Pelvic Pain in Women: Causes and When to See a Doctor

Pelvic pain in women may arise from the uterus, ovaries, fallopian tubes, bladder, bowel, pelvic floor muscles or surrounding tissues. Common causes include menstrual cramps, ovulation, endometriosis, fibroids, ovarian cysts, urinary infections and digestive problems. However, sudden severe pain, especially with bleeding, fever, vomiting, faintness or a possible pregnancy, requires prompt medical assessment. Pain that keeps returning or interferes with work, sleep, exercise or intimacy should also be evaluated. Women in and around New BEL Road can consult the gynaecology team at Shirdi Sai Hospital to understand the cause and discuss appropriate next steps.

Pelvic Pain in Women at a Glance

• Pelvic pain is felt in the lower abdomen, usually below the navel.
• It may be sudden, recurring or present for several months.
• The pain may come from reproductive, urinary, digestive or muscular structures.
• The timing of pain can provide clues, but it cannot confirm the cause.
• Sudden severe pain, heavy bleeding, fainting or pain during pregnancy needs urgent assessment.
• Treatment depends on the condition causing the pain.

When Is Pelvic Pain an Emergency?

Some causes of pelvic pain require prompt treatment. Seek urgent medical care when the pain is severe, begins suddenly or occurs with other concerning symptoms.

Emergency assessment may be needed for:

• Sudden, intense or worsening pelvic pain
• Severe pain on one side of the pelvis
• Pelvic pain with fainting, dizziness or marked weakness
• Heavy vaginal bleeding
• A missed period or positive pregnancy test with pain or bleeding
• Fever, chills or repeated vomiting
• A rigid or very tender abdomen
• Difficulty passing urine
• Blood in the urine
• Pain after an injury
• Severe pain during pregnancy
• New shoulder-tip pain with abdominal or pelvic pain during a possible pregnancy

These symptoms may occur with conditions such as an ectopic pregnancy, ovarian torsion, a ruptured ovarian cyst, severe infection, appendicitis or urinary obstruction. The cause cannot be identified safely from symptoms alone.

Patients with sudden or severe symptoms can seek assessment through the hospital’s emergency medicine service.

What Is Pelvic Pain?

Pelvic pain refers to discomfort felt in the lower part of the abdomen, between the navel and the groin. It may feel like:

• Cramping
• Pressure or heaviness
• A dull ache
• Sharp or stabbing pain
• Burning discomfort
• Pain that spreads to the back or thighs
• A pulling sensation
• Pain during movement or sexual intercourse

The pain may be limited to one side or felt across the lower abdomen. It may occur around menstruation, during ovulation, after sexual intercourse, while passing urine or during a bowel movement.

Because several organs are located close together in the pelvis, different conditions can produce similar symptoms.

Acute and Chronic Pelvic Pain

Doctors often consider how quickly the pain began and how long it has continued.

Acute pelvic pain

Acute pelvic pain begins suddenly or develops over a short period. It may be linked to:

• An ovarian cyst
• Ovarian torsion
• Ectopic pregnancy
• Pelvic infection
• Urinary infection
• Kidney or ureteric stone
• Appendicitis
• A bowel condition

Sudden pain does not always mean there is a serious problem, but severe or worsening symptoms should be assessed promptly.

Recurring pelvic pain

Recurring pain comes and goes. It may follow a pattern related to:

• Menstruation
• Ovulation
• Sexual intercourse
• Urination
• Bowel movements
• Exercise or prolonged sitting

Recording the timing and accompanying symptoms can help the doctor identify a pattern.

Chronic pelvic pain

Chronic pelvic pain usually refers to pain that continues or repeatedly returns for six months or longer.

Sometimes one clear condition is responsible. In other cases, several factors may contribute, such as endometriosis combined with pelvic floor muscle tension or a digestive condition.

Common Causes of Pelvic Pain in Women

Pelvic pain is a symptom rather than a diagnosis. The possible cause depends on the pain pattern, menstrual cycle, pregnancy possibility, urinary and bowel symptoms, medical history and examination findings.

Menstrual cramps

Cramping during the first few days of a period is common. It occurs because the uterus contracts while shedding its lining.

Typical menstrual cramps may:

• Begin shortly before or when bleeding starts
• Last for one to three days
• Cause lower abdominal or back discomfort
• Improve as the period ends

Medical evaluation is advisable when period pain:

• Becomes more severe over time
• Begins later after previously manageable periods
• Continues outside menstrual days
• Does not improve with usual measures
• Causes missed work, college or daily activities
• Occurs with heavy or irregular bleeding

Severe or changing period pain can sometimes be associated with endometriosis, adenomyosis, fibroids or pelvic infection.

Ovulation pain

Some women experience one-sided pelvic discomfort around the middle of the menstrual cycle when an ovary releases an egg.

Ovulation pain may:

• Affect one side
• Last from a few minutes to one or two days
• Change sides between cycles
• Occur without heavy bleeding or fever

However, new, severe or persistent one-sided pain should not automatically be assumed to be ovulation pain. An ovarian cyst, infection or another condition may produce similar symptoms.

Endometriosis

Endometriosis occurs when tissue similar to the lining of the uterus grows outside the uterus.

Possible symptoms include:

• Period pain that worsens over time
• Pelvic pain before or after menstruation
• Pain during or after sexual intercourse
• Pain during bowel movements or urination, particularly around periods
• Heavy bleeding
• Difficulty becoming pregnant
• Ongoing lower back or pelvic discomfort

The severity of pain does not always indicate how extensive the condition is. Some women have significant pain with limited visible disease, while others have few symptoms.

Women who are unsure how their symptoms differ can read the hospital’s guide to period pain and endometriosis.

Adenomyosis

Adenomyosis occurs when tissue similar to the uterine lining grows into the muscular wall of the uterus.

It may cause:

• Painful periods
• Heavy or prolonged menstrual bleeding
• Pelvic pressure
• Tenderness in the lower abdomen
• Pain during sexual intercourse

Symptoms can overlap with endometriosis and fibroids. A clinical examination and imaging may be needed to distinguish between them.

Uterine fibroids

Fibroids are non-cancerous growths that develop in or around the uterus. Many fibroids cause no symptoms.

When symptoms occur, they may include:

• Pelvic pressure or heaviness
• Heavy or prolonged periods
• Lower abdominal fullness
• Frequent urination
• Constipation
• Pain during periods
• Discomfort during sexual intercourse

The effect of a fibroid depends on its size, number and location. A small fibroid in a particular part of the uterus may cause more bleeding than a larger fibroid elsewhere.

Treatment is not always surgical. Women can learn more about how fibroid symptoms may be managed without surgery.

Ovarian cysts

An ovarian cyst is a fluid-filled sac that develops on or inside an ovary. Many cysts are related to the menstrual cycle and resolve without treatment.

A cyst may cause:

• One-sided pelvic pain
• A feeling of pressure or fullness
• Bloating
• Pain during sexual intercourse
• Changes in menstrual bleeding
• Discomfort during movement

Sudden severe pain, especially with nausea or vomiting, may occur if a cyst ruptures or if the ovary twists. This needs urgent medical assessment.

Pelvic inflammatory disease

Pelvic inflammatory disease, also called PID, is an infection involving the female reproductive organs.

Symptoms may include:

• Lower abdominal or pelvic pain
• Unusual vaginal discharge
• Fever
• Pain during sexual intercourse
• Burning while urinating
• Bleeding between periods
• Bleeding after sexual intercourse

Symptoms can sometimes be mild. Delayed treatment may increase the risk of complications, so persistent pelvic pain with discharge, fever or abnormal bleeding should be evaluated.

Antibiotics should not be started from an old prescription because the correct treatment depends on clinical assessment.

Ectopic pregnancy

An ectopic pregnancy occurs when a pregnancy develops outside the main cavity of the uterus, most commonly in a fallopian tube.

Possible warning signs include:

• A missed period
• A positive pregnancy test
• One-sided pelvic or abdominal pain
• Vaginal bleeding or spotting
• Shoulder-tip pain
• Dizziness or fainting
• Increasing weakness

An ectopic pregnancy can become an emergency if internal bleeding occurs. Anyone with a possible pregnancy and new pelvic pain should seek medical advice promptly. Severe pain, fainting or heavy bleeding requires emergency care.

Pregnancy-related causes

Pelvic discomfort can occur during pregnancy because of changes in the uterus, muscles, joints and ligaments. However, pain during pregnancy should not be dismissed without considering its pattern and severity.

Contact a medical professional if pelvic pain during pregnancy:

• Is severe or persistent
• Occurs with vaginal bleeding
• Is accompanied by fever
• Occurs with dizziness or fainting
• Is associated with fluid leakage
• Comes with painful urination
• Is accompanied by regular tightening or contractions
• Causes concern at any stage of pregnancy

The appropriate assessment depends on the stage of pregnancy and accompanying symptoms.

Urinary tract infection

A bladder or urinary tract infection may cause discomfort in the lower abdomen or pelvis.

Other symptoms may include:

• Burning while urinating
• Frequent urination
• Urgent urination
• Cloudy or strong-smelling urine
• Blood in the urine

Fever, chills, vomiting or pain in the side or back may indicate that the infection involves the kidneys and needs prompt evaluation.

Kidney or ureteric stone

A urinary stone may cause pain that begins in the side or back and moves towards the lower abdomen, pelvis or groin.

It may also cause:

• Nausea or vomiting
• Blood in the urine
• Frequent urination
• Burning while urinating
• Difficulty finding a comfortable position

Stone pain can overlap with gynaecological and abdominal conditions. Imaging and urine testing may be needed to identify the source.

Bladder pain conditions

Some women experience recurring bladder or pelvic discomfort without a routine bacterial infection.

Symptoms may include:

• Pressure around the bladder
• Frequent urination
• Urgency
• Pain that changes as the bladder fills or empties
• Repeated negative urine cultures

A doctor may consider bladder, pelvic floor and gynaecological causes before recommending treatment.

Digestive causes

The bowel lies close to the female reproductive organs. Digestive conditions can therefore produce pain that feels pelvic rather than abdominal.

Possible causes include:

• Constipation
• Irritable bowel syndrome
• Gastrointestinal infection
• Inflammatory bowel conditions
• Diverticular disease
• Appendicitis

Bloating, diarrhoea, constipation, changes in stool, pain during bowel movements or pain related to eating may suggest a digestive contribution.

Sudden severe right-sided pain with fever, nausea or vomiting may require urgent assessment for appendicitis or another acute abdominal condition.

Pelvic floor muscle problems

The pelvic floor is a group of muscles supporting the bladder, uterus and bowel. These muscles may become tight, weak or poorly coordinated.

Pelvic floor dysfunction may cause:

• Pelvic pressure
• Pain during sexual intercourse
• Difficulty passing urine or stool
• Pain with prolonged sitting
• Lower back discomfort
• A sensation of incomplete bladder or bowel emptying

Treatment may include pelvic floor physiotherapy when the condition has been properly assessed. Pelvic floor exercises are not suitable for every type of pelvic pain, particularly when the muscles are already overly tight.

Musculoskeletal or nerve-related pain

Pain from the lower back, hips, abdominal wall, pelvic joints or nearby nerves may be felt in the pelvis.

This type of pain may:

• Worsen with movement
• Change with posture
• Increase after prolonged sitting
• Follow an injury
• Spread into the hip, groin or thigh

A clinical examination can help determine whether the pain appears to arise from a gynaecological organ or the surrounding muscles and joints.

What Can the Pattern of Pelvic Pain Suggest?

The timing and associated symptoms can help guide the evaluation, but they cannot confirm a diagnosis.

The same condition can cause different symptoms in different women. More than one condition may also be present.

Pelvic Pain Without a Period

Pelvic pain can occur at any point in the menstrual cycle.

Possible causes include:

• Ovulation
• Ovarian cysts
• Endometriosis
• Pelvic inflammatory disease
• Pregnancy-related conditions
• Urinary infection
• Kidney stones
• Constipation or bowel conditions
• Pelvic floor dysfunction
• Muscular or joint pain

The absence of menstrual bleeding does not rule out a gynaecological cause. Persistent or recurring pain should be evaluated, particularly when it is accompanied by discharge, urinary symptoms, bowel changes or pain during sexual intercourse.

Pelvic Pain After Sexual Intercourse

Pain during or after intercourse may be felt near the vaginal opening, deeper in the pelvis or both.

Possible contributing factors include:

• Vaginal dryness
• Infection
• Endometriosis
• Pelvic inflammatory disease
• Ovarian cysts
• Fibroids
• Pelvic floor muscle tension
• Scar tissue after surgery or childbirth
• Menopausal changes

Pain during intercourse is not something a patient needs to feel embarrassed about discussing. Its location, depth, timing and relationship to the menstrual cycle can provide useful diagnostic information.

How Is Pelvic Pain Evaluated?

Not every woman needs every available test. The evaluation is guided by the symptoms, age, menstrual history, pregnancy possibility and clinical findings.

Medical history

The doctor may ask:

• Where exactly is the pain?
• When did it begin?
• Is it constant or intermittent?
• Does it occur on one side?
• Is it related to menstruation or ovulation?
• Does it occur during sexual intercourse?
• Is there abnormal bleeding or vaginal discharge?
• Are there urinary or bowel symptoms?
• Could pregnancy be possible?
• Has there been a previous infection, surgery or pregnancy?
• What medicines are being taken?
• Is the pain affecting sleep, work or daily activities?

A symptom and menstrual diary can help identify patterns that may not be obvious during a single consultation.

Pregnancy test

A pregnancy test may be recommended for women of reproductive age when pregnancy is possible. This is important because pregnancy-related conditions can change the urgency and choice of investigations.

Physical and pelvic examination

A physical examination may include checking the abdomen for tenderness, swelling or muscle-related pain.

A pelvic examination may be considered when symptoms suggest a gynaecological cause. The clinician should explain why the examination is being recommended and what it involves.

Urine testing

A urine test may be used to look for:

• Urinary infection
• Blood in the urine
• Other urinary abnormalities

A urine culture may be advised when infection is suspected.

Vaginal or cervical tests

When there is unusual discharge, bleeding or concern about infection, the doctor may recommend samples for laboratory testing.

Blood tests

Blood tests may be used to check for:

• Anaemia
• Signs of infection or inflammation
• Pregnancy-related findings
• Other abnormalities based on the suspected cause

Hormone tests are not necessary for every woman with pelvic pain. They are selected when the history suggests a hormonal or ovulatory concern.

Pelvic ultrasound

An ultrasound may help assess:

• The uterus
• The ovaries
• Fibroids
• Ovarian cysts
• The thickness of the uterine lining
• Pregnancy-related concerns
• Other structural findings

A normal ultrasound does not exclude every cause of pelvic pain. Some conditions, including certain forms of endometriosis and pelvic floor dysfunction, may not be clearly visible.

Additional imaging

MRI, CT imaging or other investigations may be considered when the symptoms or initial test results require further assessment.

The imaging choice depends on the suspected condition. CT may be more useful for urinary stones or certain abdominal causes, while MRI may provide additional detail for selected gynaecological findings.

Laparoscopy

Laparoscopy is a surgical procedure that allows doctors to examine the pelvic organs through small abdominal incisions.

It may be considered in selected cases when symptoms persist, endometriosis or another pelvic condition is suspected, and the result is likely to influence treatment. It is not required for every woman with pelvic pain.

How Is Pelvic Pain Treated?

Treatment depends on the cause rather than the pain location alone.

Possible approaches include:

Pain management

A doctor may recommend suitable pain-relieving or anti-inflammatory medicine based on symptoms, medical history and other medicines being taken.

Regular painkiller use without assessment may delay the diagnosis of a recurring condition.

Hormonal treatment

Hormonal medicines may be considered for selected causes such as:

• Painful periods
• Endometriosis
• Adenomyosis
• Some ovarian cyst patterns
• Heavy bleeding associated with fibroids

The choice depends on age, symptoms, pregnancy plans and medical history.

Antibiotics

Antibiotics may be prescribed when a bacterial infection is confirmed or strongly suspected.

Completing the prescribed course is important. A partner may also require evaluation or treatment in some infections.

Management of ovarian cysts

Some ovarian cysts can be monitored with follow-up imaging. Treatment may be considered when a cyst:

• Persists
• Increases in size
• Causes ongoing symptoms
• Has concerning imaging features
• Twists or ruptures
• Occurs after menopause

Management of fibroids or endometriosis

Treatment may include medicines, hormonal options, monitoring or surgery, depending on symptoms, findings and future pregnancy plans.

Surgery is not automatically required for every fibroid or suspected case of endometriosis.

Pelvic floor physiotherapy

Pelvic floor physiotherapy may help when examination suggests muscle tension, weakness, poor coordination or pain arising from the pelvic floor.

The exercises and treatment plan should be individualised. Repeated strengthening exercises without an assessment may worsen pain in someone whose muscles are already tight.

Treatment of urinary or digestive conditions

A gynaecologist may coordinate with urology, internal medicine, general surgery or another relevant specialty when the pain appears to come from the bladder, urinary tract, bowel or abdominal organs.

What Can You Do Before the Appointment?

A few practical steps can make the consultation more useful:

• Record when the pain occurs.
• Note whether it is on one side or across the pelvis.
• Track the relationship to periods and ovulation.
• Record abnormal bleeding or vaginal discharge.
• Note pain during sexual intercourse.
• Write down urinary and bowel symptoms.
• Carry previous ultrasound reports and blood test results.
• Bring a list of medicines and supplements.
• Mention any possibility of pregnancy.
• Record whether the pain is affecting work, exercise or sleep.

Avoid using leftover antibiotics or hormonal medicines without medical advice. Also avoid delaying evaluation because the pain temporarily improves.

When Should You See a Gynaecologist?

Arrange a consultation when pelvic pain:

• Is new or unexplained
• Keeps returning
• Lasts for several days
• Worsens over time
• Interferes with daily activities
• Occurs between periods
• Is associated with heavy or irregular bleeding
• Occurs during or after sexual intercourse
• Is accompanied by unusual vaginal discharge
• Occurs with fertility concerns
• Continues despite a normal initial scan
• Develops after menopause

A gynaecologist can evaluate reproductive causes while also considering urinary, digestive and musculoskeletal conditions.

Gynaecology Evaluation on New BEL Road

Shirdi Sai Hospital provides obstetrics and gynaecology care at its New BEL Road location. The department’s published scope includes menstrual disorders, pelvic inflammatory disease, endometriosis, fibroids, ovarian concerns, ectopic pregnancy and other women’s health conditions. (Shirdi Sai Hospital Pvt Ltd)

Women with new, recurring or unexplained pelvic pain can learn more about the hospital’s obstetrics and gynaecology services.

An evaluation may begin with a detailed symptom and menstrual history. Urine tests, pregnancy testing, blood tests, ultrasound or other investigations may then be considered according to the clinical findings.

Shirdi Sai Hospital is located at No. 519, 2nd Main, Nethravathi Street, Devasandra, New BEL Road, Bengaluru, Karnataka 560054.

Frequently Asked Questions

What are the most common causes of pelvic pain in women?

Common causes include menstrual cramps, ovulation, endometriosis, adenomyosis, fibroids, ovarian cysts, pelvic infection, urinary infections, bowel conditions and pelvic floor muscle problems. The likely cause depends on the pain pattern and accompanying symptoms.

Can ovulation cause pelvic pain?

Yes. Some women experience mild, one-sided discomfort around the time an ovary releases an egg. It usually settles within a short period. Severe, persistent or worsening one-sided pain should be evaluated because other ovarian conditions may cause similar symptoms.

Why do I have pelvic pain when I am not on my period?

Pelvic pain outside menstrual days may be linked to ovulation, endometriosis, an ovarian cyst, infection, pregnancy-related conditions, urinary problems, bowel conditions or pelvic floor muscle tension. Recurring or persistent pain should be assessed.

When is sudden pelvic pain an emergency?

Seek urgent care for sudden severe pain, particularly when it occurs with heavy bleeding, fainting, vomiting, fever, a possible pregnancy, difficulty passing urine or marked weakness. These symptoms may indicate a condition needing prompt treatment.

Can a urinary infection cause pelvic pain?

Yes. A bladder or urinary infection may cause lower abdominal or pelvic discomfort, burning urination, urgency and frequent urination. Fever or pain in the side or back may indicate a more significant infection and needs prompt medical attention.

Is pelvic pain during pregnancy normal?

Mild discomfort can occur as the body changes during pregnancy. However, severe, persistent or one-sided pain, especially with bleeding, fainting, fever or fluid leakage, should be assessed promptly.

Which doctor should I consult for pelvic pain?

A gynaecologist is an appropriate first point of consultation when pelvic pain is associated with periods, vaginal bleeding, discharge, sexual intercourse, pregnancy or other reproductive symptoms. Depending on the findings, care may also involve urology, internal medicine, general surgery or another specialty.

Arrange an Evaluation

Pelvic pain may be caused by a temporary menstrual change, but recurring, worsening or unexplained pain deserves medical attention. A proper evaluation can distinguish between gynaecological, urinary, digestive and muscular causes.

Women with non-emergency symptoms can arrange a gynaecology consultation at Shirdi Sai Hospital on New BEL Road.

Seek urgent medical care for sudden severe pain, heavy bleeding, fainting, repeated vomiting, fever or pain associated with a possible pregnancy.