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Objective To see whether surgical adhesiolysis would improve pelvic pain in women with pelvic adhesions. Design Randomized clinical trial comparing surgery (adhesiolysis) with no surgery with final analysis of results after 9–12 months. Setting Department of Gynecology, Leiden University Medical Center, the Netherlands. Subjects 48 women known by laparoscopy to have stage II‐IV pelvic adhesions. Interventions Midline laparotomy and surgical adhesiolysis. Main outcome results Pelvic pain assessed by the McGill pain score, subjective pain assessment and disturbance of daily activities. Results 24 women were randomly allocated to undergo surgical adhesiolysis and 24 to a control group who did not have surgery. After 9–12 months there were no significant differences between the two groups overall with regard to pelvic pain. A subgroup of women with severe, vascularized and dense adhesions involving bowel (stage IV) had significantly less pelvic pain after adhesiolysis for two of the three methods of assessment. Conclusions Adhesiolysis for the treatment of pelvic pain is not indicated in women with light or moderate degree pelvic adhesions. It may be beneficial in those with severe adhesions involving the intestinal tract.