What Causes Pelvic Pain in Women?

Medically Reviewed By Carla Prophete, MPAS, PA-C
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Females typically experience varying degrees of pains in the pelvic region — the area between the belly button and groin. There are different causes of pelvic pain, and identifying the specific cause may require professional clinical evaluation.

Sex and gender exist on a spectrum. This article uses the terms “female” and/or “male” to refer to sex that was assigned at birth. 

Learn more about the difference between sex and gender here.

The causes of pelvic pain typically stem from infection, inflammation, or functional changes in the female reproductive system and surrounding local tissues and organs in the pelvic region. Some causes of pelvic pain are temporary, while others may be persistent and life threatening.

This article explains more about the various causes of pelvic pain and how doctors typically treat them.

Menstruation and ovulation

A close up of a female with her hand on her pelvis
STUDIO TAURUS/Stocksy United

Some females experience mild or severe menstrual pains during their monthly cycle. Menstrual pain results from uterus contractions to expel its lining. Menstrual pain does not require any urgent medical intervention except for severe cases.

Ovulation pain is generally mild and felt in the lower region of the abdomen. It indicates the release of ova from the ovaries typically during the midpoint of your monthly cycle. You may also experience pain near the time of ovulation, either before or after.

Although pain relief medication may reduce menstrual and ovulation pain, consult your doctor if you notice any changes in the intensity and duration of the pain.

Learn more about ovulation pain.

Constipation and irritable bowel syndrome (IBS)

Infrequent bowel movement causes stools to harden and leads to constipation. The movement of these hard stools along the intestinal wall results in painful muscular contractions.

In IBS, there are alterations in bowel movement and also painful intestinal contractions. However, people with IBS may have the following associated symptoms

  • changes in stool consistency and frequency
  • bloating
  • increased gas or mucus in the stool

Eating a high fiber diet typically reduces your risk of constipation, but if you notice a persistent change in your bowel habit, contact your doctor.

Read about IBS with constipation.

Urinary tract infection (UTI) and cystitis

Infections along the lower urinary tract — the bladder and urethra — are one of the common causes of pelvic pain in females. The vagina and urethra opening in females are close together, and this increases the risk of bacteria invasion of the urethra from the vagina. Apart from pelvic pain, here are other symptoms of a UTI:

  • pain while urinating
  • the presence of blood in the urine
  • increased the frequency and urgency of urination
  • cloudy and foul-smelling urine

Generally, a short course of oral antibiotics helps to resolve UTI symptoms in mild cases. This is why it is important to seek early treatment if you notice any of these symptoms. 

Learn more about UTIs.

Pelvic inflammatory disease (PID)

PID is an infection of the uterus, fallopian tubes, and surrounding tissues. It typically results from an untreated sexually transmitted infection (STI). The most common untreated infections that lead to PID are chlamydia and gonorrhea.

In PID, associated damage to tissues and the formation of adhesive scars cause pelvic pain. Foul-smelling vagina discharge, fever, and pain during sexual intercourse are typically associated symptoms of PID. 

PID is typically treatable with a dose of antibiotics. Untreated PID can lead to fertility issues and long-term or chronic pain.

Learn more about PID.

STIs

STIs such as gonorrhea and chlamydia can cause pelvic pain in females. The organisms that cause these infections invade the female reproductive tract and lead to intense inflammatory changes.

Pelvic pain typically occurs with local tissue damage unless there is quick intervention. Generally, the use of specific antibiotics helps to kill these bacteria organisms and reduce progressive tissue injury. 

If you suspect you may have an STI, consult your doctor. The early treatment of STIs reduces your risk of PID and other complications.  

Learn more about STIs.

Endometriosis and ovarian cysts

Endometriosis is a condition in which the endometrial tissues that line the inner layer of the uterus grow outside the womb. These external endometrial tissues typically form in the pelvic region. During the monthly menstrual cycle, hormonal changes also affect these peripheral uterine tissues. Inflammation and tissue reactions occur due to hormonal changes, and this may cause pelvic pain.

In ovarian cysts, ovarian follicles that do not release ova may accumulate fluid and expand. Pelvic pain occurs as the follicle grows, and in the case of a follicular rupture, the pelvic pain becomes severe.

Imaging tests, such as ultrasounds, are critical in diagnosing endometriosis and ovarian cysts.  

Learn more about ovarian cysts.

Pregnancy and ectopic pregnancy

Pelvic pain during pregnancy results from hormonal and mechanical factors. Hormonal changes in pregnancy not only help the fetus grow but also affects the musculoskeletal tissues.

The pubic symphysis — the joint between your left and right pelvic bone — and the pelvic ligaments relax as pregnancy advances, and this causes varying degrees of pelvic discomfort and mild pain. As the fetus grows, the head compresses the pelvic floor tissues, which may cause pain.   

Ectopic pregnancy and pregnancy loss are complications of early pregnancy that cause pelvic pain.

Apart from pelvic pain, here are some associated features of ectopic pregnancy:

Ectopic pregnancy typically requires urgent medical intervention, so contact your doctor if you notice any of these symptoms.

Learn more about ectopic pregnancy.

Appendicitis

Appendicitis is an inflammation of the appendix. The pain is usually located in the lower right abdominal region but may radiate to the pelvic area in some people. The pain often comes on suddenly and may even wake you up at night. The pain may also begin as abdominal discomfort in the area of your bellow button and then suddenly move to the low right abdominal area or pelvic area.

Appendicitis typically presents with fever, vomiting, and varying intensity of pelvic pain. Untreated appendicitis can lead to serious complications. Contact your doctor if you experience unusual pain along with any of these other symptoms.

Learn more about appendicitis.

Uterine fibroids

Uterine fibroids are noncancerous growths of the smooth muscles and fibrous tissues in the uterus. Fibroids are more common among females of reproductive age. Female hormones cause fibroids to grow and undergo changes that may lead to pelvic pain. 

Fibroids present with different symptoms depending on the location but here are some other features of uterine fibroids: 

The definitive treatment of uterine fibroids depends on the severity of symptoms and other clinical features your doctor notes upon evaluation. For larger, more severe fibroids, your doctor may recommend surgery to remove them.

Learn more about uterine fibroids.

Tumors

Malignant, or cancerous, tumors affecting the female reproductive system and surrounding organs in the pelvis may cause pelvic pain. The degree of pelvic pain may differ depending on the stage of the cancer and the extent of local tissue damage.

Generally, doctors initiate definitive treatment for the malignancy and use pain relief medications to ease pain from malignancies. 

Read about ovarian cancer.

When to contact a doctor 

Most cases of pelvic pain are mild and may resolve without any medical intervention. However, seek your doctor’s advice if you notice any changes in the intensity and frequency of the pain.

Here are some cases that require you to consult your doctor early:

  • pelvic pain due to an infection 
  • presence of unexplained profuse vaginal bleeding and severe pain
  • presence of associated symptoms such as fever, vomiting, and constipation

Early diagnosis and prompt intervention reduce your risk of developing some complications of these medical conditions.

Summary 

Pelvic pain can present as a mild or severe symptom alone or with other symptoms of a medical condition.

Pelvic pain in females is due to multiple factors. Healthy conditions such as menstruation and pregnancy may cause pains in some females.

Also, infections affecting the female reproductive system or lower the urinary tract are common causes of pelvic pain. Benign tumors such as fibroids and malignant tumors involving pelvic organs may also cause pelvic pain.

However, it is essential to seek early clinical care from your doctor if your pain is severe or worsens. You should also contact your doctor if you notice associated symptoms such as unexplained severe vaginal bleeding, fever, vomiting, and constipation.

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Medical Reviewer: Carla Prophete, MPAS, PA-C
Last Review Date: 2022 Aug 16
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