Women's lower abdominal pain

Nearly every woman occasionally suffers from pain in the lower abdomen. Most of these pains are mild, temporary and harmless and do not require treatment. The most common causes for women's lower abdominal pain are either intestinal or gynaecological. Recognising the symptoms requiring medical attention is, therefore, extremely important.

Location and nature of pain

It is important to keep track of the pain: its severity, the nature of the pain (stinging, aching, fluctuating, sense of pressure, etc.), any developments in its intensity, the location of the pain in the abdomen and any radiating pain in other parts of the body, such as the back. Note whether the pain grows worse when you are moving or resting. Pay attention to the timing of the pain in relation to your menstrual cycle or the occurrence of any bloody or whitish discharge. It is also important to note whether the pain is accompanied by a fever.

Sometimes, only one side of the lower abdomen may feel painful. This may indicate that the cause of the pain is located on the same side. For example, pain in the lower right-hand side of the abdomen may be a sign of appendicitis. Pain in the lower left-hand side of the abdomen, in turn, may be caused by inflammation of pouches in the large intestine, also known as diverticulitis.

Sometimes, the pain may be felt in both the lower and the upper abdomen, which may indicate other than gynaecological reasons. Pain in the upper abdomen may result from acid reflux or gallstones. Sometimes, spinal diseases may cause radiating pain in the abdominal area. It is advisable to consult a physician for a correct diagnosis.

Reasons for lower abdominal pain

Women may experience pain in the lower abdomen for a number of reasons. The most common causes are:

  • uteritis or vaginitis
  • sexually transmitted disease (such as chlamydia)
  • urinary tract infection
  • appendicitis
  • ovarian cyst or ovarian torsion
  • menstrual cramps or endometriosis
  • ovulation pain
  • uterine fibroids
  • ovarian tumours (e.g. ovarian cancer)
  • ectopic pregnancy
  • miscarriage
  • inflammation of pouches in the large intestine, i.e. diverticulitis
  • Irritable Bowel Syndrome (IBS)
  • sequelae of gynaecological procedures (e.g. IUD insertion, gynaecological surgery)

Examining lower abdominal pain

When diagnosing lower abdominal pain, the most important part is to assess the urgency of treatment. If a woman suffers from pain in the lower abdomen, a gynaecological examination is conducted, including a transvaginal ultrasound. The ultrasound provides a clear image of the uterus, ovaries and the surrounding areas, thus improving the diagnostics. The ultrasound can also help discover any cysts or tumours in the ovaries or fibroids in the uterus and examine various pregnancy-related issues.

When suspecting an inflammation, physicians often order chlamydia, gonorrhoea, CRP and urine tests. If there is a chance of pregnancy, a pregnancy test is also ordered. A Pap smear is rarely necessary for acute pain in the lower abdomen but can be ordered in the event of a long-term ailment if the previous smear test was taken more than 1–2 years ago. Unclear cases may sometimes call for an MRI scan of the lower abdomen.

If the pain does not seem like a solely gynaecological issue, the gynaecologist cooperates with other specialists to find out the cause.

Treating lower abdominal pain

The likely cause of pain in the lower abdomen is usually discovered at the first appointment and the best treatment can be started without delay. Sometimes, however, the pain or the symptoms may require emergency care.

When should you see a doctor?

If the pain in your lower abdomen is severe or includes the following symptoms or conditions, please seek urgent medical attention:

  • fever
  • nausea or vomiting for two or more days
  • blood in stool or in vomit
  • the abdomen is sensitive to the touch
  • the pain continues for several days
  • you are pregnant
  • your abdomen or vagina was injured before the pain started

The symptoms above may be related to inflammation or bleeding in the abdomen and this may require urgent treatment.

Early stages of pregnancy usually involve mild pains in the lower abdomen but pain may sometimes also be a sign of an ectopic pregnancy. If the pain is severe or there is bleeding, the pregnancy must always be examined with an ultrasound. The symptoms may also result from a gynaecological or other abdominal tumour that requires urgent treatment. If you are unsure about your symptoms, always contact a physician.

Expert consulted for the article Tuuli Soini, Doctor of Medical Science, Specialist, Gynaecology and obstetrics