Chronic pelvic pain

In short

  • Chronic pelvic (or abdominal) pain lasts a long time or keeps coming back, often for weeks to months.
  • There are many possible causes: gynaecological, but also the bowel, the bladder or stress can play a part.
  • Often no single clear cause is found — that does not make the pain any less real.
  • The gynaecologist checks whether there is a gynaecological cause and discusses the best next step with you.
  • You need a referral from your GP (huisarts) for an appointment.

What is chronic pelvic pain?

Chronic pelvic pain is abdominal pain that persists or keeps returning. Almost everyone has abdominal pain now and then; it usually goes away by itself. There is no strict cut-off: for some conditions doctors only speak of chronic pain after 6 months, but pain that lasts for weeks to months is always a good reason to seek help.

The pain may be constant or come in waves, and may be linked to your period, sex, urinating or bowel movements. Always mention such patterns to your doctor: they help to find the cause.

What causes chronic pelvic pain?

Chronic pelvic pain in women can have many causes. Sometimes the cause is gynaecological, for example:

  • Endometriosis. Tissue similar to the lining of the womb grows outside the womb, for example on the ovaries or the lining of the abdomen. This can cause pain around your period, but also at other times, and sometimes pain during sex.
  • Period pain. Cramps in the lower abdomen caused by the womb contracting.
  • Fibroids, benign muscle lumps in the wall of the womb.
  • Adhesions or scar tissue, for example after previous abdominal surgery or an infection.

But the cause is often not gynaecological at all: the bowel (irritable bowel syndrome, constipation), the bladder (a bladder infection, a sensitive bladder) and stress or tension can also cause long-lasting abdominal pain. Often several factors play a role at once.

What if no cause for the pelvic pain is found?

In many women with chronic pelvic pain, no clear abnormality is found even after investigation. That can be disappointing, but it does not mean the pain is “all in your head”. The pain is real.

Often the nervous system has become more sensitive to signals from the abdomen. The brain and the abdomen work closely together, and that interaction can become disturbed — for example after an earlier infection, operation or distressing event. Pain also causes stress, and stress tends to make pain worse — a vicious circle can develop.

That is why a broad approach works best for chronic pelvic pain: not only searching for one physical cause, but also looking at what the pain does to you and what keeps it going. Sometimes this means working with other professionals, such as a pelvic physiotherapist or a psychologist.

When should you see your GP about pelvic pain?

See your GP if your abdominal pain does not go away, slowly gets worse, or worries you. Contact your GP in any case if you also have any of the following:

  • fever;
  • losing weight without knowing why;
  • blood in your stool, or a clear change in your bowel habit;
  • vaginal bleeding after the menopause;
  • sudden, severe abdominal pain (call immediately);
  • abdominal pain while you are pregnant (call immediately).

Your GP will examine you first and can refer you to us if a gynaecological cause is (or may be) involved.

What happens at your appointment for chronic pelvic pain?

We take the time to map out your symptoms properly. An appointment usually includes:

  • An in-depth conversation. When does the pain occur, what does it feel like, and how does it affect your daily life, work and relationship? This includes questions about your period, sex, urinating and bowel movements.
  • A physical examination, usually also internal (pelvic).
  • A transvaginal ultrasound of the womb and ovaries.
  • A clear explanation. We calmly discuss what we did — and did not — find, and what that means for you.

If tests or treatment are needed that we do not provide, such as a laparoscopy (keyhole surgery) in a hospital, we refer you on and explain what to expect.

Frequently asked questions

How long does pelvic pain last before it is called chronic?

There is no strict cut-off: for some conditions doctors only speak of chronic pelvic pain after 6 months. Pain that lasts weeks to months or keeps coming back is always a good reason to seek help.

Can chronic pelvic pain be caused by stress?

Yes. Stress and tension can cause long-lasting abdominal pain or make it worse, and pain itself causes stress — a vicious circle. That is why we look at the whole picture, not just your abdomen.

Do I need a referral to a gynaecologist for chronic pelvic pain?

Yes. Your GP (huisarts) examines you first and refers you to us if a gynaecological cause is (or may be) involved.

Related care

Ask your GP for a referral, then make an appointment.

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