Version May 2024
| Pelvic causes of abdominal pain in women | Lateralization | Clinical features | Comments |
| Ectopic pregnancy | Either side or diffuse abdominal pain | Vaginal bleeding with abdominal pain, typically six to eight weeks after last menstrual period. | Patients can present with life-threatening hemorrhage if ruptured. |
| Pelvic inflammatory disease | Lateralization uncommon | Characterized by the acute onset of lower abdominal or pelvic pain, pelvic organ tenderness, and evidence of inflammation of the genital tract. Often associated with cervical discharge. | Wide spectrum of clinical presentations. |
| Ovarian torsion | Localized to one side | Acute onset of moderate-to-severe pelvic pain, often with nausea and possibly vomiting, in a woman with an adnexal mass. | Generally not associated with vaginal discharge. |
| Ruptured ovarian cyst | Localized to one side | Sudden-onset unilateral lower abdominal pain. The classic presentation is sudden onset of severe focal lower quadrant pain following sexual intercourse. | Generally not associated with vaginal discharge. |
| Endometriosis | Associated with dysmenorrhea, pelvic pain, dyspareunia, and/or infertility, but other symptoms may also be present (eg, bowel or bladder symptoms). | Patients may present with one symptom or a combination of symptoms. | |
| Acute endometritis | Most often preceded by pelvic inflammatory disease. | Diagnostic criteria the same as pelvic inflammatory disease. | |
| Chronic endometritis | Present with abnormal uterine bleeding, which may consist of intermenstrual bleeding, spotting, postcoital bleeding, menorrhagia, or amenorrhea. Vague, crampy lower abdominal pain accompanies the bleeding or may occur alone. | ||
| Leiomyomas (fibroids) | Symptoms related to bulk or infrequently acute pain from degeneration or torsion of pedunculate tumor. Pain may be associated with a low-grade fever, uterine tenderness on palpation, elevated white blood cell count, or peritoneal signs. | ||
| Ovarian hyperstimulation | Abdominal distention/discomfort, nausea/vomiting, and diarrhea. More severe cases can have severe abdominal pain, ascites, intractable nausea, and vomiting. | Women undergoing fertility treatment. | |
| Ovarian cancer | Abdominal or pelvic pain. May have associated symptoms of bloating, urinary urgency or frequency, or difficulty eating/feeling full quickly. | ||
| Ovulatory pain (Mittelsmerz) | Occurs mid-cycle, coinciding with timing of ovulation. | May be right- or left-sided, depending on site of ovulation during that cycle. | |
| Pregnancy and related complications* | |||
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