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OBJECTIVE: To evaluate the course of chronic pelvic pain (CPP) symptoms in women and to explore factors associated with changes in pain intensity and adjustment to pain in the long term. DESIGN: Follow-up study. METHOD: All women who had visited a Chronic Pelvic Pain team of a university hospital in the past were invited to participate. All completed a set of questionnaires at their first visit and follow-up. RESULTS: Of the 131 women who met the inclusion criteria, 84 (64%) consented to participation in this follow-up study. After a mean follow-up period of 3 years, significant changes were found as regards a reduction in pain intensity, an improvement in adjustment to pain (i.e., physical well-being and depressive symptoms), a reduction in catastrophizing pain and an increase in perceived pain control. Neither sociodemographic, clinical nor pain-related variables were associated with these changes. Pain appraisals and pain coping strategies at baseline did not predict changes from baseline in pain intensity. A reduction in catastrophizing pain, however, was associated with a reduction in pain intensity and adjustment to pain, especially as regards physical well-being and depressive symptoms. CONCLUSION: After 3 years' follow-up, an improvement in pain intensity was observed in women with CPP, and this was not associated with baseline pain appraisals and coping strategies. A reduction in catastrophizing pain was related to better outcome in the long term.