Merck Manual

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Some Causes of Pelvic Pain in Women*

Some Causes of Pelvic Pain in Women*

Cause

Common Features†

Tests‡

Related to the menstrual cycle

Menstrual cramps (dysmenorrhea)

Sharp 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

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

A doctor's examination

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

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

Often light spotty bleeding

A doctor's examination

Related to the reproductive system but not the menstrual cycle

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

A ruptured ovarian cyst

Pain that

  • Begins suddenly

  • Is most severe when it begins

  • Often rapidly decreases over a few hours

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

A doctor's examination

Sometimes ultrasonography of the pelvis

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

Vaginal bleeding

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)

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

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)

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

Pelvic pain that

  • Develops gradually

  • Often becomes chronic

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

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

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

Pain just above the pubic bone

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

A urine test

Pain or tenderness in the lower left part of the abdomen

Fever

Sometimes CT of the abdomen

Often colonoscopy after the infection subsides

  • 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)

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.