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

Some Causes of Pelvic Pain in Women*

Cause	Common Features†	Diagnostic Approach‡
Related to the menstrual cycle
Endometriosis Endometriosis In endometriosis, patches of endometrial tissue—normally occurring only in the lining of the uterus (endometrium)—appear outside the uterus. Why endometrial tissue appears outside the uterus... read more (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 Menstrual Cramps Menstrual cramps are pains in the lowest part of the torso (pelvis), a few days before, during, or after a menstrual period. The pain tends to be most intense about 24 hours after periods begin... read more (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 Ectopic Pregnancy Ectopic pregnancy is attachment (implantation) of a fertilized egg in an abnormal location, such as the fallopian tubes. In an ectopic pregnancy, the fetus cannot survive. When an ectopic pregnancy... read more (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 Shock Shock is a life-threatening condition in which blood flow to the organs is low, decreasing delivery of oxygen and thus causing organ damage and sometimes death. Blood pressure is usually low... read more ) due to severe internal bleeding	A pregnancy test Ultrasonography of the pelvis Sometimes laparoscopy or laparotomy
A miscarriage Miscarriage A miscarriage is the loss of a fetus before 20 weeks of pregnancy. Miscarriages may occur because of a problem in the fetus (such as a genetic disorder or birth defect) or in the woman (such... read more (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 Noncancerous Ovarian Growths Noncancerous (benign) ovarian growths include cysts (mainly functional cysts) and tumors. Most noncancerous cysts and tumors do not cause any symptoms, but some cause pain or a feeling of heaviness... read more 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 Noncancerous Ovarian Growths Noncancerous (benign) ovarian growths include cysts (mainly functional cysts) and tumors. Most noncancerous cysts and tumors do not cause any symptoms, but some cause pain or a feeling of heaviness... read more	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 Adnexal Torsion Adnexal torsion is twisting of the ovary and sometimes the fallopian tube, cutting off the blood supply of these organs. Twisting causes sudden, severe pain and often vomiting. Doctors use an... read more (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 Ovarian Cancer, Fallopian Tube Cancer, and Peritoneal Cancer Ovarian cancer is cancer of the ovaries. It is related to fallopian tube cancer, which develops in the tubes that lead from the ovaries to the uterus, and peritoneal cancer, which is cancer... read more	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 Ectopic Pregnancy Ectopic pregnancy is attachment (implantation) of a fertilized egg in an abnormal location, such as the fallopian tubes. In an ectopic pregnancy, the fetus cannot survive. When an ectopic pregnancy... read more (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 Shock Shock is a life-threatening condition in which blood flow to the organs is low, decreasing delivery of oxygen and thus causing organ damage and sometimes death. Blood pressure is usually low... read more ) 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 Fibroids A fibroid is a noncancerous tumor composed of muscle and fibrous tissue. It is located in the uterus. Fibroids can cause pain, abnormal vaginal bleeding, constipation, repeated miscarriages... read more 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 Pelvic Inflammatory Disease (PID) Pelvic inflammatory disease is an infection of the upper female reproductive organs (the cervix, uterus, fallopian tubes, and ovaries). Pelvic inflammatory disease is usually transmitted during... read more	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 Appendicitis Appendicitis is inflammation and infection of the appendix. Often a blockage inside the appendix causes the appendix to become inflamed and infected. Abdominal pain, nausea, and fever are common... read more	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 Bladder Infection Cystitis is infection of the bladder. Usually, bacteria are the cause of cystitis. A frequent need to urinate and pain or burning while urinating are the most common symptoms. Doctors can often... read more	Pain just above the pubic bone Sometimes an urgent need to urinate, more frequent urination, or burning during urination	A urine test
Diverticulitis Diverticulitis Diverticulitis is inflammation of one or more balloon-like sacs (diverticula). Infection may or may not develop. Diverticulitis usually affects the large intestine (colon). Left lower abdominal... read more	Pain or tenderness in the lower left part of the abdomen Fever	Sometimes CT of the abdomen
Inflammatory bowel disease Overview of Inflammatory Bowel Disease (IBD) In inflammatory bowel diseases, the intestine (bowel) becomes inflamed, often causing recurring abdominal pain and diarrhea. The two primary types of inflammatory bowel disease (IBD) are Crohn... read more 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 Stones in the Urinary Tract Stones (calculi) are hard masses that form in the urinary tract and may cause pain, bleeding, or an infection or block of the flow of urine. Tiny stones may cause no symptoms, but larger stones... read more	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.