Optimal management of chronic cyclical pelvic pain: an evidence-based and pragmatic approach

Ha Ryun Won, Jason Abbott
International journal of women's health · 2010 · vol. 2 , pp. 263 · doi:10.2147/ijwh.s7991 · PMID:21151732 · W1980315190
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This review discusses the identification and management of chronic cyclical pelvic pain in women, from initial assessment to treatment options like oral contraceptives, given a lack of high-quality evidence.

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This paper is an evidence-based, pragmatic review of the literature on managing chronic cyclical pelvic pain, using searches of multiple databases (Medline, PubMed, CINAHL, Cochrane Library, Current Contents, and EMBASE) with MeSH terms and keywords including endometriosis and dysmenorrhea. It reports that high-quality evidence is scarce for this common problem (estimated to affect 4%–25% of reproductive-age women), and it summarizes that endometriosis is identified as the most common pathological cause, with other gynecologic contributors including adenomyosis, uterine fibroids, and pelvic floor myalgia. The review describes an approach to evaluation and management based on history, physical examination, and investigations to identify pain causes, while noting that management options span from simple medical treatments (e.g., combined oral contraceptive pill as a first-line option) to invasive strategies. This paper is centrally about endometriosis — it explicitly frames endometriosis as the commonest pathological cause of chronic cyclical pelvic pain and discusses it within an evidence-based management approach, with adenomyosis also listed among other gynecologic causes.

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Abstract

This article reviews the literature on management of chronic cyclical pelvic pain (CCPP). Electronic resources including Medline, PubMed, CINAHL, The Cochrane Library, Current Contents, and EMBASE were searched using MeSH terms including all subheadings and keywords: "cyclical pelvic pain", "chronic pain", "dysmenorrheal", "nonmenstrual pelvic pain", and "endometriosis". There is a dearth of high-quality evidence for this common problem. Chronic pelvic pain affects 4%-25% of women of reproductive age. Dysmenorrhea of varying degree affects 60% of women. Endometriosis is the commonest pathologic cause of CCPP. Other gynecological causes are adenomyosis, uterine fibroids, and pelvic floor myalgia, although other systems disease such as irritable bowel syndrome or interstitial cystitis may be responsible. Management options range from simple to invasive, where simple medical treatment such as the combined oral contraceptive pill may be used as a first-line treatment prior to invasive management. This review outlines an approach to patients with CCPP through history, physical examination, and investigation to identify the cause(s) of the pain and its optimal management.
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Abstract

This article reviews the literature on management of chronic cyclical pelvic pain (CCPP). Electronic resources including Medline, PubMed, CINAHL, The Cochrane Library, Current Contents, and EMBASE were searched using MeSH terms including all subheadings and keywords: “cyclical pelvic pain”, “chronic pain”, “dysmenorrheal”, “nonmenstrual pelvic pain”, and “endometriosis”. There is a dearth of high-quality evidence for this common problem. Chronic pelvic pain affects 4%–25% of women of reproductive age. Dysmenorrhea of varying degree affects 60% of women. Endometriosis is the commonest pathologic cause of CCPP. Other gynecological causes are adenomyosis, uterine fibroids, and pelvic floor myalgia, although other systems disease such as irritable bowel syndrome or interstitial cystitis may be responsible. Management options range from simple to invasive, where simple medical treatment such as the combined oral contraceptive pill may be used as a first-line treatment prior to invasive management. This review outlines an approach to patients with CCPP through history, physical examination, and investigation to identify the cause(s) of the pain and its optimal management.

Keywords

cyclical pelvic pain, chronic pain, dysmenorrhea, nonmenstrual pelvic pain, endometriosis © 2010 The Author(s). This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms and incorporate the Creative Commons Attribution - Non Commercial (unported, 3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

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Condition tags

endometriosisadenomyosischronic_pelvic_paindysmenorrheainterstitial_cystitisirritable_bowel_syndrome

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Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

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