Chronic pelvic pain is a debilitating condition that can affect up to one in four women and gender diverse people. A new McMaster University study has found that early warning signs may appear in adolescence.
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Scientific Frontline: Extended "At a Glance" Summary: Chronic Pelvic Pain in Adolescence
The Core Concept: Chronic pelvic pain (CPP) is a debilitating condition involving ongoing pain in the lower abdomen or pelvis lasting for months or years, the early warning signs of which frequently manifest during adolescence.
Key Distinction/Mechanism: Rather than emerging spontaneously in adulthood, vulnerability to CPP is often foreshadowed years prior by adolescent reproductive health complaints, alongside related gastrointestinal problems, mental health conditions, and other chronic pain patterns.
Major Frameworks/Components:
- Longitudinal population tracking to identify early risk factors from adolescence into adulthood.
- Early gynecologic and reproductive health care encounters as primary predictive indicators.
- Comorbid symptom assessment, including associated gastrointestinal and mental health conditions.
- Integrated care modeling to recognize systemic vulnerabilities before chronic pain becomes established.
Branch of Science: Gynecology, Epidemiology, Preventive Medicine.
Future Application: The development and implementation of early screening protocols and integrated care pathways for teenagers presenting with severe menstrual or pelvic symptoms, aiming to mitigate or prevent adult CPP.
Why It Matters: Recognizing these early warning signs prevents the dangerous normalization of severe adolescent pain, providing a critical window for early intervention to improve the long-term well-being of the one in four individuals affected by CPP.
A new McMaster University study of nearly half a million people has found that many individuals who go on to develop chronic pelvic pain (CPP) may have shown 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 was published in The Lancet Regional Health—Americas on October 6, 2026, was that by 10 years into adulthood, CPP affected 28% of those who had sought care for gynecologic or reproductive health problems as teenagers, compared with about 15% 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% 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,” says lead author Shay Freger, a PhD candidate in McMaster’s Department of Obstetrics and Gynecology.
To conduct the study, researchers used 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 is characterized 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,” says Mathew Leonardi, senior author and associate professor in the Department of Obstetrics and Gynecology at McMaster University. “It suggests that adolescent menstrual and pelvic health may be part of a broader health picture that deserves earlier attention and more integrated care.”
Researchers say the findings do not prove adolescent health problems cause CPP, but rather suggest the health care system may already be seeing recognizable patterns of vulnerability years before the condition is established.
Funding: The study was funded by the Canadian Society for the Advancement of Gynecologic Excellence (CanSAGE) through its Early Career Investigator Grant.
Published in journal: The Lancet Regional Health – Americas
Authors: Shay M. Fregera, Olga Bougieb, Maya Djerbouac, Maria P. Velezc, and Mathew Leonardi
Source/Credit: McMaster University | Adam Ward
Edited by: Scientific Frontline
Reference Number: med100726_01
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