Table: Some Causes of Pelvic Pain in Women*-Merck Manual Consumer Version

Some Causes of Pelvic Pain in Women*

Cause	Common Features†	Diagnostic Approach‡
Related to the menstrual cycle
Endometriosis (abnormally located patches of tissue that is normally located only in the lining of the uterus)	Painful menstrual cramps Pain that may be unrelated to the menstrual cycle Sometimes pain during sexual intercourse and/or during bowel movements Sometimes infertility	Ultrasonography of the pelvis Usually laparoscopy (insertion of a thin viewing tube into the abdomen) to check for abnormal tissue and to obtain a sample for biopsy or sometimes laparotomy (a large incision into the abdomen enabling doctors to directly view organs), Sometimes sigmoidoscopy (insertion of a flexible viewing tube to examine the lower portion of the large intestine, the rectum, and the anus) or cystoscopy (insertion of a flexible viewing tube to examine the bladder)
Painful menstrual periods (dysmenorrhea)	Dull or crampy pain that Occurs a few days before or during menstrual periods Is most intense about 24 hours after periods begin and subsides after 2–3 days Sometimes headache, nausea, constipation, diarrhea, or an urge to urinate often (urinary frequency)	A doctor's examination
Mittelschmerz (pain in the middle of the menstrual cycle)	Severe, sharp pain that Begins suddenly Can occur on either side but on only one side at a time Occurs at the same time during the menstrual cycle, usually midway between the start of menstrual periods (when the egg is released) Is most intense when it begins, then subsides over 1–2 days Sometimes light spotty bleeding	A doctor's examination
Related to pregnancy
An ectopic pregnancy (an abnormally located pregnancy—not in its usual place in the uterus)	Pelvic or abdominal pain and/or vaginal bleeding during early pregnancy If the ectopic pregnancy ruptures, severe pain that Begins suddenly Is at first confined to one area of the lower abdomen, then spreads Sometimes light-headedness, fainting, a racing heart, or dangerously low blood pressure (shock) due to severe internal bleeding	A pregnancy test Ultrasonography of the pelvis Sometimes laparoscopy or laparotomy
A miscarriage (spontaneous abortion) or one that may occur (threatened abortion)	Pelvic or abdominal pain and/or vaginal bleeding during early pregnancy 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
Related to the reproductive system but not the menstrual cycle or pregnancy
An ovarian cyst or a noncancerous ovarian tumor	Dull or sharp persistent pelvic or abdominal pain, often on one side	Ultrasonography of the pelvis Occasionally a CT or MRI of the pelvis and abdomen
A ruptured ovarian cyst	Pain that Begins suddenly Is most severe when it begins Often rapidly decreases over a few hours Sometimes happens after sexual intercourse Sometimes light-headedness, fainting, slight vaginal bleeding, nausea, or vomiting	Ultrasonography of the pelvis
Adnexal torsion (twisting) of an ovary	Severe pain that Begins suddenly Occurs on one side Peaks quickly Occasionally pain that comes and goes (as the ovary twists and untwists) Usually nausea, vomiting and sometimes light-headedness or fainting	Ultrasonography of the pelvis Laparoscopy
Cancer of the ovaries	Dull or sharp persistent pelvic or abdominal pain, often on one side Digestive or urinary symptoms that are new and persistent (bloating, difficulty eating or feeling full quickly, feeling an urgent need to urinate, or needing to urinate frequently) Sometimes unexplained weight loss	Ultrasonography of the pelvis Sometimes blood tests to measure substances secreted by tumors Often a CT or MRI of the pelvis and abdomen
A ruptured ectopic pregnancy (an abnormally located pregnancy—not in its usual place in the uterus)	Constant (not crampy) pain that Begins suddenly Is at first confined to one area of the lower abdomen 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)
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 Sometimes vaginal bleeding	Ultrasonography of the pelvis If results are unclear, MRI
Pelvic inflammatory disease	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 yellow-green Sometimes pain during sexual intercourse or fever	Tests to detect sexually transmitted infections using a sample of secretions taken from the cervix Sometimes ultrasonography of the pelvis
Adhesions (bands of scar tissue between normally unconnected structures in the uterus or pelvis)	Pelvic pain that Develops gradually Often becomes chronic Occurs in women who have had abdominal surgery or an infection in the pelvis Pain during sexual intercourse No vaginal bleeding or discharge Rarely nausea and vomiting (suggesting a blockage of the intestine)	Laparoscopy or sometimes laparotomy
Not related to the reproductive system
Appendicitis	Pain that usually settles in the lower right part of the abdomen Loss of appetite and usually nausea and vomiting Often fever	CT or ultrasonography of the abdomen
Urinary tract infection	Pain just above the pubic bone Sometimes an urgent need to urinate, more frequent urination, or burning during urination	A urine test
Diverticulitis	Pain or tenderness in the lower left part of the abdomen Fever	Sometimes CT of the abdomen
Inflammatory bowel disease including Crohn disease Ulcerative colitis	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)
Kidney stones	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
* Some causes of pain in the lower abdomen are included.
† Features include symptoms and results of the doctor's examination. Features mentioned are typical but not always present.
‡ 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.
CT = computed tomography; MRI = magnetic resonance imaging.

Cause

Common Features†

Diagnostic Approach‡

Related to the menstrual cycle

Endometriosis (abnormally located patches of tissue that is normally located only in the lining of the uterus)

Painful menstrual cramps

Pain that may be unrelated to the menstrual cycle

Sometimes pain during sexual intercourse and/or during bowel movements

Sometimes infertility

Ultrasonography of the pelvis

Usually laparoscopy (insertion of a thin viewing tube into the abdomen) to check for abnormal tissue and to obtain a sample for biopsy or sometimes laparotomy (a large incision into the abdomen enabling doctors to directly view organs),

Sometimes sigmoidoscopy (insertion of a flexible viewing tube to examine the lower portion of the large intestine, the rectum, and the anus) or cystoscopy (insertion of a flexible viewing tube to examine the bladder)

Painful menstrual periods (dysmenorrhea)

Dull or crampy pain that

Occurs a few days before or during menstrual periods
Is most intense about 24 hours after periods begin and subsides after 2–3 days

Sometimes headache, nausea, constipation, diarrhea, or an urge to urinate often (urinary frequency)

A doctor's examination

Mittelschmerz (pain in the middle of the menstrual cycle)

Severe, sharp pain that

Begins suddenly
Can occur on either side but on only one side at a time
Occurs at the same time during the menstrual cycle, usually midway between the start of menstrual periods (when the egg is released)
Is most intense when it begins, then subsides over 1–2 days

Sometimes light spotty bleeding

A doctor's examination

Related to pregnancy

An ectopic pregnancy (an abnormally located pregnancy—not in its usual place in the uterus)

Pelvic or abdominal pain and/or vaginal bleeding during early pregnancy

If the ectopic pregnancy ruptures, severe pain that

Begins suddenly
Is at first confined to one area of the lower abdomen, then spreads

Sometimes light-headedness, fainting, a racing heart, or dangerously low blood pressure (shock) due to severe internal bleeding

A pregnancy test

Ultrasonography of the pelvis

Sometimes laparoscopy or laparotomy

A miscarriage (spontaneous abortion) or one that may occur (threatened abortion)

Pelvic or abdominal pain and/or vaginal bleeding during early pregnancy

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

Related to the reproductive system but not the menstrual cycle or pregnancy

An ovarian cyst or a noncancerous ovarian tumor

Dull or sharp persistent pelvic or abdominal pain, often on one side

Ultrasonography of the pelvis

Occasionally a CT or MRI of the pelvis and abdomen

A ruptured ovarian cyst

Pain that

Begins suddenly
Is most severe when it begins
Often rapidly decreases over a few hours

Sometimes happens after sexual intercourse

Sometimes light-headedness, fainting, slight vaginal bleeding, nausea, or vomiting

Ultrasonography of the pelvis

Adnexal torsion (twisting) of an ovary

Severe pain that

Begins suddenly
Occurs on one side
Peaks quickly

Occasionally pain that comes and goes (as the ovary twists and untwists)

Usually nausea, vomiting and sometimes light-headedness or fainting

Ultrasonography of the pelvis

Laparoscopy

Cancer of the ovaries

Dull or sharp persistent pelvic or abdominal pain, often on one side

Digestive or urinary symptoms that are new and persistent (bloating, difficulty eating or feeling full quickly, feeling an urgent need to urinate, or needing to urinate frequently)

Sometimes unexplained weight loss

Ultrasonography of the pelvis

Sometimes blood tests to measure substances secreted by tumors

Often a CT or MRI of the pelvis and abdomen

A ruptured ectopic pregnancy (an abnormally located pregnancy—not in its usual place in the uterus)

Constant (not crampy) pain that

Begins suddenly
Is at first confined to one area of the lower abdomen

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)

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

Sometimes vaginal bleeding

Ultrasonography of the pelvis

If results are unclear, MRI

Pelvic inflammatory disease

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 yellow-green

Sometimes pain during sexual intercourse or fever

Tests to detect sexually transmitted infections using a sample of secretions taken from the cervix

Sometimes ultrasonography of the pelvis

Adhesions (bands of scar tissue between normally unconnected structures in the uterus or pelvis)

Pelvic pain that

Develops gradually
Often becomes chronic
Occurs in women who have had abdominal surgery or an infection in the pelvis

Pain during sexual intercourse

No vaginal bleeding or discharge

Rarely nausea and vomiting (suggesting a blockage of the intestine)

Laparoscopy or sometimes laparotomy

Not related to the reproductive system

Appendicitis

Pain that usually settles in the lower right part of the abdomen

Loss of appetite and usually nausea and vomiting

Often fever

CT or ultrasonography of the abdomen

Urinary tract infection

Pain just above the pubic bone

Sometimes an urgent need to urinate, more frequent urination, or burning during urination

A urine test

Diverticulitis

Pain or tenderness in the lower left part of the abdomen

Fever

Sometimes CT of the abdomen

Inflammatory bowel disease including

Crohn disease
Ulcerative colitis

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)

Kidney stones

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

* Some causes of pain in the lower abdomen are included.

† Features include symptoms and results of the doctor's examination. Features mentioned are typical but not always present.

‡ 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.

CT = computed tomography; MRI = magnetic resonance imaging.