When the abdominal pain arrives mid-cycle, during or after sex, on the way to the bathroom, or on days that seem to have no connection to your period at all, it is hard to know what to make of it. Pain that falls outside that pattern is easier to dismiss, both by you and sometimes by the first doctor you mention it to. It is, however, a recognised presentation that deserves investigation.
Pelvic pain covers anything felt in the lower abdomen, pelvis, or the area between the vaginal opening and the anus. When it has been present for six months or more it is described as chronic pelvic pain. Pain that shows up outside your period, whether mid-cycle, after sex, when going to the toilet, or during a bowel movement, falls within this and is worth paying attention to rather than putting down to something else.1
What are the common causes of pelvic pain outside your period?
Several conditions can produce pelvic pain across the cycle rather than only around your period. The most significant are endometriosis, adenomyosis, and uterine fibroids, though other causes exist and a GP assessment is needed to tell them apart.
Endometriosis and how it affects the whole cycle
Endometriosis is a condition where tissue similar to the lining of the uterus grows outside it. It affects roughly 1 in 10 women and people with a uterus in the UK and is one of the most common causes of chronic pelvic pain.2
With endometriosis, the pain usually follows the rhythm of your period, although this is not always the case. Symptoms worth raising with a GP include ongoing pelvic pain, period pain that gets in the way of your daily life, deep pain during or after sex, bowel or bladder symptoms that come and go with your cycle, and difficulty getting pregnant. These are prompts for a conversation with a doctor, not a checklist for self-diagnosis.3
One important point about diagnosis: a normal gynaecological examination or a clear ultrasound scan does not rule out endometriosis. In many cases, a laparoscopy (a small surgical procedure to look inside the abdomen) is needed to confirm it. If your tests have come back clear but the pain continues, that result alone is not enough to exclude the condition, and it is worth going back to your GP. Diagnosis can take many years from when symptoms first start, which is one reason why tracking what you notice and raising it with a doctor matters.4
Adenomyosis
Adenomyosis happens when tissue similar to the uterine lining grows into the muscular wall of the uterus itself. It is a common cause of pelvic pain and heavy periods, can exist alongside endometriosis, and often goes undiagnosed for a long time. Where period pain tends to cluster around the days you bleed, adenomyosis can produce pain across the full cycle. You might notice pelvic pressure, bloating, or deep pain during sex at different points in your cycle, not only around your period.5
Fibroids and other contributing conditions
Uterine fibroids are non-cancerous growths in the uterus. They are very common, with some estimates suggesting they affect up to 70% of women by the age of 50, though many fibroids cause no symptoms at all. Depending on their size and position, fibroids can cause pelvic pain or pressure, heavy bleeding, and symptoms affecting your bladder or bowel.6
Other conditions that can produce pelvic pain outside your period include ovarian cysts, pelvic inflammatory disease (PID, an infection of the reproductive organs), irritable bowel syndrome (IBS), interstitial cystitis (a bladder condition that causes ongoing pelvic pain), and musculoskeletal issues. Because the symptoms of these conditions can overlap, a GP assessment is the way to identify what is contributing to your pain.7
Mid-cycle pain and ovulation
Some people feel a one-sided pain in the lower abdomen around the time of ovulation. This is a recognised and usually harmless pattern. That said, mid-cycle pain that is new, severe, or feels different to usual is worth getting checked, since it can be difficult to know what is behind it without a proper assessment.8
Tracking pain across your cycle
When you see a GP about pelvic pain, they will want to understand when the pain occurs in relation to your cycle, how it feels, and what else is happening at the time. Keeping a pain and symptom diary before your appointment makes that conversation more useful. Helpful things to note include:
- Which day of your cycle the pain occurs
- Where in your pelvis or abdomen the pain is located
- Pain intensity on a scale of 0 to 10
- Any bowel or bladder symptoms that coincide with the pain
- Whether pain occurs during or after sex
- How the pain affects your daily activities9
Keeping a record like this means you go into any appointment with a much clearer picture of what has been happening, which makes the conversation with your GP more useful for both of you.
When should you consider seeing your GP
See a GP if your pelvic pain is persistent, severe, getting worse, affecting your daily life, or accompanied by unusual vaginal discharge, pain during or after sex, or pain on urination. You do not need to have reached any particular age or stage of life to raise these concerns. A specialist referral should not be delayed based on age or whether you have had children.10
This article is for informational purposes only and does not constitute medical advice or diagnosis. If you are concerned about pelvic pain, speak to your GP.