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9 Causes of Pelvic Pain That Aren’t Your Period

Identifying the source of your discomfort can help you determine the best way to find relief.

Medically reviewed in January 2021

Updated on November 5, 2021

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Pelvic pain can be caused by a variety of different conditions, and sometimes a combination of multiple conditions. But what is pelvic pain and where is it located?

In general, any type of pain you feel low in your torso—below the abdomen and between the hip bones—can be referred to as pelvic pain.

Pelvic pain may come from any of the organs in that part of your body, including the uterus, ovaries, fallopian tubes, bowel, and bladder, says Alex Letham, DO, an OBGYN with LewisGale Hospital Montgomery in Blacksburg, Virginia. Due to the nerve supply to the area, it can be hard to pinpoint the exact source. That’s also why pain can spread to the back or thighs, he adds.

Depending on the cause, the pain can present itself in different ways and on different sides of the pelvis. Determining the underlying cause can help you determine the best ways to treat it and find relief.

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Endometriosis

Pelvic pain and pressure are the most common symptoms of endometriosis. It’s a condition in which the endometrium (the lining of the uterus) forms outside of the uterus in places like the ovaries, fallopian tubes, intestines, or bladder. Endometriosis is common: About 1 in every 10 women of reproductive age have it.

Because endometrial tissue is the same type of tissue that’s in your uterus, the growths can mature and bleed as estrogen levels fluctuate. This may cause the surrounding area to become inflamed or swollen and could even result in scarring. All of this irritation can trigger pain in the pelvic region, especially before and during menstruation.

Nonsteroidal anti-inflammatory drugs (NSAIDs), birth control options like oral contraceptive pills or hormonal intrauterine devices (IUDs), or a combination of NSAIDs and birth control are the preferred treatment options for endometriosis. If these methods are unsuccessful, or if you’re trying to get pregnant, other options such as gonadotropin releasing hormone (GnRH) antagonists or GnRH agonists are often suggested. Sometimes, surgery may be needed.

Some also find relief with complementary therapies like acupuncture, chiropractic, or herbs and supplements.

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Uterine adenomyosis

Adenomyosis is a condition similar to endometriosis, since it involves the tissue that usually lines the uterus. But with adenomyosis, the tissue grows into the muscular wall of the uterus.

“The intense pelvic pain associated with adenomyosis typically follows trends with the menstrual cycle,” says Dr. Letham. That’s because your uterus swells and expands during that time. You’re likely to have heavy bleeding and even a feeling of heaviness or tenderness in your abdomen. Some people don’t have any symptoms at all, though.

Adenomyosis usually goes away on its own after menopause. In the meantime, you can find relief with anti-inflammatory drugs, birth control options like oral contraceptive pills or hormonal intrauterine devices (IUDs), GnRH antagonists, selective progesterone receptor modulators like ulipristal acetate (UPA),  and in some cases a hysterectomy.

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Ovarian cysts

When a cyst, or a sac consisting of fluid and tissue, forms in or around the ovaries, it's known as an ovarian cyst. While small ovarian cysts typically don’t cause symptoms, they can sometimes lead to pain, pressure, and bloating. Ovarian cyst pain can feel dull or sharp, sometimes on one side of your abdomen. “Pain associated with ruptured cysts can be random and sporadic and can cause some brief, intense pain that resolves over the course of a few days,” says Letham. Cysts are almost always non-cancerous.

Treatment for ovarian cysts depends on a few things, including:

  • Their size, shape, and location
  • Your age
  • Whether or not you want to have children
  • Whether or not you’re experiencing symptoms
  • Your history of ovarian or breast cancer

Many people may not need any treatment since most cysts go away on their own after a couple of menstrual cycles. If cysts don’t disappear by themselves, your healthcare provider (HCP) may want to monitor them through ultrasounds and watch for any changes.

If there are concerns that the cysts may be cancerous, if the cysts are getting larger or look unusual, or if the cysts are causing major pain or other severe symptoms, a cystectomy (surgery to remove the cyst) or an oophorectomy (surgery to remove the ovary) may be needed, especially if you’re past menopause.

In rare cases, a ruptured cysts can be a medical emergency, particularly if you experience sudden, severe abdominal pain with fever, vomiting, faintness, dizziness, weakness, or rapid breathing.

Oral contraceptives are often recommended to help prevent new cysts from forming.

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Uterine fibroids

Uterine fibroids, also known as leiomyomas or myomas, are non-cancerous growths that contain uterine muscle and fibrous connective tissue. “A fibroid slowly enlarges to a very firm ball-like mass,” says Letham. They can develop on the inside or outside of the uterus, inside the uterine wall itself, or be attached to it by a stem-like structure. Fibroids can get bigger over time but may remain small forever.

Some people who have uterine fibroids don’t experience any symptoms, but others will. “Because they are disrupting the muscle around the uterus, fibroids can cause pain, heavy periods, and can get large enough and impact the bladder or rectum,” Lethem adds. Pelvic pain or lower back pain that’s achy and sometimes sharp may accompany fibroids. Pain during sex is common, too.

If you’re not experiencing any symptoms, you probably won’t need treatment. For more mild pain, over-the-counter pain relievers may help. If pain or other symptoms are interfering with your daily life, talk to your HCP. To help reduce pain and heavy bleeding, you may be prescribed birth control pills, a hormonal IUD, or a hormonal contraceptive injection. Your doctor may also prescribe a GnRH antagonist or agonist either on its own or with estradiol, a type of estrogen.

If your symptoms are severe, your HCP may recommend certain procedures, like uterine artery embolization or a myomectomy, to remove the fibroids. Myomectomies are usually recommended for those who want to have children. New fibroids can still form after this surgery, though. If your fibroids are extremely large or other treatments haven’t worked, a hysterectomy may be needed.

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Pregnancy and miscarriage

Up to 75 percent of pregnant women experience some sort of pelvic pain (or lower back pain) during pregnancy. It can occur at any time due to the way the bones and ligaments loosen and shift in the body to accommodate your growing baby, though it’s often most prominent in the third trimester as the baby gets larger. This puts added pressure on the pelvic area.  Digestive and urinary tract pain may also be common during the earlier stages of pregnancy.

Down the road, about two to four weeks before delivery, you may notice some pelvic heaviness that reaches around to your back. This may occur as the fetus drops lower into the pelvis to prepare for delivery.

Certain serious conditions that may crop up during pregnancy can cause intense pain. These include:

  • Ovarian torsion, or twisted ovary 
  • Ectopic pregnancy, when the fertilized egg implants outside the uterus, such as in a fallopian tube
  • Miscarriage, or loss of pregnancy before the 20th week

If you have a sharp pain on one side that makes it hard for you to walk, breathe, or talk, or is accompanied by other symptoms like vomiting or bleeding, see your HCP immediately or head to the emergency room.

Regardless of how far along you are, it’s best to talk with your HCP if you’re having any type of pain. After evaluation, if you’re told that your pain is normal, you can try stretching, walking, and breathing techniques to get some relief.

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Ovulation

“Some people will have pain for a few short days during ovulation, which is usually sometime between day 11 and day 15 of their menstrual cycle,” says Letham. “This type of pain is technically called mittelschmerz, which is German for the words ‘middle’ and ‘pain.’”

It occurs because the ovary is releasing an egg. The pain typically occurs on one side of the body per month, but it may switch sides from month to month.

If you’re having pain, the easiest way to connect it to ovulation is to start taking a closer look at your menstrual cycle. “Keeping a pain diary and tracking your cycle can be very helpful for the doctor when you come in for evaluation,” says Letham. Use a regular notepad or one of the many phone apps available, like Flo, Clue, or Cycles, to record the day of your first period, how long your period lasts, and any symptoms you’re experiencing.

Ovulation pain isn’t something you usually need to worry about, unless it lasts for more than a couple of days or is accompanied by burning urination and irregular bleeding. Over-the-counter anti-inflammatory medications like ibuprofen can give you some relief in the moment.

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Urinary tract infections

In addition to gynecological issues, other health conditions can cause discomfort in the pelvic region. A urinary tract infection (UTI) most often occurs when bacteria get into the urinary tract and start to multiply in the bladder. The telltale symptom is a burning sensation while urinating combined with the urge to go more frequently. When a UTI is severe, says Letham, it may also result in lower abdominal soreness and pelvic pressure.

Antibiotics, such as nitrofurantoin, fosfomycin, and trimethoprim-sulfamethoxazole are almost always the recommended treatment option for UTIs.

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Irritable bowel syndrome

Pelvic pain can also be caused by irritable bowel syndrome (IBS), a condition that often triggers pain in the abdominal and pelvic areas. Bloating and bowel problems like constipation and diarrhea are also common symptoms.

Many IBS treatment options involve lifestyle changes, including:

  • Avoiding trigger foods
  • Gradually adding more fiber to your diet
  • Steering clear of large meals

Fiber supplements, antidepressants, antidiarrheals, and other IBS-specific medications can also help relieve symptoms. Sometimes, stress relief techniques are also recommended, as stress can worsen IBS symptoms.

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Pelvic inflammatory disease

Left untreated, certain sexually transmitted infections like chlamydia and gonorrhea can lead to pelvic inflammatory disease (PID), an infection of a woman’s reproductive organs. Other infections that are not sexually transmitted may also cause it. Douching can also increase your risk. Those who use intrauterine devices (IUDs) may have a small increased risk of PID in the few weeks after placement.

For some, PID is asymptomatic. Others may notice symptoms such as:

  • Pelvic pain
  • Fever
  • Irregular discharge
  • Pain or bleeding with sex
  • Burning sensation while urinating
  • Bleeding between periods

PID is curable with antibiotics. The earlier you begin treatment, the better, because untreated PID can lead to complications such as reproductive damage. Even once PID is cured, it’s possible to get it again.

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Don’t Be Afraid To See Your Healthcare Provider

When it comes to pelvic pain, Letham says, the biggest thing to remember is a diagnosis is needed for pain that arrives suddenly or worsens, pain that no longer responds to medications, or pain that keeps you from daily activities. Your HCP can examine you to determine what’s going on, refer you to another specialist if need be, and recommend your best options to find relief.

Sources:

Office on Women’s Health. U.S. Department of Health and Human Services. Endometriosis. Page last updated: April 1, 2019.
Mayo Clinic. Adenomyosis. June 18, 2020.
Li J-J, Chung JPW, Wang S, Li T-C, Duan H. The investigation and management of adenomyosis in women who wish to improve or preserve fertility. Biomed Res Int. 2018;2018:6832685.
Office on Women’s Health. U.S. Department of Health and Human Services. Ovarian cysts. Page last updated: April 1, 2019.
Office on Women’s Health. U.S. Department of Health and Human Services. Uterine fibroids. Page last updated: April 1, 2019.
Emily E. Bunce, MD and Robert P. Heine, MD. Pelvic Pain During Early Pregnancy. Merck Manual Consumer Version. Content last modified Jun 2021.
Kanakaris NK, Roberts CS, Giannoudis PV. Pregnancy-related pelvic girdle pain: an update. BMC Med. 2011;9:15.
U.S. National Library of Medicine. Mittelschmerz. Review date March 8, 2019.
National Institute of Diabetes and Digestive and Kidney Diseases. Bladder Infection (Urinary Tract Infection—UTI) in Adults. Accessed October 29, 2021.
Office on Women’s Health. U.S. Department of Health and Human Services. Irritable bowel syndrome. Page last updated: April 1, 2019.
Centers for Disease Control and Prevention. Pelvic Inflammatory Disease (PID) – CDC Fact Sheet.

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