Pelvic pain in women is most often caused by menstrual cramps, ovulation, urinary tract infections or bowel problems, but it can also come from conditions such as endometriosis, fibroids, ovarian cysts and pelvic inflammatory disease. Sudden, severe pain, especially with fever, fainting or a possible pregnancy, needs emergency care. This guide from the HeliosCheck.com library sorts the common causes by type and explains what a doctor usually checks.
Key Takeaways
- Pelvic pain can come from the reproductive organs, the bladder, the bowel, or the muscles and nerves of the pelvis.
- Pain that lasts six months or longer is called chronic pelvic pain and can be treated even when no single cause is found.
- Sudden severe pain, pain with fever, fainting or dizziness, or pain with a positive pregnancy test needs emergency care.
- A work-up usually starts with your history, a pregnancy test, a urine test and a pelvic exam, often followed by an ultrasound.
Acute vs. Chronic Pelvic Pain
Doctors first sort pelvic pain by how long it has been going on, because the likely causes are different.
- Acute pelvic pain comes on suddenly, over hours or days. It is more likely to be caused by an infection, a ruptured or twisted ovarian cyst, appendicitis or a problem with an early pregnancy, and it needs prompt attention.
- Chronic pelvic pain is pain in the pelvic area that lasts for 6 months or longer, according to ACOG. It may follow the menstrual cycle or be present most days. ACOG notes that more than one condition can contribute, that sometimes no cause is found, and that the pain is real and treatable either way.
Pain can also be cyclic, meaning it rises and falls with your period. Noting whether pain follows your cycle is one of the most helpful clues you can give a doctor.
Gynecologic Causes
These causes involve the uterus, ovaries, fallopian tubes or cervix. Many of them are covered in more depth in the HeliosCheck.com Pelvic Health and Menstrual Health sections.
| Cause | Typical pattern | Helpful clue |
|---|---|---|
| Menstrual cramps (dysmenorrhea) | Cramping low in the belly just before and during a period | Eases as the period ends |
| Ovulation pain | One-sided, short-lived ache mid-cycle | Happens about two weeks before a period |
| Endometriosis | Painful periods that worsen over time, pain with sex or bowel movements | Pain may start days before bleeding |
| Adenomyosis | Heavy, painful periods and an enlarged, tender uterus | Often noticed in the 40s |
| Fibroids | Pressure, heaviness, heavy periods, frequent urination | Found on pelvic exam or ultrasound |
| Ovarian cysts | Dull one-sided ache, or sudden severe pain if a cyst ruptures or twists the ovary | Sudden severe pain needs emergency care |
| Pelvic inflammatory disease (PID) | Lower pelvic pain with abnormal discharge and sometimes fever | Often linked to an untreated sexually transmitted infection |
| Ectopic pregnancy | One-sided cramping or pain with a missed period or abnormal bleeding | A medical emergency if a fallopian tube ruptures |
If your pain is worst around your period and keeps getting harder to manage, read our guide to the early signs of endometriosis. ACOG explains that an ectopic pregnancy can first feel like mild one-sided cramping, with sudden severe pain, shoulder pain, weakness, dizziness or fainting if a tube ruptures.
Causes Outside the Reproductive Organs
The pelvis is crowded, and pain from the bladder, bowel or muscles can feel very similar to gynecologic pain. MedlinePlus notes that pelvic pain can be a sign of infection or a problem with any of the pelvic organs.
Bladder and Urinary Causes
A urinary tract infection (UTI) often causes burning when you pee, urgency and lower belly pain. Interstitial cystitis, also called bladder pain syndrome, causes ongoing bladder pressure or pain that often eases after urinating. Kidney stones can cause severe pain that spreads from the side or back toward the groin.
Bowel and Digestive Causes
Irritable bowel syndrome (IBS) and constipation are common causes of crampy lower belly pain that changes with bowel movements. Appendicitis usually starts as pain around the belly button that moves to the lower right side and gets worse over hours. Inflammatory bowel disease and diverticulitis are other possibilities, especially with diarrhea, blood in the stool or fever.
Muscles, Nerves and the Pelvic Floor
Tight or overactive pelvic floor muscles can cause aching, pressure, pain with sex and trouble emptying the bladder or bowel. Pelvic floor physical therapy is often part of treatment. Our guide to pelvic floor and bladder health covers this in more detail. Over time, long-lasting pain can also make the nerves more sensitive, which is why pain specialists and physical therapists may be involved.
Red Flags That Need Emergency Care
Call 911 or go to the emergency room if pelvic pain comes with any of the following:
- Sudden, severe pain, or pain that keeps getting worse over a few hours
- A positive pregnancy test or a missed period, especially with bleeding or one-sided pain
- Fainting, dizziness, a racing heart or shoulder pain
- Fever, chills or vomiting that will not stop
- Very heavy vaginal bleeding
- A hard, swollen belly that hurts to touch
These signs can point to conditions such as a ruptured ectopic pregnancy, a twisted ovary, appendicitis or a serious infection, all of which need treatment quickly.
What a Pelvic Pain Work-Up Usually Involves
For pain that is not an emergency, start with your primary care provider or OB-GYN. A typical evaluation follows these steps:
- Your history: when the pain started, where it is, how it relates to your period, sex, urination and bowel movements, and what makes it better or worse.
- A pregnancy test: usually done first in anyone who could be pregnant.
- A urine test: to look for infection or blood.
- A pelvic exam: often with swabs to test for sexually transmitted infections.
- Imaging: a pelvic ultrasound, often transvaginal, is the most common first scan; CT or MRI may follow in some cases.
- Further tests if needed: blood tests, referral to a specialist, or laparoscopy, a minor surgery that lets a surgeon look inside the pelvis.
Keeping a simple pain diary for a few weeks before your visit makes this process faster. Our checklist on how to prepare for a gynecologist appointment shows what to bring. More guides on these topics are on HeliosCheck.com.
Frequently Asked Questions
Is Pain During Sex a Normal Thing to Put Up With?
No. Pain during or after sex is common, but it is not something you simply have to accept. It can be linked to vaginal dryness, infections, endometriosis, pelvic floor muscle tension or other conditions, and many of these are treatable. Mention it to your doctor or OB-GYN, even if it feels awkward to bring up.
Can Stress Make Pelvic Pain Worse?
It can. Stress, anxiety and poor sleep can make the nervous system more sensitive, which may increase how strongly pain is felt, and they can also tighten the pelvic floor muscles. That does not mean the pain is imagined. Treating both the physical cause and the stress often works better than either alone.
Which Side Does Appendicitis Usually Hurt On?
Appendicitis pain usually starts around the belly button and then moves to the lower right side of the abdomen, getting worse over several hours. It may come with fever, nausea, vomiting or loss of appetite. Because a burst appendix is dangerous, seek emergency care right away if you notice this pattern.
Can Pelvic Pain Start After Menopause?
Yes. After menopause, pelvic pain can come from vaginal dryness and thinning tissue, bladder problems, bowel conditions, pelvic floor changes or, less often, growths on the ovaries or uterus. New pelvic pain after menopause, especially with bloating, bleeding or weight loss, should be checked by your doctor.
Talk to your doctor: This guide is for general information, not medical advice. Always talk to your own doctor or OB-GYN about your symptoms, and call 911 if you think you have an emergency.
