The enigma of chronic pelvic pain

Chronic pelvic pain (CPP) remains a difficult gynaecological ‘headache’. Despite its prevalence in 15% of women in the general population,there have been limited advances made in the last decade in terms of its clinical management. In this article, we review the currentevidence available in the treatment of patients with CPP and also discuss some of the important management strategies that may provevaluable. It is important to individualise treatment based on each patient’s history, signs and symptoms. The currently available informationabout the treatment of women with CPP provides some support for the use of ultrasound scanning as an aid to counselling andreassurance, the use of progestogen (medroxyprogesterone acetate) or goserelin for pelvic congestion and (with the aim of improvedfunction and self-rating) the use of a multidisciplinary approach to assessment and treatment. Adhesiolysis has not been shown to be ofbenefit other than in women with severe adhesions. Ablation of endometriosis may provide benefit when this is the cause of CPP. Selectiveserotonin re-uptake inhibitor (SSRI) antidepressants have not been shown to be of benefit. The management of CPP remains an enigmaand much needs to be done in terms of basic science and clinical research to address this problem.