

§         Pain on urination

The course of CPP is unpredictable, both for individual women and from patient to patient.  Symptoms may stay constant, disappear without treatment or suddenly increase.  Over time, unrelieved, unrelenting pelvic pain can have a negative impact on a woman’s quality of life, affecting many areas of her life.  Women with CPP may limit their physical activities and show signs of depression, including sleep problems and eating disorders.    Contributing to this problem is the fact that women who suffer from persistent pelvic pain may have a hard time getting their doctors as well as their families and friends to understand the severity of their pain.   One recent study found that 40% of the women surveyed have been told they exaggerate their pain.

CPP can be caused by several underlying conditions.  A complete physical exam by a gynecologist is recommended.  Your doctor should ask you for a detailed description of your health history and the pain you experience.  Additional diagnostic tests such as blood analysis, ultrasound or laparoscopy may be required to determine the source of your pain.  Four out of five patients are diagnosed with pelvic disease or disorder.  The most common is endometriosis, in which pieces of the lining of the uterus attach to other organs or structures within the abdomen and grow outside the uterus.  Experts say up to 83 percent of patients with CPP have endometriosis, either alone or in combination with one or more other disorders, including adhesions (scar tissue from previous surgery) and fibroids (clumps of tissue that grow inside, in the wall or, or on the surface of the uterus).   Other causes of and contributors to pelvic pain can be pelvic infections and diseases of the urinary tract or bowel, hernias, slipped discs and psychological problems.  Despite the number of possible causes, 20 percent of women with CPP have no diagnosable condition to explain their pain. 

If an underlying condition is diagnosed, then your doctor will recommend appropriate treatment for your specific condition.  If you are one of the 20 percent of patients for whom an underlying condition is not found, your doctor may recommend treatment options to help manage the pain, including nonsteriodal anti-inflammatory pain relievers, hormone treatment to stop ovulation, relaxation exercises, physical therapy or other pain management treatments.

The most important thing women with CPP can do is communicate.  It’s important for women to discuss their pelvic pain with their healthcare providers.  This will allow them to receive prompt and effective treatment.