Clinical Review

Chronic pelvic pain in women

BMJ 2010; 341 doi: http://dx.doi.org/10.1136/bmj.c4834 (Published 05 October 2010) Cite this as: BMJ 2010;341:c4834
  1. Jane P Daniels, research fellow 1,
  2. Khalid S Khan, professor of women’s health and clinical epidemiology2
  1. 1University of Birmingham, Reproduction, Genes and Development and Clinical Trials Unit, Birmingham B15 2TT, UK
  2. 2Barts and the London School of Medicine and Dentistry, London E1 2DD, UK
  1. Correspondence to: J P Daniels j.p.daniels{at}bham.ac.uk
  • Accepted 25 August 2010

Summary points

  • Chronic pelvic pain is a common and debilitating condition

  • Women with chronic pelvic pain want to be taken seriously and attach a high value to identifying a cause for their pain

  • No organic cause is found on laparoscopy in at least a third of women with chronic pelvic pain, and patients should be made aware of this before they consent to investigations

  • Psychological symptoms, such as anxiety and depression, are frequently present

  • Gynaecological treatment for chronic pelvic pain is often unsatisfactory even when directed by an identified cause

  • A multidisciplinary approach is thought to be essential for effective management

Chronic pelvic pain in women is a debilitating condition that impairs quality of life. Studies using various definitions estimated that its prevalence ranges from 2.1% to 24% of the female population worldwide.1 It is a common presentation in UK primary care, with 38 per 1000 women affected annually—a rate comparable to those of asthma (37 per 1000) and back pain (41 per 1000).2 Because pelvic pain is associated with conditions such as endometriosis and interstitial cystitis, a diagnosis is often difficult to establish, leading to a delay in appropriate treatment. Social and psychological factors are strongly associated with chronic pelvic pain, so tailored, effective treatment can be challenging to provide.

Sources and selection criteria

We searched EMBASE and Medline for articles with titles that included the keywords “chronic pelvic pain” with the limits “meta-analysis, review and randomised controlled trial”. We restricted the search to articles published in English in the past five years. We identified all systematic reviews and trial citations in the Cochrane Library under the MeSH terms pelvic pain and dysmenorrhoea. Articles of interest cited in these papers were identified. Finally we reviewed published clinical guidelines from international pain associations and gynaecological societies and searched the National Guidelines Clearing House.

What is chronic pelvic pain and who gets it?

Chronic …

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