Lower abdominal or pelvic pain in women can have many causes, ranging from menstrual cramps and digestive problems to urinary infections and conditions affecting the reproductive organs. Some causes are temporary and mild, while others require prompt medical attention.
Pelvic pain is generally felt in the lower part of the abdomen, although it can also spread to the lower back, buttocks or thighs. It may be sharp, dull, cramping, constant or intermittent, depending on its cause.
Common causes
Menstrual cramps are a common cause of lower abdominal pain. They occur when the uterus contracts during a period and may cause cramping in the lower abdomen. More severe or increasingly painful periods can sometimes be linked to conditions such as endometriosis, adenomyosis, fibroids or pelvic inflammatory disease.
Some women also experience pain around the time of ovulation. This is known as mittelschmerz and can cause pain on one side of the lower abdomen, sometimes lasting from several minutes to a day or two.
Digestive conditions can also cause pain in the lower abdomen. Constipation and irritable bowel syndrome are among the common causes, while conditions such as Crohn’s disease, diverticulitis and intestinal obstruction can also cause abdominal or pelvic pain.
Urinary tract infections and other urinary conditions, including kidney stones and kidney infections, can also cause pain in or around the pelvis.
Problems affecting the reproductive organs are another important group of causes. These include ovarian cysts, endometriosis, pelvic inflammatory disease and uterine fibroids. Pregnancy-related conditions can also cause pelvic pain.
Endometriosis occurs when tissue similar to the lining of the uterus grows outside the uterus. It can cause pelvic or lower abdominal pain, particularly around menstrual periods, as well as pain during sex or when urinating or having a bowel movement.
When pregnancy may be involved
Pelvic pain during pregnancy can have several causes, but pain in someone who is pregnant or could be pregnant should not be ignored.
An ectopic pregnancy occurs when a fertilised egg implants outside the main cavity of the uterus, most commonly in a fallopian tube. Early symptoms can include pelvic pain and vaginal bleeding. Severe abdominal or pelvic pain, fainting, extreme dizziness or shoulder pain can indicate a medical emergency.
Women who have missed a period and develop unusual vaginal bleeding together with lower abdominal or pelvic pain should seek urgent medical assessment because an ectopic pregnancy needs to be ruled out.
Appendicitis is another possible cause
Appendicitis can initially cause pain around the belly button before the pain moves to the lower right side of the abdomen and becomes worse. It may also cause nausea, vomiting, loss of appetite, fever, constipation or diarrhoea.
Because appendicitis can require urgent treatment, worsening abdominal pain should not simply be assumed to be menstrual or digestive pain.
When to see a doctor
The appropriate treatment for lower abdominal pain depends on its underlying cause. A healthcare professional may need to assess the symptoms and, depending on the circumstances, perform an examination or arrange tests.
Medical advice is particularly important when pain keeps returning, does not go away, becomes more severe or interferes with normal activities. Other symptoms such as unusual vaginal bleeding or discharge, pain when urinating, persistent constipation or diarrhoea, vomiting, fever or unexplained weight loss can also require assessment.
Severe or rapidly worsening pelvic pain, fainting or severe dizziness, heavy vaginal bleeding, difficulty breathing or severe pain during a possible pregnancy requires urgent medical attention.
Lower abdominal pain is a symptom rather than a diagnosis. Its cause cannot reliably be determined from the location of the pain alone, so persistent or severe symptoms should be assessed by a healthcare professional.
