Pelvic pain in women: causes, red flags and what to expect

Pelvic pain is a symptom, not a diagnosis. The NHS describes it as pain felt in the lower part of the tummy, which may be sudden and severe (acute) or last 6 months or longer (chronic). It may sit in a small area, spread to the lower back or involve the whole region.

The quality of the pain varies and the way it is described can offer clues. The NHS lists sharp, stabbing or burning pain that comes on suddenly, a pain that builds slowly and does not go away, a dull or heavy ache or sense of pressure, a twisted or knotted feeling, cramping or throbbing that comes and goes, and pain that appears only with certain activities such as exercise, sex or passing urine.

Pelvic pain is more common in women, and the NHS says common causes include period pain, conditions affecting the reproductive organs such as ovarian cysts or endometriosis, and pelvic pain in pregnancy. Because many organs share the same space, the bowel and bladder are frequent contributors: constipation, irritable bowel syndrome, urinary tract infections and sexually transmitted infections are all on the NHS list.

Endometriosis is where cells similar to those in the lining of the womb grow in other places. The NHS says it can cause severe period pain, heavy periods, pain in the lower tummy and back, pain when passing urine or stools, and pain during or after sex, as well as extreme tiredness and difficulty getting pregnant. Pelvic inflammatory disease is an infection of the womb, fallopian tubes and ovaries, usually caused by sexually transmitted infections such as chlamydia or gonorrhoea, though common vaginal bacteria can also be responsible.

Pelvic organ prolapse, where the womb, bladder or bowel bulge into the vagina, can cause heaviness, pressure or discomfort in the lower tummy or vagina. The NHS says it is common in women over 50 and is linked to weakened pelvic floor muscles, childbirth, long-term constipation and persistent coughing.

The NHS is clear that some causes need urgent treatment and that pelvic pain should not be self-diagnosed. It names appendicitis and peritonitis, which require surgery, and says that in women the pain could rarely be a sign of something more serious such as an ectopic pregnancy, womb cancer, ovarian cancer or pelvic inflammatory disease.

This is why persistent symptoms that sound like other conditions, such as bloating that comes and goes, feeling full quickly, losing weight without trying or ongoing bowel changes, should always be raised with a GP. These are listed by the NHS as reasons to book an appointment.

The NHS separates the advice into three levels. For pelvic pain that comes and goes or does not go away, or is accompanied by persistent bloating, unintentional weight loss, quickly feeling full or ongoing bowel changes, it advises seeing a GP. It advises contacting NHS 111 if there is difficulty passing urine or stools, blood in urine or stools, unusual vaginal discharge or bleeding, pain when passing urine, a very high temperature or feeling hot, cold or shivery, vomiting and diarrhoea, or if you are or may be pregnant.

It advises calling 999 or going to A&E if the pain is severe, getting worse or hurts when you move or touch the area, if you feel faint, dizzy or pass out, have pain at the tip of the shoulder, have difficulty breathing, have heavy vaginal bleeding or suddenly feel confused. It also advises not to drive yourself to A&E.

The NHS warns that getting a diagnosis may take some time because symptoms overlap with many common conditions, so the more information you can give your doctor the better. A GP typically asks about the pain pattern, periods, sex, bowel and bladder symptoms, and family history, and may examine your tummy and pelvis. The NHS pages on pelvic inflammatory disease and endometriosis mention an internal examination, blood tests, a pregnancy test, swabs to check for infection and an ultrasound scan, and you can ask for a chaperone or a female doctor.

If endometriosis is suspected, further tests can include an ultrasound scan, an MRI scan and a laparoscopy, where a camera is passed through a small cut in the tummy, which can confirm the diagnosis and sometimes allow areas of endometriosis to be removed in the same procedure. You may be referred to a gynaecologist if the cause is unclear.

The NHS says any treatment will depend on the cause and could include antibiotics, painkillers, physiotherapy such as pelvic floor exercises, or hormone treatments. Pelvic inflammatory disease is treated with antibiotics, usually an injection and a course of tablets for 2 weeks, and the NHS says it is usually easy to treat when found early. Left untreated it can lead to abscesses, long-term pelvic pain, fertility problems and a higher risk of ectopic pregnancy.

Endometriosis cannot currently be cured, but painkillers such as paracetamol and ibuprofen, and hormones such as the combined contraceptive pill, are often the first treatment, with surgery an option if other treatments are not working. Support for pain management, fatigue, fertility and mental health is also part of care. For prolapse, options range from pelvic floor muscle training and vaginal pessaries to hormone treatment and surgery.