Pelvic pain is a common complaint among female patients of all ages.  It can be a very frustrating disease for both the patient and the physician and, in many cases; excessive and chronic use of narcotics to control the pain can lead to drug dependency. 
Chronic pelvic pain is defined as pain that has been present for six months or longer and can be intermittent or constant in nature.  It can be caused by various conditions and therefore thorough investigation is necessary to properly diagnose and treat pelvic pain. Sometimes pain can be associated with menstrual cycle or it can be accompanied by other symptoms such as pain during intercourse or constipation and diarrhea.  In many instances the character of pain and associated symptoms can guide the clinician in the diagnosis of pelvic pain. 
Pain during menstruation, also known as dysmenorrhea, is a common symptom of uterine fibroids, adenomyosis, and endometriosis.  Uterine fibroids are benign tumors that can be diagnosed by transvaginal ultrasound.  Treatment for uterine fibroids can be removal of fibroids with the preservation of the uterus. This is a procedure that is usually reserved for people desiring future fertility.  For patients who have completed their childbearing, hysterectomy is a reasonable option that will not only treat the condition but most importantly prevent any future possibility of recurrence. 
Adenomyosis is also a benign condition of the uterus and is also treated with hysterectomy.    Adenomyosis is often not seen on a pelvic ultrasound and a MRI is needed to diagnose this condition.  Unlike uterine fibroids and adenomyosis, endometriosis cannot be seen on radiologic studies and requires laparoscopy for diagnosis.    The benefit of laparoscopy is that it allows for the diagnosis as well as the treatment of endometriosis during the same procedure.  
After laparoscopy, recurrence and symptoms of endometriosis can be controlled with several hormonal methods.   In some patients, however, subsequent surgical procedures are required to treat recurrence of endometriosis. For a patient whose pelvic pain is unresponsive to medical treatment,  laparoscopic presacral neurectomy is used to transect nerve fibers that are responsible for transmission of pain.  In severe cases or in  patients who have completed their childbearing, hysterectomy with removal of both ovaries is also an option which will lead to resolution of symptoms in greater than 90% of cases.
Another very common cause of pelvic pain is pelvic adhesions or scar tissue.  Pelvic adhesions can be caused by previous pelvic infections or surgical procedures.   Open procedures or procedures performed through a large incision can cause more scar tissue than laparoscopic procedures.  Lysis of pelvic adhesions can be performed laparoscopically and  several materials can be used to decrease the risk of future scar tissue. However, even with these methods scar tissue can reform.
While above conditions are common culprits of pelvic pain, it is important to understand that many other possible etiologies exist.   Other conditions that maybe responsible for pelvic pain include benign or malignant ovarian tumors, interstitial cystitis, irritable bowel syndrome, inflammatory bowel disease, diverticulitis, musculoskeletal conditions and psychological causes.