What’s the Cause of Your Pelvic Pain?

Most women experience this at some point, but do you know why?


Throughout our lives we can experience pelvic pain from when we first start to menstruate, through our fertile years and even beyond menopause.

If you have pain below your belly button and above your legs, it counts as pelvic pain. It can be caused by a lot of things: just a harmless sign that you’re fertile, a digestive disorder, or a red flag that you need to go to the hospital.

Hormones when they are out of sync, or rebalancing, can sometime be behind this but here are the most common reasons women will experience it.


If you have a sharp pain in the lower right part of your belly, are vomiting, and have a fever, it could be appendicitis.

If you have these symptoms, go immediately to hospital. An infected appendix may need surgery and if it bursts, it can spread the infection inside your body which can cause serious complications.

Irritable Bowel Syndrome (IBS)

This is an increasingly common condition and characterised by belly pain, cramps, bloating, and diarrhoea or constipation.

You may get one or more symptoms but if they keep coming back you need to see your doctor for a diagnosis.

It could be IBS, sometimes called spastic colon, and Doctors aren’t sure what causes it. Diet changes, stress management, and medications may help.

Painful ovulation or mittelschmerz

Ever feel a painful twinge between periods? You may be feeling your body ovulate.

When you do, the ovary releases an egg along with some fluid and blood. This can cause irritation and this feeling is called mittelschmerz — German for “middle” and “pain.”

That’s because it happens midway through your monthly cycle. The pain may switch sides from month to month. It isn’t harmful and usually goes away in a few hours.

PMS and menstrual cramps

You can usually feel these cramps in your lower belly or back. They typically last 1 to 3 days.

Why the pain? Every month, your uterus builds up a lining of tissue. That’s where an embryo can implant and grow. If you don’t get pregnant, the lining breaks down and is shed during your period. When the uterus tightens to push it out, you get a cramp.

Progesterone helps PMS symptoms and you can try a heating pad and over-the-counter pain relievers.  Exercise and de-stressing can help, and if severe talk to your doctor.

Ectopic pregnancy

This happens when an embryo implants somewhere outside of the uterus and begins to grow. This usually happens in the fallopian tubes.

Sharp pelvic pain or cramps (particularly on one side), vaginal bleeding, nausea, and dizziness are symptoms. Get medical help right away as this is a life-threatening emergency.

Sexually transmitted diseases

Pelvic pain is a warning sign of some STDs. Two of the most common are chlamydia and gonorrhoea and you often get both at the same time.

They don’t always cause symptoms, but when they do, you may have pain when you pee, bleeding between periods, and abnormal vaginal discharge.

See your doctor or a specialist clinic and it’s important to get partners checked and treated, too, so you don’t pass the infection back and forth.

Pelvic inflammatory disease

This is a complication of sexually transmitted diseases and is the No. 1 preventable cause of infertility in women and can cause permanent damage to the uterus, ovaries, and fallopian tubes.

Belly pain, fever, abnormal vaginal discharge, and pain during sex or urination can be symptoms. Get it treated right away to avoid damage.

Usually it is treated with antibiotics but in severe cases, you may need to be hospitalised. Get your partner treated, too.

Ovarian cysts

Ovaries release eggs when you ovulate. Sometimes a follicle doesn’t open to release the egg, or it recloses after it does and swells with fluid. This causes an ovarian cyst.

They’re usually harmless and go away on their own but may cause pelvic pain, pressure, swelling, and bloating. And if a cyst bursts or twists, it can cause sudden, severe pain, sending you to the hospital. Doctors can spot them during a pelvic exam or ultrasound.

Uterine fibroids

These grow on or in the wall of the uterus. While they’re sometimes called fibroid tumours, they are not cancerous.

Fibroids are common in women in their 30s and 40s and they usually don’t cause problems. But some women may have pressure in the belly, low back pain, heavy periods, painful sex, or trouble getting pregnant.

Often a feature of oestrogen dominance they can be helped by bioidentical progesterone which balances the excess oestrogen.


In some women, there is tissue growing outside the uterus that is similar to tissue that lines the uterus. It can happen on the ovaries, fallopian tubes, bladder, intestines, and other parts of the body.

When it’s time for your period, these clumps of tissue break down, but the tissue has no way to leave the body. While this is rarely dangerous, it can cause pain and form scar tissue that may make it tough to get pregnant.

Again a feature of oestrogen dominance so progesterone can help but there are several treatment options but usually these include pain medications, birth control pills, hormones to stop periods, surgery with small incisions, and even a hysterectomy (taking out your uterus) are options.

Urinary tract infection

Do you have to pee often, or does it hurt when you do? Or do you feel like your bladder is full? It could be a UTI.

This happens when germs get into your urinary tract and treating it quickly can keep it from it getting worse. But if it spreads to the kidneys, it can cause serious damage.

Signs of a kidney infection include fever, nausea, vomiting, and pain in one side of the lower back.

Kidney stones

These are globs of salt and minerals that your body tries to get rid of in urine. They can be as tiny as a grain of sand or as large as a golf ball and are very painful.

Your urine may turn pink or red from blood so immediately see your doctor if you think you have a kidney stone.

Most will pass out of your system on their own, but some need treatment. Even if they can pass on their own, your doctor can help with pain medication and will tell you to drink lots of water.

Interstitial cystitis (IC)

This condition causes ongoing pain and is related to inflammation of the bladder and is most common in women in their 30s and 40s.

Doctors aren’t sure why it happens but if you have severe IC you may need to pee several times an hour. You might also feel pressure above the pubic area, pain when you urinate, and pain during sex.

Although this can be a long-term condition, there are ways to ease the symptoms and avoid flares.

Pelvic organ prolapse

As you get older, this may happen as your bladder or uterus drops into a lower position. It usually isn’t a serious health problem, but it can be uncomfortable.

You may feel pressure against the vaginal wall, or your lower belly may feel full. It may also give you an uncomfortable feeling in the groin or lower back and make sex hurt. Special exercises like Kegel’s or surgery may help.

Pelvic congestion syndrome

We’ve all seen varicose veins in legs, but they can sometimes happen in the pelvis, too. When blood backs up in veins, they become swollen and painful. This is known as pelvic congestion syndrome.

This is a condition that’s difficult to diagnose and treat and ends to hurt worse when you sit or stand. Lying down may feel better, but because the best treatment is still unclear, you need to work with your doctor to learn what the options are and to find what works well for you.

Scar tissue

If you’ve had surgery or an infection, you could have ongoing pain from this.

Adhesions are a type of scar tissue inside your body and form between organs or structures that aren’t meant to be connected.

Adhesions in your belly can cause pain and other problems, depending on where they are. In some cases, you may need a procedure or surgery to get rid of them.


Does it hurt when you ride a bike or have sex? If it burns, stings, or throbs around the opening of your vagina, it could be this.

The feelings can be ongoing or come and go. Before you’re diagnosed with this, your doctor will rule out other causes. This isn’t caused by an infection and treatment options range from medication to physical therapy.

Painful sex

This can be caused by many things and most are treatable. It could be a vaginal infection, or you just may need more lubrication. Oestrogen is the hormone for this so a combination cream with both progesterone and oestrogen, such as 20-1, can be helpful

The medical name is dyspareunia and sometimes the pain gets better after sexual therapy. This type of talk therapy can focus on inner conflicts about sex or past abuse.

Chronic pelvic pain

If you have pain that lasts at least 6 months, it’s considered chronic. It may be so bad it interferes with your sleep, career, or relationships.

What to do next?

Most of the conditions covered here get better with treatment. Sometimes, even after a lot of testing, the cause of pelvic pain remains a mystery but there are treatments and medications discussed here that can help.

Any lasting pelvic pain should be reported to your doctor for investigation, so don’t put it off.

Helpful information: 

Several of these conditions relate to hormone imbalance so whether you need a little extra oestrogen, or just progesterone to balance out any oestrogen dominance, it will help to investigate that too.

If you are not sure which hormone you may need help with, then this article can be useful.