Pelvic Pain: What Does It Signal?

Updated 10 November 2021

Fact Checked

Reviewed by Olga Adereyko, MD, Primary Care Physician, General Practitioner, Medical Consultant

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Pelvic pain is a pretty common occurrence. However, if you experience pain regularly or have any additional symptoms, read on to learn about potential causes, available treatment options, and when to see your health care provider.

Potential causes of pelvic pain

Although many people experience cramps once in a while — especially during their periods — it can also be a sign of an underlying condition.

Mittelschmerz

This condition, which is derived from the German word for “middle pain,” occurs when an egg is released from an ovary into a uterine tube.

If you’ve ever asked yourself, “Why do I have pain in my left ovary?” Mittelschmerz could be the answer. It can cause pain in the right or left side of your lower abdomen, depending on which ovary releases the egg. This lower abdominal pain is usually dull and may feel like a cramp, but it can also be more intense. It lasts between a few minutes and a few hours, but it may continue for as long as a day or two. Sometimes it’s accompanied by mild vaginal discharge or spotting. The pain may alternate sides from cycle to cycle, switching from right side to left side, or it may stay on the same side for several cycles in a row. It may happen every time you ovulate or only periodically.

While the exact cause of Mittelschmerz is unknown, doctors have several theories about it. It’s believed to be caused by the normal enlargement of the egg in the ovary just before ovulation. The pain could also be caused by the normal bleeding that comes with ovulation.

If you find that pain is happening on or close to the middle day of your menstrual cycle, it most likely is Mittelschmerz. 

Ovarian cysts

While they aren’t generally cause for alarm, ovarian cysts can cause pelvic pain. Located on the surface of the ovary, ovarian cysts are fluid-filled sacs that can cause pain. The discomfort, which may be stronger during sex or your period, can also radiate to the lower back and thighs.

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Although less frequent, other symptoms may present with ovarian cysts. These include the need to urinate frequently, painful bowel movements, nausea, and vomiting. At the same time, some ovarian cysts don’t cause any pain at all, so they can go unnoticed for quite a while. If you experience any of these symptoms, it’s important to see your health care provider (OB-GYN or family physician), who can perform an examination and order blood work or an ultrasound to determine a diagnosis.

Endometriosis

When the type of tissue that normally lines the uterus grows outside the uterus, it causes a condition called endometriosis. Pelvic pain often associated with periods is the primary symptom of this condition, and the pain can range from mild tenderness to acute pain. Endometriomas — a type of cyst — can develop when endometrial tissue attaches to an ovary and forms a growth.

There are a number of possible causes for endometriosis, including surgery, retrograde menstruation, or an immune system disorder. If you or your health care provider suspects endometriosis, a pelvic exam, followed by an ultrasound, laparoscopy, or MRI, is often used for diagnosis.

Pelvic inflammatory disease

Pelvic inflammatory disease (PID), which affects the uterus, ovaries, and uterine tubes, happens when bacteria travel to the uterus and surrounding reproductive organs. In addition to pain in the pelvic region, irregular or painful menstrual cycles, burning urination, flu-like symptoms, and nausea or vomiting can also be symptoms of PID.

Because PID can lead to infertility, if you’re planning to become pregnant, it’s important to speak to your doctor, who can diagnose PID with a pelvic exam and either an ultrasound or laparoscopy. Even if you’re not planning on getting pregnant, it’s a good idea to see a doctor, because untreated PID can lead to long-term pelvic or abdominal pain.

Ovarian remnant syndrome

If you’ve had your ovaries surgically removed and are experiencing pelvic pain, you may want to speak with your health care provider about ovarian remnant syndrome (ORS). Leftover tissue from ovarian surgery can lead to ORS, which often manifests as pelvic pain. Most people experience some degree of symptoms in the first five years following surgery.

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Ovarian cancer

While pelvic pain can be a sign of cancer, know that ovarian cancer is rare, affecting roughly 11 out of 100,000 people with ovaries. Statistically, most people are diagnosed at the median age of 63. 

Taking certain medications, having particular genetic mutations, or having a family history of the disease are all considered risk factors for ovarian cancer. 
Cancer treatment success is higher when detected early, so speak with your doctor if you are concerned. Both early and later stages of ovarian cancer often have no symptoms, so it can be difficult to detect. Some of the potential symptoms of ovarian cancer include:

• Unexplainable weight loss
• Abdominal swelling or bloating
• Feeling full sooner while eating
• Changes in bowel habits
• Frequent urination

Other medical conditions

Because the ovaries are close to other major organs in the body, pelvic pain that seems like ovary pain might actually be caused by other medical conditions, including (but not limited to):

• Pregnancy: Pelvic pain (cramps) coupled with a missed period and pregnancy symptoms like breast tenderness, nausea, and fatigue may signal pregnancy. 
• Urinary tract infection: If you have a UTI, the pain will be located more centrally in the pelvis. UTIs also typically manifest as a frequent need to pee and burning, cloudy urine.
• Appendicitis: Pain associated with appendicitis typically begins like sudden pain that originates around your navel and often shifts to your lower right abdomen (or sudden pain that begins on the right side of the lower abdomen). Pain accompanied by low-grade fever that may worsen as the illness progresses could be a sign of appendicitis.
• Kidney stones: Kidney stones usually cause pain that is more acute and felt more along your side and back, below the ribs. You may also have fever, chills, nausea, or vomiting.

What does ovarian cyst pain feel like?

Although ovarian cysts often present with no pain at all, they do cause some people pain. Felt in the lower abdomen or on the side where the cyst is located, the pain can be like a dull, throbbing ache, or it could be sharp and intense. It may be constant, or it may come and go. 

Sometimes ovarian cysts grow large and rupture. If an ovarian cyst ruptures, the pain and discomfort can be sudden and intense. It will often be accompanied by fever and nausea or vomiting. A ruptured cyst may send you into shock, with rapid breathing and feelings of light-headedness. 

Ruptured cysts are serious and require immediate medical attention.

Treatment options for ovary pain

Is there a way to get rid of ovarian cysts? If you have pelvic pain associated with Mittelschmerz or ovarian cysts, taking an over-the-counter (OTC) pain reliever can help (if you’re planning to get pregnant check with your health care provider before taking any medication). If, however, your pelvic pain is caused by endometriosis or PID, other treatment may be needed. 

While pain relievers may be recommended, additional treatments or surgery are often recommended for endometriosis. Hormone therapy, including birth control and progestin therapy, is often used to reduce or eliminate endometriosis pain; however, it isn’t considered a permanent fix. Surgery is another treatment option, although endometriosis sometimes returns after surgery.

If pelvic pain is caused by PID, which is a bacterial infection, treatment usually includes one or more rounds of antibiotics. Because people can have PID without symptoms, your partner should also be examined and treated, if necessary.

When to see a health care provider

When your pain level is high or includes symptoms of a more serious underlying condition, such as endometriosis or PID, it’s important to work with a medical professional who can help diagnose and treat the issue. 

There are some symptoms that should never be ignored because they could be signs of a ruptured cyst: sudden and severe pelvic pain that’s accompanied by fever, vomiting, or signs of shock. Since cyst ruptures can result in more serious complications, such as internal bleeding, it’s important to immediately seek medical attention, either from your health care provider or the closest emergency room. 

Even if you aren’t having intense pain, if you suspect an underlying condition, it’s best to seek treatment. Given the overlap in symptoms with conditions ranging from endometriosis to appendicitis, it’s best to work with a health care professional who can pinpoint the specific causes using the right diagnostic tools.

Conclusion

Pelvic pain isn’t something you have to live with. The sooner you identify the condition, the sooner you can get back to living a life free from it.

History of updates

Current version (10 November 2021)

Reviewed by Olga Adereyko, MD, Primary Care Physician, General Practitioner, Medical Consultant

Published (23 December 2019)