Overview

The pelvis houses the reproductive organs. It’s located at the lower abdomen, where your abdomen meets your legs. Pelvic pain can radiate up into the lower abdomen, making it hard to differentiate from abdominal pain.

Read on to learn possible causes for pelvic pain in women, when to seek help, and how to manage this symptom.

Causes

There are many causes of both acute and chronic pelvic pain. Acute pelvic pain refers to sudden or new pain. Chronic pain refers to a long-lasting condition, which may remain constant or come and go.

Pelvic inflammatory disease (PID)

Pelvic inflammatory disease (PID) is an infection of the female reproductive organs. It’s typically caused by an untreated sexually transmitted infection, such as chlamydia or gonorrhea. Women often experience no symptoms when they’re first infected. If left untreated, PID can cause serious complications, including chronic, severe pain in the pelvis or abdomen.

Other symptoms can include:

PID requires immediate medical attention to avoid additional complications, including:

Endometriosis

Endometriosis can occur at any time during your reproductive years. It’s caused by the growth of uterine tissue outside of the uterus. This tissue continues to act the way it would if it were within the uterus, including thickening and shedding in response to the menstrual cycle.

Endometriosis often causes varying degrees of pain, which ranges from mild, to severe and debilitating. This pain is often most pronounced during menstruation. It can also occur during intercourse and with bowel or bladder movements. Pain is often centered within the pelvic region, but can extend into the abdomen.

Endometriosis can also affect the lungs and diaphragm, although this is rare.

In addition to pain, symptoms can include:

  • heavy periods
  • nausea
  • bloating

Endometriosis can also result in subfertility or infertility.

Treatments for pain management may include over-the-counter (OTC) pain medications or surgical procedures, such as laparoscopy. There are also effective treatments for endometriosis and conception, such as in vitro fertilization. Early diagnosis can help reduce chronic symptoms, including pain and infertility.

Ovulation

Some women experience a temporary sharp pain during ovulation when an egg is released from an ovary. This pain is called mittelschmerz. It usually lasts for only a few hours and often responds to OTC pain medication.

Menstruation

Pelvic pain can occur before and during menstruation and is usually described as cramps in the pelvis or lower abdomen. The severity can vary from month to month.

Pain prior to menstruation is called premenstrual syndrome (PMS). When pain is so severe that you can’t enjoy your normal, day-to-day activities, it’s referred to as premenstrual dysphoric disorder (PMDD). PMS and PMDD are often accompanied by other symptoms, including:

These symptoms usually, though not always, dissipate once menstruation begins.

Pain during menstruation is called dysmenorrhea. This pain may feel like cramps in the abdomen, or like a nagging pain in the thighs and lower back. It may be accompanied by:

  • nausea
  • headache
  • lightheadedness
  • vomiting

If your menstrual pain is severe, discuss pain management with your doctor. OTC medications or acupuncture may help.

Ovarian (adnexal) torsion

If your ovary twists suddenly on its spindle, you will feel immediate, sharp, excruciating pain. The pain is sometimes accompanied by nausea and vomiting. This pain can also begin days before as intermittent cramping.

Ovarian torsion is a medical emergency which usually requires immediate surgery. If you experience anything like this, seek medical care immediately.

Ovarian cyst

Cysts in the ovary often don’t cause any symptoms. If they’re large, you may feel either a dull or sharp pain on one side of your pelvis or abdomen. You may also feel bloated, or a heaviness in your lower abdomen.

If the cyst ruptures, you’ll feel a sudden, sharp pain. You should seek treatment if you experience this, however, ovarian cysts usually dissipate on their own. Your doctor may recommend removing a large cyst to avoid rupture.

Uterine fibroids (myomas)

Uterine fibroids are benign growths in the uterus. Symptoms vary based on the size and location. Many women don’t have any symptoms at all.

Large fibroids may cause a feeling of pressure or a dull aching pain in the pelvis or lower abdomen. They may also cause:

  • bleeding during intercourse
  • heavy periods
  • trouble with urination
  • leg pain
  • constipation
  • back pain

Fibroids can also interfere with conception.

Fibroids occasionally cause a very sharp, severe pain if they outgrow their blood supply and start to die. Seek immediate medical help if you experience:

Gynecologic cancers

Cancer can occur in many areas of the pelvis, including the:

Symptoms vary, but often include dull, aching pain in the pelvis and abdomen, and pain during intercourse. Unusual vaginal discharge is another common symptom.

Getting regular checkups and gynecological exams can help you find cancers early, when they’re easier to treat.

Pelvic pain in pregnancy

Pelvic pain during pregnancy is usually not cause for alarm. As your body adjusts and grows, your bones and ligaments stretch. That can cause feelings of pain or discomfort.

However, any pain that makes you nervous, even if its mild, should be discussed with your doctor. Especially if it’s accompanied by other symptoms such as vaginal bleeding, or if it doesn’t go away or lasts for an extended period of time. Some possible causes of pain during pregnancy include:

Braxton-Hicks contractions

These pains are often referred to as false labor and happen most commonly during the third trimester. They may be brought on by:

  • physical exertion
  • the baby’s movements
  • dehydration

Braxton-Hicks contractions can be uncomfortable, but aren’t as intense as labor pain. They also don’t come at regular intervals or increase in intensity over time.

Braxton-Hicks contractions aren’t a medical emergency, but you should let your doctor know you’re having them when you go for your next prenatal appointment.

Miscarriage

A miscarriage is the loss of a pregnancy before the 20th week of gestation. Most miscarriages occur during the first trimester, before the 13th week. They’re often accompanied by:

  • vaginal bleeding or bright red spotting
  • abdominal cramps
  • feelings of pain in the pelvis, abdomen, or lower back
  • flow of fluid or tissue from the vagina

If you think you’re having a miscarriage, call your doctor or go to an emergency room immediately.

Premature labor

Labor that occurs before the 37th week of pregnancy is considered premature labor. Symptoms include:

  • pain in your lower abdomen, which can feel like sharp, timed contractions or like dull pressure
  • lower back pain
  • fatigue
  • heavier-than-normal vaginal discharge
  • cramping in the stomach with or without diarrhea

You may also pass your mucus plug. If labor is being brought on by an infection, you may also have fever.

Premature labor is a medical emergency which requires immediate attention. It can sometimes be stopped by medical treatment before you give birth.

Placental abruption

The placenta forms and attaches itself to the uterine wall early in pregnancy. It’s designed to provide oxygen and nutrition for your baby until delivery. Rarely, the placenta detaches itself from the uterine wall. This may be a partial or complete detachment, and is known as placental abruption.

Placental abruption can cause vaginal bleeding, accompanied by sudden feelings of pain or tenderness in the abdomen or back. It’s most common in the third trimester, but may occur at any time after the 20th week of pregnancy.

Placental abruption also requires immediate medical treatment.

Ectopic pregnancy

Ectopic pregnancies occur shortly after conception if a fertilized egg implants itself in a fallopian tube or other part of the reproductive tract instead of in the uterus. This type of pregnancy is never viable and may result in rupture of the fallopian tube and internal bleeding.

The primary symptoms are sharp, intense pain and vaginal bleeding. The pain may occur in the abdomen or pelvis. Pain may also radiate up toward the shoulder or neck if internal bleeding has occurred and blood has pooled under the diaphragm.

Ectopic pregnancies may be dissolved with medication or may require surgery.

Other causes

Pelvic pain can be caused by a wide range of additional conditions in both men and women. These include:

Diagnosis

Your doctor will take an oral history to learn about the type of pain you have, and about your other symptoms and overall health history. They may also recommend a pap smear if you have not had one within the past three years.

There are several standard tests you can expect. These include:

  • Physical exam, to look for areas of tenderness in your abdomen and pelvis.
  • Pelvic (transvaginal) ultrasound, so that your doctor can view your uterus, fallopian tubes, vagina, ovaries, and other organs within your reproductive system. This test uses a wand inserted into the vagina, which transmits sound waves to a computer screen.
  • Blood and urine tests, to look for signs of infection.

If the cause of the pain isn’t discovered from these initial tests, you may need additional tests, such as:

Home remedies

Pelvic pain often responds to OTC pain medications, but make sure to check with your doctor before you take any type of drug during pregnancy.

In some instances, resting may help. In others, gentle movement and light exercise will be more beneficial. Try these tips:

  • Place a hot water bottle on your abdomen to see if it helps to ease cramps or take a warm bath.
  • Elevate your legs. This may help alleviate pelvic pain and pain which affects your lower back or thighs.
  • Try yoga, prenatal yoga, and meditation which can also be helpful for pain management.
  • Take herbs, such as willow bark, which can help decrease pain. Get your doctor’s approval before you use it during pregnancy.

Takeaway

Pelvic pain is a common condition in women with a wide range of causes. It can be chronic or acute. Pelvic pain often responds to at-home treatments and OTC medications. It can, however, be caused by many serious conditions which require a doctor’s immediate care.

It’s always a good idea to see your doctor if you’re experiencing pelvic pain, especially if it’s occurring regularly. They can run tests to find out the cause.