Many women in the early stages of pregnancy experience pelvic pain. Pelvic pain refers to pain in the lower part of the torso, in the area below the abdomen and between the bones of the hip (pelvis). The pain may be sharp or crampy (such as menstrual cramps) and may come and go. It can be sudden and excruciating, dull and persistent, or a combination of these. Temporary pelvic pain isn’t usually a cause for concern. It can usually occur naturally when the bones and ligaments change and stretch to accommodate the fetus.
If pelvic pain is caused by a disorder, it may be associated with other symptoms, including vaginal bleeding ( ). In some disorders, such as bleeding that may be severe, a dangerous drop in blood pressure (shock) sometimes occurs.
Pelvic pain differs from abdominal pain in that it occurs higher than the torso, in the area of the stomach and intestines. However, women sometimes have difficulty distinguishing whether the main source of pain is from the abdomen or pelvis. Causes of abdominal pain during pregnancy are not usually related to pregnancy.
During the early stages of pregnancy, pelvic pain may result from disorders associated with:
Pregnancy (obstetric disorders)
Female reproductive system (gynecological disorders) but not pregnancy
Other organs, especially the digestive tract and urinary tract
Sometimes a particular disorder is not detected.
The most common obstetric causes during the early stages of pregnancy are:
Normal changes in pregnancy
A miscarriage that has occurred or is occurring (spontaneous abortion)
A miscarriage that may occur (threatened miscarriage)
In the case of a miscarriage that has occurred, all or part of the contents of the uterus (fetus and placenta) may be expelled (complete miscarriage) or part of it (incomplete miscarriage).
The most common cause of dangerous birth is:
An abnormally positioned rupture (ectopic pregnancy) — where it is not in its usual place in the uterus, such as in the fallopian tubes
When an ectopic pregnancy ruptures, blood pressure may drop too low, the heart may race, and blood may not clot normally. Immediate surgery may be necessary.
Pelvic pain can also occur when the ovary becomes wrapped around the ligaments and tissues that support it, cutting off its blood supply. This disorder, called adnexal torsion, is not associated with pregnancy but is more common during pregnancy. The ovaries enlarge during pregnancy, making the ovaries more susceptible to torsion.
Disorders of the digestive and urinary tracts, which are common causes of pelvic pain in general, are common during pregnancy. These disorders include:
Gastroenteritis (infection of the digestive tract) caused by a virus
Irritable Bowel Syndrome
inflammatory bowel disease
Urinary tract infections (UTIs)
Pelvic pain during the advanced stages of pregnancy may be caused by the labor or by a disorder unrelated to the pregnancy.
Different characteristics (risk factors) increase the risk of some obstetric disorders that cause pelvic pain.
Risk factors for a miscarriage include:
Age over thirty-five years
One or more miscarriages in previous pregnancies
Using drugs such as cocaine, drinking alcohol, or consuming a lot of caffeine.
Abnormalities of the uterus, such as fibroids or scarring, which may be caused by surgery, dilation and curettage (D and C), radiation therapy, or infections
Risk factors for an ectopic (ectopic) pregnancy include:
A previous pregnancy outside the womb (ectopic) (the most important risk factor)
Previous abdominal surgery, especially surgery to sterilize a woman (tubal ligation)
Previous infection with a sexually transmitted disease or pelvic inflammatory disease (salpingoophoritis)
Use of an intrauterine device (IUD)
Age over 35
A history of infertility, use of infertility medications, or use of assisted reproductive technologies
Multiple sexual partners.
If a pregnant woman has sudden, severe pain in the lower abdomen or pelvis, doctors should quickly try to determine if prompt surgery is needed — such as when the cause is an ectopic pregnancy or appendicitis.
In pregnant women with pelvic pain, the following symptoms are cause for concern:
Fainting, light-headedness, or a fast heartbeat—symptoms that indicate very low blood pressure.
Fever, especially if accompanied by a vaginal discharge containing pus
Severe pain that worsens with movement
When should you see a doctor?
Women with warning signs should see a doctor immediately. Women without warning signs should try to see a doctor within a day or so if they have pain or burning during urination, or if the pain is interfering with their daily activities. Women whose discomfort is minimal and mild and without any other symptoms should contact their doctor. The doctor can help them decide how quickly to see it.
What will the doctor do?
To determine whether urgent surgery is needed, doctors first check blood pressure and temperature and ask about major symptoms, such as vaginal bleeding. Then doctors ask about other symptoms and medical history. They also perform a physical examination. The results of what they find during a medical history and physical examination often indicate the cause and which tests may be needed (see table).