Chronic pelvic pain treatment should focus on quality of life, not pain alone

For many women living with chronic pelvic pain, finding an explanation for their symptoms can take years. Getting a diagnosis may bring some relief, but treatment does not always bring an end to the pain. Even when symptoms improve, their effects on sleep, work and everyday life can continue. Chronic pelvic pain is persistent or recurring pain in the lower abdomen or pelvis. It can be linked to several conditions, including endometriosis, bladder pain syndrome and vulvodynia, which causes ongoing pain around the external genitals. Some women have more than one condition contributing to their symptoms. Endometriosis occurs when tissue similar to the lining of the womb grows elsewhere in the body. It can cause painful periods, ongoing pelvic pain, fatigue and difficulties getting pregnant. Hormone treatments can reduce pain, while surgery can remove areas of endometriosis. The National Institute for Health and Care Excellence (Nice), which produces treatment guidance for the NHS, recommends choosing endometriosis treatments according to someone’s symptoms and priorities, rather than how extensive the disease appears to be. The amount of endometriosis visible does not always reflect the severity of someone’s pain. Some women with extensive disease experience relatively mild symptoms, while others have severe pain despite having little visible disease. Across different causes of chronic pelvic pain, the nervous system can become more sensitive to pain signals over time, meaning discomfort may continue even after the original source has been treated. Muscles in the pelvic floor, which support organs including the bladder and bowel, can also become tense and contribute to pain. What our research found Our recent study of 147 women with chronic pelvic pain – pain in the lower part of the abdomen lasting at least three months – examined how different treatments related to quality of life. Nearly two-thirds of participants (91) reported endometriosis. Others reported conditions such as vulvodynia, bladder pain syndrome and polyendocrine metabolic ovarian syndrome (PMOS), previously known as polycystic ovary syndrome (PCOS), a condition affecting hormones and periods. Read more: Why has PCOS been given a new name? Women who said they had undergone surgery for pelvic pain scored lower on a measure of physical quality of life covering areas such as sleep, mobility and everyday activities. Those who had used painkillers also reported poorer quality of life in several areas, including physical and emotional wellbeing. These results do not mean the treatments made people worse. Women whose pain is more severe or difficult to treat may be more likely to undergo surgery or use painkillers. The study asked women which treatments they had used at any point and how they were doing at the time of the survey. It cannot tell us whether those treatments helped, harmed or made no difference to a patient. Nor can it tell us how participants would have felt without them. Surgery and hormone treatments remain important options for endometriosis. Nice guidance recommends discussing the benefits and risks of surgery, including the possibility that symptoms may return and further surgery may be needed. But pain scores alone cannot tell us how well someone is living. Being able to sleep, work, exercise or spend time with family may be just as valuable to patients as a reduction in pain. Looking beyond pain relief In our study, only 31% of participants reported having used psychological therapies, such as counselling or structured treatments that help people manage distress. Those who had received psychological support tended to report better emotional wellbeing and greater satisfaction with aspects of daily life. Because our study was a snapshot rather than a trial, we cannot conclude that therapy caused these improvements. Psychological support can help people cope with disrupted sleep, strained relationships and the emotional toll of persistent pain. This does not suggest that their physical pain is imagined. A review of seven trials involving 757 women with endometriosis found that psychological treatments may improve mental health and some pain symptoms, although weaknesses in the studies limit how certain we can be. Pelvic health physiotherapy was also mentioned relatively rarely in our survey. However, because participants were not asked about it as a separate treatment category, we cannot reliably say how many had received it. This specialist physiotherapy can help when muscles around the pelvis are tense or overactive. It may involve exercises, hands-on treatment and guidance on moving more comfortably. A review of 38 clinical trials found that approaches combining different forms of physical therapy reduced pain in some women with persistent pelvic pain. These treatments can be used alongside medical care. A 2025 review found that care involving several types of healthcare professional could reduce pain more than treatment from a single speciality. However, the studies did not show a clear improvement in overall quality of life. For women with endometriosis, effective care may therefore require surgery, medicines or hormone treatment alongside support for the wider effects of persistent pain. Which approaches are appropriate will depend on each person’s symptoms and circumstances. Healthcare services need to assess more than whether pain has fallen on a numerical scale. Whether someone can sleep, manage work, maintain relationships and take part in everyday life should also help determine whether treatment is working.