Warning signs for chronic pelvic pain emerge during adolescence

A new McMaster University study of nearly half a million people has found that many people who go on to develop chronic pelvic pain (CPP) may have been showing warning signs years before diagnosis, offering a potential opportunity to identify people at increased risk earlier in life.

One of the most significant findings of the study, which published in The Lancet Regional Health – Americas on Oct. 6, 2026, was that by 10 years into adulthood, CPP affected 28 per cent of those who had sought care for gynecologic or reproductive health problems as teenagers, compared with about 15 per cent of those who had not. The association remained even after accounting for other health problems and health-care use during adolescence.

Furthermore, the rate of developing CPP was 41 per cent higher among those with earlier gynecologic or reproductive health-care encounters.

We asked a simple question: Were there signs, years earlier, that someone was on a path toward chronic pelvic pain? This study shows that indeed the gap between those affected by CPP was already visible early in adulthood and grew over time."

Shay Freger, lead author, PhD candidate, McMaster's Department of Obstetrics and Gynecology

To conduct the study, researchers utilized linked population-based health administrative data of nearly half a million Ontarians held at ICES, following those individuals through adolescence into adulthood. The study was conducted with collaborators from ICES Toronto, the University of Toronto and McGill University.

The study also found that adolescents with gynecologic or reproductive health-care encounters were more likely to experience gastrointestinal problems, mental health conditions and chronic pain elsewhere in the body.

CPP is a debilitating condition that affects up to one in four people assigned female at birth and gender diverse people. It's represented by ongoing pain in the lower abdomen or pelvis that lasts for months or years and can significantly affect daily life, work, school, relationships and mental health. Researchers say symptoms of CPP are often normalized as simply part of growing up, even when they are severe or persistent.

What is important about this study is that the warning signs were not limited to reproductive health alone. It suggests that adolescent menstrual and pelvic health may be part of a broader health picture that deserves earlier attention and more integrated care."

Mathew Leonardi, senior author and associate professor, Department of Obstetrics and Gynecology, McMaster University

Researchers say the findings don't prove adolescent health problems cause CPP but rather suggest the health-care system may already be seeing recognizable patterns of vulnerability years before it's established. 

The study was funded by the Canadian Society for the Advancement of Gynecologic Excellence (CanSAGE) through its Early Career Investigator Grant.