Among women of reproductive age, chronic pelvic pain (CPP) affects 15–20% and is defined as persistent pain lasting over six months, independent of the menstrual cycle. CPP has a multifactorial etiology, involving gynecological (e.g., endometriosis), urological (e.g., interstitial cystitis), gastrointestinal (e.g., irritable bowel syndrome), neural (e.g., nerve damage or entrapment), musculoskeletal and psychological components. A musculoskeletal component is identified in 50–90% of cases, often presenting as myofascial trigger points, local tenderness, and referred pain.Currently, no unified therapeutic approach targets musculoskeletal no component. Each specialty addresses CPP in isolation: gynecologists assess the pelvic floor, neurologists target neural pathways, and physical therapists focus on postural dysfunction.To address this gap, we conducted a systematic literature review (2016–2026) in PubMed, Google Scholar, and Web of Science using the keywords: "chronic pelvic pain," "musculoskeletal pain," "pelvic floor," and "physical rehabilitation." Inclusion criteria were studies on CPP more than 6 months in female patients. Exclusion criteria were acute pain , pregnancy , malignant tumors with tumors, inflammatory diseases. From 120 full-text articles, 45 high-quality studies were included. Based on this synthesis, we developed FEM-pelvic (Functional exercise Method for the pelvis) - an 8-week rehabilitation protocol targeting the musculoskeletal component of CPP in women.

The program is divided into three phases:

Phase 1 (Weeks 1–2): Manual muscle testing , pain neuroscience education, diaphragmatic breathing, and myofascial release of the hip, pelvis, and lumbar regions.

Phase 2 (Weeks 3–5): Neuromuscular control, pelvic floor activation, core stabilization, and proprioceptive training.

Phase 3 (Weeks 6–8): Functional integration, dynamic strengthening and stretching, progressive core stabilization.

The protocol includes a therapist manual and a patient booklet and is designed for individual delivery under the supervision of a trained specialist. A pilot feasibility study is planned to assess its clinical applicability and preliminary outcomes.

Olga Filimonova is a fifth-year medical student at Sechenov University and an active member of the Student Scientific Society in Obstetrics and Gynecology. She also works as a rehabilitation specialist for ballet dancers and rhythmic gymnasts and delivers lectures on female biomechanics and rehabilitation in elite sports. This work was supervised by Guzel F. Proklova, MD, PhD, Professor at the Department of Mother and Child Health, Sechenov University.