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Chronic pelvic pain: causes, symptoms, diagnosis, treatment
Last reviewed: 06.07.2025
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Chronic pelvic pain can be a source of great discomfort for women of reproductive age. The history usually includes a long history of chronic pelvic pain with secondary dysmenorrhea and profound dyspareunia. The pain may be the cause or the consequence of emotional problems. The patient may be depressed.
Laparoscopy can identify the most likely cause: chronic pelvic infection, endometriosis, adenomyosis, adhesions or congestion in the pelvic veins. If this does not happen (or if all gynecological causes are “excluded” surgically), the cause may be a gastrointestinal disease: irritable bowel syndrome.
Pelvic venous congestion. Painful blood congestion is observed in the "weakened" veins of the pelvis. The pain increases when the patient is standing, when walking (gravitational filling of the veins) and in the premenstrual period. Typical variability in the location and intensity of pain, as well as pain after sexual intercourse, is characteristic. Palpation reveals the greatest pain with deep palpation of the ovarian area. As a result of congestion, cyanosis of the vagina and cervix, as well as varicose veins of the lower extremities can be observed - as a result or in combination. Dilated veins can be visualized with venography or laparoscopy.
Treatment of chronic pelvic pain is complex, although the patient's condition may improve subjectively if the cause of the pain is explained to her ("pelvic migraine"). The pain is reduced by taking medroxyprogesterone acetate at a dose of 30 mg every 24 hours orally for 3 months (side effects: amenorrhea, weight gain, bloating); you can try prescribing drugs used for migraines and antispasmodics. In cases of extreme severity of chronic pelvic pain symptoms, bilateral ligation of the ovarian veins is used.
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