An update on the management of chronic pelvic pain in women

Abstract

Summary Chronic pelvic pain represents a major public health problem for women and impacts significantly on their quality of life. Yet it is under‐researched and a challenge to manage. Women who suffer from chronic pelvic pain frequently describe their healthcare journey as long, via a variety of specialists and frustrating, with their pain often dismissed. Aetiological factors and associations are best conceptualised using the ‘three P’s’ model of predisposing, precipitating and perpetuating factors. This integrates the numerous biological, psychological and social contributors to the complex, multifactorial nature of chronic pelvic pain. Overall management involves analgesia, hormonal therapies, physiotherapy, psychological approaches and lifestyle advice, which like other chronic pain conditions relies on a multidisciplinary team approach delivered by professionals experienced and trained in managing chronic pelvic pain.

2021 European guideline for the management of vulval conditions

“…Lifestyle factors such as physical inactivity, stress, poor sleep, unhealthy diet and smoking are associated with chronic pain severity and sustainment, and lifestyle changes have a positive impact on chronic pain 198 . Although there is no specific evidence of these data and benefits in women with vulvodynia, lifestyle advice could be part of the multidimensional approach 151 …”

Chronic pelvic pain in women

“…These have been shown to improve dysmenorrhoea, pelvic pain, dyspareunia and improve quality of life. COC pills can reduce the recurrence of endometrial lesions (Grandi et al., 2019; Vincent and Evans, 2021). Gonadotrophin-releasing agonists with low-dose hormone replacement therapy may give benefit after 3 months of therapy (Vincent and Evans, 2021).…”

“…COC pills can reduce the recurrence of endometrial lesions (Grandi et al., 2019; Vincent and Evans, 2021). Gonadotrophin-releasing agonists with low-dose hormone replacement therapy may give benefit after 3 months of therapy (Vincent and Evans, 2021). Interestingly, some research has suggested that women who ate more than two servings of red meat a day were 56% more likely to have endometriosis in comparison with those who did not.…”

“…Most options are extrapolations from treatment of other neuropathic pain conditions. Hormonal modifiers, in the form of contraceptive pills, if not contraindicated, or gonadotrophin-releasing agonists may be good for cyclical pain (Vincent and Evans, 2021). Women can experience a flare of their pain at menstruation, regardless of the cause.…”

“…These may include endometriosis, interstitial cystitis, and irritable bowel syndrome (Shin and Howard, 2011; Speer et al., 2016; Till et al., 2019). Despite this, it remains under-researched and patient journeys can be long and frustrating (Vincent and Evans, 2021). Some possible causes of pelvic pain are listed in Box 1.…”