Almost every woman I’ve worked with has some version of the same two-part story: the pelvic pain, and the anxiety that showed up somewhere alongside it. And almost every one of them has been treated like those are two separate problems that just happen to be occurring in the same body at the same time.
I don’t believe that. I never have.
For years, I was one of those women being handed two different treatment plans for what felt, to me, like one experience. A gynecologist for the pain. A prescription or a worksheet for the anxiety. Nobody ever once suggested they might be coming from the same place, running through the same wiring, showing up as two symptoms of one underlying system that had been on high alert for a very long time.
What that actually looked like, in real life
My anxiety never showed up as some separate, unrelated thing that happened to coexist with my pain. It showed up as lying in bed at night doing an inventory of every sensation in my pelvis, trying to decide if today’s ache meant tomorrow was going to be a bad day. It showed up as scanning a restaurant’s menu three times before I’d even agreed to go. It showed up as a racing mind before a doctor’s appointment I’d been waiting months for, terrified they’d tell me, again, that everything looked normal.
I used to think of that as two problems stacked on top of each other. The pain, and then, separately, my brain being “too much” about it. It took me a long time to consider a different possibility: that it wasn’t two problems at all. It was one nervous system, sounding the same alarm through two different channels.
What the research actually shows
This isn’t just my personal theory. A review published in the journal Neural Plasticity, examining the neural circuitry shared between chronic pain and anxiety, found that the two conditions overlap in brain regions like the amygdala, the anterior cingulate cortex, and the prefrontal cortex — all areas involved in how we process both pain and fear. The researchers’ hypothesis is that persistent pain disrupts the brain’s reward and motivation systems, which then throws off the same regulatory circuits responsible for managing anxiety. In plain terms: chronic pain and anxiety may not be two different problems influencing each other from a distance. They may be two different expressions of the same disrupted system.
A separate review on chronic pain and comorbid emotional disorders, published through the National Center for Biotechnology Information, adds another piece worth naming: chronic pain keeps the body’s stress response system, sometimes called the HPA axis, activated for far longer than it was ever designed to be. That system is supposed to switch on during a real threat and then switch back off once the threat passes. But when pain is persistent, that “off” switch rarely gets flipped. The body stays in a low-grade state of alert, day after day, and anxiety is often what that sustained alert state feels like from the inside.
That reframes something enormous for me. It means the anxiety wasn’t becasue something was wrong with me — it was layered on top of a physical problem. It wasn’t me being “too sensitive” or “too in my head,” which is language I heard more times than I can count, from providers, friends and from myself. It was the same nervous system dysregulation, showing up in two directions at once.
Why this matters more than it sounds like it should
Here’s my actual opinion, and I know it goes against a lot of standard care: treating the pain and the anxiety as separate issues, with separate specialists, separate appointments, and separate treatment plans, misses the actual mechanism entirely. You can medicate the anxiety and still be bracing your pelvic floor every time you sit down. You can get injections for the pain and still lie awake replaying every physical sensation from the day, waiting for something to go wrong.
I don’t say this to dismiss medication, therapy, or any of the individual pieces that genuinely help. They can. They did, for me, at different points, and I’d never tell a woman to walk away from something that’s actually working. What I’m pushing back on is the assumption that they’re each solving a fully separate problem, rather than two visible symptoms of one nervous system that hasn’t yet learned it’s safe.
What actually shifted things for me
The turning point in my own healing wasn’t finding a better anxiety protocol or a better pain protocol run side by side. It was understanding that my body had learned, over years, to treat an ordinary dinner out, a trip to the beach, or my own husband’s hands as a potential threat. Once I understood that the anxiety and the pain were both downstream of that same alarm system, the work stopped being about managing two conditions and started being about addressing one root cause.
In practice, that meant I stopped treating my racing thoughts before a flare as a separate mental health issue to push through, and started treating it as more information from the same system that was also driving the physical bracing. The two had always been talking to each other. I just hadn’t been listening to them as one conversation.
That’s the piece I don’t see talked about enough in either the pelvic pain space or the anxiety space. They’re so often treated as neighbors instead of what they actually might be: the same house.
If you’ve spent years wondering why your anxiety spikes right alongside your worst flares, or why a “good pain day” still comes with a racing mind, I don’t think that’s a coincidence, and I don’t think you’re broken for it. I think your nervous system has been trying to tell you something the same way, twice.
Research + Further Reading
Your pain deserves to be taken seriously — with compassion, nuance, and evidence. These resources helped inform the science shared in this article.
Sources
Neural Plasticity (Wiley) — Current Understanding of the Neural Circuitry in the Comorbidity of Chronic Pain and Anxiety
PMC / National Institutes of Health — Chronic Pain and Comorbid Emotional Disorders: Neural Circuitry and Neuroimmunity Pathways
PubMed / National Center for Biotechnology Information — Current Understanding of the Neural Circuitry in the Comorbidity of Chronic Pain and Anxiety
Quick Note
The information shared here is for educational purposes only and is not intended to diagnose, treat, or replace medical, nutritional, or mental health care. Chronic pelvic pain can have many contributing factors, so please work with a qualified provider to rule out anything that needs medical support.
