Pain in the lower abdomen can originate from the menstrual cycle, the organs, or the urinary tract — the timing and accompanying symptoms help with assessment.
Possible causes
Menstrual pain
Cycle-dependent and cramp-like, usually around the start of bleeding.
Pregnancy
Pregnancy can also cause pelvic pain. If it is located outside the uterus (ectopic pregnancy), the pain is often one-sided and accompanied by a missed period or spotting — this is an emergency.
Inflammation of the fallopian tubes and ovaries
An ascending infection (adnexitis) usually causes pain on both sides, often with fever, altered discharge and pain during intercourse.
Ovarian cyst or ovarian torsion
Cysts cause variable, often one-sided symptoms. If an ovary twists around its vascular stalk (torsion), the pain starts suddenly and severely, usually with nausea — this is also an emergency.
Urinary tract
A bladder infection causes pain above the pubic bone, usually together with burning during urination.
Bowel
Irritable bowel syndrome, constipation or inflammatory bowel disease can also cause pain in the lower abdomen.
Typical steps at the doctor's office
- 1The doctor asks about the cycle, last period, contraception and accompanying symptoms and performs a gynaecological examination.
- 2For women of childbearing age, a pregnancy test is part of the basic work-up — even if pregnancy seems unlikely.
- 3An ultrasound assesses the uterus, ovaries and free fluid in the abdomen; depending on the suspected cause, urine and blood tests or a swab may be added.
- 4Treatment depends on the underlying cause.
What makes serious causes more likely
- A possible pregnancy fundamentally changes the assessment — this is why the last period is always part of the medical history.
- A previous ectopic pregnancy, prior inflammation of the fallopian tubes, endometriosis or fertility treatment make an ectopic pregnancy more likely.
- An IUD in place does not rule out pregnancy; if a pregnancy occurs despite an IUD, it is more often located outside the uterus.
- Unprotected intercourse and multiple partners increase the likelihood of ascending infections.
What typically happens next?
Menstrual pain follows the cycle and eases with bleeding, but returns regularly. A bladder infection usually improves within a few days with treatment. Many ovarian cysts resolve on their own and are monitored over time. Inflammation of the fallopian tubes requires consistent treatment, as it can otherwise lead to adhesions and later fertility problems. If pain persists over several cycles or keeps recurring, further assessment is advisable — even if an initial examination was unremarkable.
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