Pelvic pain affects the lowest part of the abdomen, between the belly button and groin. In some people, pelvic pain may signify menstrual cramps, ovulation, or a gastrointestinal issue, such as food intolerance. It can also develop due to a more serious problem.

Sometimes, pelvic pain indicates an infection or issue with the reproductive system or other organs in the area. When this is the case, a person may need to see a doctor.

This article looks at 15 possible causes of pelvic pain.

1. Menstrual pain and cramps

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Menstrual cramping is a common cause of pelvic pain.

According to the American College of Obstetricians and Gynecologists (ACOG), pain is the most common symptom of all menstrual disorders.

Over half of people who menstruate will experience some pain for at least 1–2 days each cycle.

Menstrual cramping will typically occur immediately before a person starts their period, as the uterus contracts and sheds its lining. The pain may feel similar to a muscle spasm or a jabbing pain.

Using a warm heat pad may relieve the sensation. Over-the-counter medications, such as ibuprofen (Advil) and naproxen (Aleve), may also help relieve pain.

In cases of severe pain from menstruation, doctors can recommend other medications.

Learn more about menstruation here.

2. Ovulation

If an individual feels a painful sensation on one side of their pelvis in the middle of their menstrual cycle, they may be experiencing mittelschmerz. Doctors use this German word to describe painful ovulation.

When a person ovulates, the ovaries release an egg and some other fluid. The egg will then travel down the fallopian tube and into the uterus. The fluid released by the ovary can also enter the abdominal cavity and pelvis, which can cause irritation.

The discomfort may last for minutes or hours, and it may switch sides of the body, depending on which ovary released the egg. The pain is temporary and requires no specific treatment.

However, consult a healthcare professional if the pain is sharp or occurs at other times during the menstrual cycle.

Learn more about ovulation cramps here.

3. Interstitial cystitis

It is also possible for an individual to experience ongoing bladder inflammation that has no known cause. The medical term for this is interstitial cystitis, and doctors are currently unsure why it happens.

Interstitial cystitis can cause pelvic pain and symptoms such as painful urination, needing to urinate frequently, and pain during sex. Treatment often involves managing symptoms as best as possible.

Learn more about cystitis here.

4. Cystitis or urinary tract infections

Cystitis refers to inflammation in the bladder due to a bacterial infection. This happens because vaginal, rectal, or skin bacteria can enter the urethra, a tube that drains urine from the bladder, and travel to the bladder.

A urinary tract infection (UTI) can occur anywhere in the urinary system, while cystitis occurs only in the bladder.

Both conditions are common in women. These infections will sometimes clear up without treatment, but a short course of antibiotics will typically treat cystitis and other UTIs.

Learn how to treat a UTI without antibiotics here.

5. Sexually transmitted infections

Pelvic pain may indicate the presence of a sexually transmitted infection (STI), such as gonorrhea or chlamydia. STIs occur in people who are sexually active.

Chlamydia affects around 4 million people each year.

The Centers for Disease Control and Prevention (CDC) also estimates that in 2018, 1.6 million people had gonorrhea, making it the second most commonly reported bacterial sexually transmitted infection in the United States.

Along with pelvic pain, other symptoms of STIs may include painful urination, bleeding between periods, and changes in vaginal discharge.

Anyone experiencing these changes should seek medical advice. A doctor can diagnose a STI and prescribe treatment, usually antibiotics. It is also critical to inform all sexual partners about the infection so they can receive treatment and avoid transmitting it.

Speak with a healthcare professional about taking precautions to decrease your chances of contracting an STI.

Learn more about contracting STIs here.

6. Pelvic inflammatory disease

Pelvic inflammatory disease (PID) is an infection in the womb that can damage the surrounding tissue. PID can arise if bacteria from the vagina or cervix enter the womb (uterus) and take hold. It affects approximately 2.5 million women in the United States.

While 2006-2016 saw a decrease in incidences of PID, there has been an increase in diagnosis in all populations. However, the incidence of PID is not equal across all groups. A recent study found the rates highest among non-Hispanic Black women and women living in the South of the United States.

However, the results did not take mitigating factors, such as healthcare coverage, environmental factors, and access to screening, into account.

PID is usually a complication of an STI, such as gonorrhea or chlamydia. Females may experience other symptoms along with pelvic pain, including abnormal vaginal discharge and bleeding.

The condition can increase a woman’s risk of infertility. The CDC notes that 1 in 8 women who have had PID also have trouble becoming pregnant.

Treatment typically involves taking antibiotics to treat the bacterial infection. However, they cannot treat scarring, so early treatment is crucial. Scarring typically occurs within the pelvic organs due to recurrent or untreated infections causing PID.

Learn about other complications with pregnancy here.

7. Endometriosis

Endometriosis occurs when the endometrium, or tissue that lines the inside of the uterus, grows outside of the womb. The condition affects about 11% of females aged 15–44 years in the U.S. However, a 2019 report indicates that Hispanic and Black women are less likely to receive a diagnosis for endometriosis than white females, while Asian women are more likely to receive a diagnosis.

This study finds that race and ethnicity appear to play a role in the prevalence of endometriosis. However, there is limited literature examining the influence of race and ethnicity on the symptoms of endometriosis or access to healthcare and response.

Endometriosis can cause chronic, prolonged pelvic pain in some females. When a person’s period begins, the tissue outside of the uterus responds to hormonal changes, which may cause bleeding and inflammation in the pelvis.

Some people may experience mild to severe pain. Endometriosis may make it difficult for some women to become pregnant. Doctors may recommend various treatments, depending on symptom severity.

Learn more about living with endometriosis as a Black woman here.

8. Irritable bowel syndrome

Irritable bowel syndrome (IBS) is a gut disorder that causes pain and symptoms, including constipation, diarrhea, and bloating.

IBS symptoms tend to flare up and go away over time, especially after a bowel movement. There is no cure for IBS, so treatment focuses on managing symptoms through changes in diet, stress levels, and medications.

Learn how to identify IBS here.

9. Appendicitis

Appendicitis is inflammation in the appendix, which is a small organ in the lower-right abdomen. An infection causes this condition, and, although common, it can be severe.

Anyone experiencing sharp pain in their lower-right abdomen, along with other symptoms, such as vomiting and fever, should seek immediate medical care, as this may be a sign of appendicitis.

Learn about the early signs of appendicitis here.

10. Urinary stones

Stones in the urinary tract consist of salts and minerals, such as calcium, that the body has trouble getting rid of in the urine.

These minerals can build up and form crystals in the bladder or kidneys that often cause pain in the pelvis or lower back. Stones may also cause the urine to change color, often turning it pink or reddish with blood.

Some stones do not require treatment, but passing them can be painful. Sometimes, a doctor may recommend medications to break up stones or surgery to remove them.

Learn more about blood in urine in females here.

11. Ectopic pregnancy

An ectopic pregnancy occurs when an embryo implants itself anywhere outside the uterus and grows. Ectopic pregnancy incidence is approximately 1% in women aged 24–44.

However, studies have found that Black women have higher rates of ectopic pregnancies than white women.

A person may feel a very sharp pain and cramps in their pelvis, which are usually focused on one side. Other symptoms include nausea, vaginal bleeding, and dizziness.

Anyone who suspects an ectopic pregnancy should seek immediate medical care, as this is a life threatening condition.

Learn more about maternal health in BIPOC females here.

12. Pelvic adhesions

An adhesion is scar tissue that occurs inside the body and joins two tissues that should not connect. This may result in pain as the body struggles to adapt to the adhesion.

The scar tissue could form due to an old infection, endometriosis, prior surgeries, or other issues in the area. Pelvic adhesions may lead to chronic pelvic pain in some women, and they may cause other symptoms, depending on where the scar tissue appears.

A doctor may recommend minimally invasive surgery to help reduce adhesions and relieve symptoms.

Learn about other causes of pelvic pain here.

13. Ovarian cysts

Ovarian cysts occur when the ovaries fail to release an egg. The follicle holding the egg may not open entirely or become clogged with fluid.

When this happens, a growth called a cyst forms in the area, which may cause bloating, pressure, or pelvic pain on the side of the body with the cyst.

According to the American College of Obstetricians and Gynecologists, most cysts are noncancerous, and most go away on their own. However, sometimes, a cyst may bleed or burst, which can cause sharp, severe pain in the pelvis and may require medical treatment.

Doctors can identify ovarian cysts using ultrasound, and they may recommend treatments that range from watchful waiting to surgery.

Learn about complex ovarian cysts here.

14. Uterine fibroids

Fibroids are lumps of muscle and fibrous tissue within the uterus. They are the most common benign gynecologic tumor. A 2017 article states that 65% of all women will have fibroids by 50 years old. However, that number is closer to 90% in African American women

African American women also have a higher prevalence of clinically significant fibroids than white women – 50% and 35%, respectively. They are also twice as likely to have a hysterectomy for their fibroids than white and Hispanic females.

However, a Nurses’ Health Study II found that while the incidence of uterine fibroids among Hispanic, Asian, and white women was similar, for Black women, it was 2 to 3 times higher than other populations.

While they are noncancerous, these growths can be a source of pain, cause fullness in the pelvis, along with abnormal bleeding.

They may cause discomfort in the pelvis or lower back or pain during sex.

Fibroids may also cause excessive bleeding, cramping, or both during menstruation.

Some fibroids do not require treatment. If a person finds their symptoms difficult to manage, doctors may recommend one of many treatments, including medications, noninvasive procedures, or surgery.

Additionally, uterine fibroids can cause reproductive issues such as impaired fertility, pregnancy complications, pregnancy loss, and adverse obstetric outcomes.

Learn more about fibroids in Black women here.

15. Tumor

In rare cases, a malignant growth in the reproductive system, urinary tract, or gastrointestinal system may be the reason for pain in the pelvis. The tumor may also cause other symptoms, depending on where it appears.

Doctors will perform a thorough evaluation, often using blood and imaging tests, to identify a tumor. Once they have diagnosed the issue, they will recommend possible treatments.

Learn more about cancer here.

It is not always necessary to seek medical care for pelvic pain. However, a person should consult a healthcare professional if:

  • they suspect that an infection is causing pelvic pain
  • they experience unexpected vaginal bleeding and severe pain
  • they have a known condition and experience sudden changes in pain

A person with pelvic pain should also seek medical advice if they experience fever, nausea, and vomiting. A doctor will make a thorough evaluation and help devise a suitable treatment plan.

People should see a healthcare professional for routine check-ups to ensure overall gynecological health.

For the most part, common issues such as menstrual cramping or painful ovulation cause pelvic pain in females. However, if a person suspects that a more serious underlying problem is causing the pain, they should consider seeing a doctor.

Receiving an accurate diagnosis will help avoid potentially serious complications and ensure the best treatment.

Read the article in Spanish.