Most women experience pelvic pain at some point in their lives. A few days of discomfort is often normal, particularly around the time of your menstrual cycle, but persistent or severe pain may be a sign that something is seriously wrong.

It is important to speak up if you experience any symptoms that are unusual. The pelvis is a busy place — home to the bowel, bladder, reproductive organs, and more — and there can be many potential causes of pelvic pain.

As an OB-GYN at Summit Health, Nikole Bobadilla, MD, evaluates women with pelvic pain every day. She partners with her patients to identify the potential causes and develop a treatment plan that will improve their quality of life.

What is pelvic pain?

Pelvic pain is discomfort or pain felt anywhere in the pelvis, which includes the area below the belly button and above the border of the thighs. It may be felt in the middle of the abdomen or on one or both sides. It may also originate in one area and radiate to another or occur all over the pelvis.

What are the symptoms of pelvic pain?

Women experience pelvic pain in different ways. The pain can be constant, or it may come and go, lasting anywhere from a few hours to months at a time. Pelvic pain can also fluctuate in severity—it may be described as dull, aching, or stabbing.

The reason the pain is so variable, explains Dr. Bobadilla, is that there are so many different organs and structures inside the pelvis that can cause problems. She says it is helpful when patients can describe their pain and keep track of both when and how often it occurs.

“It is important to distinguish between acute and chronic pelvic pain,” says Dr. Bobadilla. “Acute pelvic pain is experienced for less than three months. Chronic pelvic pain lasts for more than three to six months and is not related to the menstrual cycle, pregnancy, or the vulva (the outer part of the female genitals).

How do I know if my pelvic pain is serious? When should I see a doctor?

There can be urgent and life-threatening causes of pelvic pain like ectopic pregnancy and appendicitis. “Pain that is severe, worsening, and associated with fever, nausea, or vomiting should be evaluated urgently,” advises Dr. Bobadilla. “You should see a doctor any time you believe that your pelvic pain is serious enough to be evaluated for potential life-threatening conditions.”

Women should also make an appointment with their physician for non-urgent cases of pelvic pain. “If your discomfort is persistent and does not improve with rest and intermittent use of over-the-counter medications, see a doctor to help you determine a diagnosis and treatment plan,” she adds.

What causes pelvic pain?

There are numerous potential causes for the pelvic pain, including:

• Menstrual cramps, which affect nearly 80 percent of women, are not a cause for concern. Talk to your physician if the pain lasts more than two days or is severe enough to keep you home from school or work.

• There are many gynecological conditions that can develop in the reproductive organs including ovarian cysts, ovarian torsion, ectopic pregnancy, endometriosis, and infections of the reproductive tract like pelvic inflammatory disease or a tubo-ovarian abscess. In some women, pelvic floor disorders can cause pressure or discomfort.

• Gastrointestinal causes of pelvic pain may be constipation, a viral illness, appendicitis, or diverticulitis. Appendicitis is one of the most serious causes of pelvic pain in both men and women. If you have a sharp pain, accompanied by fever, nausea, or vomiting, visit the emergency room.

• Urinary tract issues, which include kidney stones, urinary tract infections (UTIs), or a chronic bladder condition known as interstitial cystitis, are another common culprit of pelvic pain.

• With so many organs in the pelvis it can be easy to forget that there are also muscles, ligaments, and tendons. Your pain could be from a strain or tear in these soft tissues.

How is pelvic pain diagnosed?

Evaluating pelvic pain can be challenging and often takes time. Since there are so many organ systems that may contribute to the problem, Dr. Bobadilla explains, it is important to consider a broad range of diagnoses initially.

“It is very helpful when a patient is able to give specific details and descriptions of her experience with pelvic pain. This includes any factors or activities that either bring on the pain or make it worse,” she says. “The information gathered in the patient’s history helps us determine which parts of the clinical exam, laboratory testing, or imaging studies are key in identifying the potential cause of the pain.”

Some of the exams/tests that may be used include:

• Physical exam, including a pelvic exam: Your provider will check your vital signs as well as examine your abdomen and pelvis to evaluate the location and severity of your discomfort.

• Pregnancy test. When evaluating serious pelvic pain, one of the most important first steps is determining if the woman could be pregnant.

• Lab tests. Blood work, urine tests, and/or vaginal samples can help identify urinary or sexually transmitted infections.

• Imaging tests. Ultrasound is used to detect masses or cysts in the ovaries, uterus, or fallopian tubes. X-rays, computerized tomography (CT) scans, or magnetic resonance imaging (MRI) may also be ordered.

• Laparoscopy. In rare cases, where the source of pain is not clear, a minimally invasive diagnostic procedure may be performed to visualize the inside of the abdominal and pelvic cavity. A small camera is inserted into the abdomen to get a closer look at the pelvic organs. This test is helpful in diagnosing endometriosis and chronic pelvic inflammatory disease.

What treatments are available for pelvic pain?

Pelvic pain is treated based on the cause. Once the problem is identified, there are numerous treatment options that can help make you more comfortable and improve your quality of life such as medications like birth control pills, antibiotics, or stool softeners and surgical interventions.

Since there are so many potential causes of pelvic pain, some trial and error may be needed. If there is no improvement with the initial course of action, she advises that the patient be reevaluated to determine if there is a need for a change in management.

Sometimes the symptoms of pelvic pain do not pinpoint to a gynecologic source. If another organ system is suspected, a referral may be made to another specialist.