Some Causes of Pelvic Pain in Women*
Cause |
Common Features† |
Tests‡ |
Related to the menstrual cycle |
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Menstrual cramps (dysmenorrhea) |
Sharp or crampy pain that Often headache, nausea, constipation, diarrhea, or an urge to urinate often (urinary frequency) |
A doctor's examination |
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Endometriosis (abnormally located patches of tissue that is normally located only in the lining of the uterus) |
Sharp or crampy pain that occurs before and during the first days of menstrual periods Often pain during sexual intercourse and/or during bowel movements May eventually cause pain unrelated to the menstrual cycle Sometimes infertility |
A doctor's examination Laparoscopy (insertion of a thin viewing tube into the abdomen) to check for abnormal tissue and to obtain a sample |
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Mittelschmerz (pain in the middle of the menstrual cycle) |
Severe, sharp pain that Often light spotty bleeding |
A doctor's examination |
Related to the reproductive system but not the menstrual cycle |
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Aching pelvic pain that may be felt on one or both sides Usually a vaginal discharge that sometimes has a foul odor and, as infection worsens, can become puslike and yellow-green Sometimes pain during urination and/or sexual intercourse, fever or chills, nausea, or vomiting |
Tests to detect sexually transmitted diseases using a sample of secretions taken from the cervix Sometimes ultrasonography of the pelvis |
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A ruptured ovarian cyst |
Pain that Sometimes light-headedness, fainting, slight vaginal bleeding, nausea, or vomiting |
A doctor's examination Sometimes ultrasonography of the pelvis |
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A ruptured ectopic pregnancy (an abnormally located pregnancy—not in its usual place in the uterus) |
Constant (not crampy) pain that Often vaginal bleeding Sometimes light-headedness, fainting, a racing heart, or dangerously low blood pressure (shock) due to severe internal bleeding |
Urine or blood tests to measure a hormone produced by the placenta (called human chorionic gonadotropin, or hCG) Ultrasonography of the pelvis Sometimes laparoscopy or laparotomy (a large incision into the abdomen enabling doctors to directly view organs) |
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Sudden degeneration of a fibroid in the uterus |
Pain that begins suddenly Most common during the first 12 weeks of pregnancy or after delivery or termination of a pregnancy Vaginal bleeding |
Ultrasonography of the pelvis |
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Adnexal torsion (twisting) of an ovary |
Severe pain that Occasionally pain that comes and goes (as the ovary twists and untwists) Often occurs when women are pregnant, after drugs are used to treat infertility, or when ovaries are enlarged |
Ultrasonography of the pelvis Sometimes laparoscopy or laparotomy |
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Cancer of the lining of the uterus (endometrium) |
Pain that develops gradually A clear, white, brown, or blood-tinged vaginal discharge Abnormal vaginal bleeding (bleeding after menopause or bleeding between menstrual periods) Sometimes unexplained weight loss |
Ultrasonography of the pelvis A biopsy Sometimes additional imaging tests of the pelvis, such as hysteroscopy (insertion of a viewing tube through the vagina to view the uterus) or sonohysterography (ultrasonography after fluid is injected into the uterus) |
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Adhesions (bands of scar tissue between normally unconnected structures in the uterus or pelvis) |
Pelvic pain that Pain during sexual intercourse No vaginal bleeding or discharge Sometimes nausea and vomiting (suggesting a blockage of the intestine) Occurs in women who have had abdominal surgery (usually) or an infection in the pelvis (sometimes) |
A doctor's examination Sometimes x-rays or ultrasonography of the pelvis and/or abdomen |
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A miscarriage (spontaneous abortion) or one that may occur (threatened abortion) |
Crampy pain in the pelvis or back accompanied by vaginal bleeding Other symptoms of early pregnancy such as breast tenderness, nausea, and absence of periods Sometimes passage of tissue through the vagina |
A pregnancy test Ultrasonography of the pelvis to determine whether a miscarriage has occurred and, if not, whether the pregnancy can continue |
Not related to the reproductive system |
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Pain that usually settles in the lower right part of the abdomen Loss of appetite and usually nausea and vomiting Often fever |
A doctor's examination Sometimes CT or ultrasonography of the abdomen |
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Pain just above the pubic bone Sometimes an urgent need to urinate, more frequent urination, or burning during urination |
A urine test |
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Pain or tenderness in the lower left part of the abdomen Fever |
Sometimes CT of the abdomen Often colonoscopy after the infection subsides |
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Inflammatory bowel disease including |
Crampy abdominal pain Diarrhea, which in ulcerative colitis is often bloody Loss of appetite and weight |
CT of the small and large intestine (CT enterography) to check for Crohn disease Endoscopy (usually colonoscopy or sigmoidoscopy) Sometimes x-rays of the upper digestive tract after barium is given by mouth (barium swallow) or of the lower digestive tract after insertion of barium into the rectum (barium enema) |
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Excruciating intermittent pain in the lower abdomen, side, or lower back, depending on the stone's location Nausea and vomiting Blood in the urine |
Urine tests (urinalysis) Imaging tests, such as CT or ultrasonography |
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* Some causes of pain in the lower abdomen are included. |
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† Features include symptoms and results of the doctor's examination. Features mentioned are typical but not always present. |
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‡ If women are of childbearing age, a pregnancy test is always done, regardless of the cause suspected. If symptoms have begun suddenly, recur, or are severe, ultrasonography of the pelvis is usually done. Typically, doctors also do a urine test to look for a urinary tract infection. |
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CT = computed tomography; MRI = magnetic resonance imaging. |
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