Common Causes of Pelvic Pain in Women

Pelvic pain, which is pain below the abdominal area, can have many causes in females. You should see a doctor if you experience this type of pain. It often means that you have a medical problem, and it can usually be effectively treated to prevent complications.

Chronic pelvic pain is defined as lasting for six months or longer and is unrelated to pregnancy. Acute pelvic pain is pain that starts over a short period of time—from a few minutes to a few days. This type of pain is often a warning sign that something is wrong and should be evaluated promptly.

Close up of gynecological examining table with a woman in the background holding her stomach
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Ovarian Cysts

Women who have ovarian cysts may experience sharp pain if a cyst leaks fluid or bleeds a little. The pain can be severe, sharp, and continuous when a large cyst twists or ruptures. This is probably the most common gynecologic cause of acute onset pelvic pain.

Most small cysts will dissolve without medical intervention after 2 or 3 menstrual cycles. However large cysts and those that don't dissolve on their own after a few months may require surgical removal.

Ectopic Pregnancy

An ectopic pregnancy is one that starts outside the uterus, usually in one of the fallopian tubes. Pain caused by an ectopic pregnancy usually starts on one side of the abdomen soon after a missed period and may include spotting or vaginal bleeding.

Ectopic pregnancies can be life-threatening if medical intervention is not sought immediately. The fallopian tubes can burst and cause bleeding in the abdomen. In some cases, surgery is required to remove the affected fallopian tube.

Pelvic Inflammatory Disease

Any infection in the pelvic area can cause pelvic inflammatory disease (PID). This may cause discharge, blisters, or skin lesions.

This condition can often be treated with medication that targets the infection, such as antibiotics. Sometimes a procedure may be needed, such as surgical drainage, if an abscess develops.

If this condition worsens and is not treated, it may lead to severe complications, including potential septicemia (systemic infection) and infertility.

Non-Reproductive Causes

Pelvic pain can be caused by an infection or inflammation. An infection doesn't have to affect the reproductive organs to cause acute pelvic pain. Conditions affecting the bladder, bowel, or appendix can produce pain in the pelvic region.

Diverticulitis, irritable bowel syndrome, kidney stones, or bladder stones, as well as muscle spasms or strains are some examples of non-reproductive causes of pelvic or lower abdominal pain. Acute pelvic pain can also be a symptom of appendicitis.

Additional Causes of Acute Pain

Other causes of pelvic pain can include vaginal infections, vaginitis, and sexually transmitted diseases (STDs). All of these require a visit to your healthcare provider who will take a medical history and do a physical exam, which may include diagnostic testing.

Chronic Pelvic Pain

Chronic pelvic pain can be intermittent or constant. Chronic pelvic pain may be the result of more than one problem. A common example of chronic pelvic pain is dysmenorrhea or menstrual cramps. Other causes of chronic pelvic pain include endometriosis, adenomyosis, and ovulation pain.

This type of pain can also be caused by non-gynecologic issues such as:

  • Bladder infections: Interstitial cystitis or other causes of cystitis
  • Gastrointestinal problems: Irritable bowel syndrome, inflammatory bowel disease, colorectal cancer
  • Musculoskeletal issues; Fibromyalgia, abdominal wall myofascial pain, or neurologic cutaneous nerve entrapment

Sometimes an illness starts with intermittent pelvic pain that becomes constant over time. this is often a signal that the problem has become worse.

Women who have had surgery or serious illness such as PID, endometriosis, or severe infections sometimes experience chronic pelvic pain as a result of adhesions or scar tissue that forms during the healing process. Adhesions cause the surfaces of organs and structures inside the abdomen to bind to each other.

Fibroid tumors (noncancerous, benign growths from the muscle of the uterus) often have no symptoms. When symptoms do appear, they can include pelvic pain or pressure, as well as menstrual abnormalities.

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4 Sources
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  1. American College of Obstetricians and Gynecologists. Chronic pelvic pain. Updated August, 2011.

  2. Office of Women's Health. Symptoms of ovarian cysts. Updated April 1, 2019.

  3. Sivalingam VN, Duncan WC, Kirk E, Shephard LA, Horne AW. Diagnosis and management of ectopic pregnancyJ Fam Plann Reprod Health Care. 2011;37(4):231–240. doi:10.1136/jfprhc-2011-0073

  4. ten Broek RP, Issa Y, van Santbrink EJ, et al. Burden of adhesions in abdominal and pelvic surgery: systematic review and met-analysisBMJ. 2013;347:f5588. doi:10.1136/bmj.f5588