Why Does My Stomach Hurt During My Period? Lower Abdominal Pain in Women — Causes & When to Worry | Dr. Chetna Jain, Gurgaon

Lower abdominal pain is one of the most common reasons women visit my clinic in Gurgaon — and one of the most important to take seriously. It is also one of the most misread symptoms in women's health, because so many different conditions, ranging from entirely normal to genuinely urgent, can cause pain in the same general area of the body. The pelvis is a complex neighbourhood. The uterus, ovaries, fallopian tubes, bladder, bowel, and surrounding ligaments all live in close proximity — and pain from any one of them can feel remarkably similar on the surface.

I am Dr. Chetna Jain, a senior gynaecologist practising in Gurgaon, and in this blog I want to walk you through the most common causes of lower abdominal pain in women — what each one feels like, what causes it, and most importantly, which symptoms mean you need to see a doctor today rather than waiting.

Primary Dysmenorrhoea — Period Pain That Is 'Normal' but Manageable

The most common cause of lower abdominal pain in women of reproductive age is primary dysmenorrhoea — painful periods without an underlying gynaecological condition. It is caused by prostaglandins, hormone-like substances that trigger uterine contractions to shed the lining. These contractions can temporarily restrict blood flow to the uterine muscle, causing cramp-like pain typically felt in the lower abdomen and sometimes radiating to the lower back and thighs. Primary dysmenorrhoea usually begins a day or two before the period and improves as the flow establishes, typically resolving within two to three days. It responds well to anti-inflammatory painkillers such as ibuprofen or naproxen, which work by reducing prostaglandin production — most effective when started one to two days before the period begins rather than after pain has already set in.

However — and this is important — period pain that is severe enough to regularly disrupt daily life, that does not respond to standard painkillers, that is getting progressively worse over time, or that began in adulthood after years of manageable periods, is not something to simply accept. It is a red flag for an underlying condition that deserves investigation.

Endometriosis — The Most Underdiagnosed Cause of Pelvic Pain

Endometriosis is one of the most common causes of significant, recurrent pelvic pain in women — and one of the most consistently dismissed and delayed in diagnosis. It occurs when tissue similar to the uterine lining grows outside the uterus, typically on the ovaries, fallopian tubes, bladder, or bowel. Like the uterine lining, this tissue responds to monthly hormonal changes — swelling, breaking down, and bleeding with each cycle. But unlike menstrual blood, this bleeding has nowhere to go, causing inflammation, adhesions, and characteristic pain.

Endometriosis pain has several distinctive features: it is often worse just before and during menstruation; it may be felt deep in the pelvis, in the lower back, or even in the rectum or bladder; it frequently causes pain during or after sexual intercourse; and it may be present throughout the cycle, not just during periods. It is also a leading cause of infertility. If you have been told your period pain is normal for years without any investigation — please come and speak to me. A pelvic ultrasound and careful clinical assessment can often point us in the right direction, and effective treatment is available.

Ovarian Cysts — When the Ovary Itself Is the Source of Pain

Ovarian cysts are extremely common — most women will have at least one functional cyst in their lifetime. Small functional cysts usually cause no pain at all and resolve on their own. Larger cysts, however, can cause a dull ache or pressure on one side of the lower abdomen, bloating, or a feeling of heaviness in the pelvis. The pain is often vague and intermittent, and may worsen during physical activity or intercourse.

The scenario that requires urgent medical attention is a sudden, severe, one-sided lower abdominal pain — this can indicate a ruptured ovarian cyst or, more seriously, ovarian torsion — where the ovary twists on its supporting ligament, cutting off its blood supply. Ovarian torsion is a surgical emergency. It typically presents as sudden, severe, one-sided pain that may be accompanied by nausea, vomiting, and fever. If you experience this, go to an emergency department immediately — do not wait for a scheduled appointment.

Uterine Fibroids — Heavy Periods and Pelvic Pressure

Fibroids are benign (non-cancerous) muscular growths within or on the uterus — extremely common, affecting up to 70 percent of women by the age of 50. Many fibroids cause no symptoms at all. Those that do cause symptoms typically produce: a heavy, prolonged, or painful period; a sensation of pelvic pressure or heaviness; a visibly bloated or enlarged lower abdomen in cases of large fibroids; urinary frequency or difficulty if the fibroid is pressing on the bladder; and constipation if it is pressing on the bowel. Fibroid pain is typically dull and aching rather than sharp and crampy, and tends to be persistent rather than cyclical. Fibroids are diagnosed on ultrasound and are very manageable — with options ranging from medication and non-invasive procedures to minimally invasive laparoscopic surgery depending on size, location, and the woman's fertility plans.

Mittelschmerz — Ovulation Pain That Is Often Mistaken for Something Serious

Mittelschmerz — the German word for middle pain — refers to the mild to moderate one-sided lower abdominal pain that some women experience at ovulation, approximately mid-cycle. It is caused by the release of the egg from the follicle and the small amount of fluid or blood that may irritate the surrounding tissue. It typically lasts from a few minutes to a few hours, rarely more than a day or two, and alternates sides each month depending on which ovary is ovulating. It requires no treatment beyond over-the-counter pain relief if uncomfortable. Knowing about mittelschmerz can save women significant anxiety — mid-cycle pelvic pain that has this predictable pattern, on one side, lasting a short time, is almost always entirely benign.

Urinary Tract Infections — Lower Abdominal Pain That Is Not Gynaecological

Not all lower abdominal pain in women originates from the reproductive organs. Urinary Tract Infections (UTIs) are extremely common in women and frequently cause lower abdominal discomfort or pressure — often described as a dull ache or cramping sensation above the pubic bone. This is accompanied by the classic UTI symptoms: a burning sensation during urination, frequent urge to urinate, passing only small amounts of urine, and sometimes cloudy or strong-smelling urine. UTIs require antibiotic treatment — please do not self-medicate without a urine culture, as antibiotic resistance is a growing clinical problem in India in 2026. If a UTI is accompanied by fever, back pain, and chills, it may have spread to the kidneys — a condition called pyelonephritis that requires urgent medical attention and often intravenous antibiotics.

Pelvic Inflammatory Disease — An Infection That Must Not Be Ignored

Pelvic Inflammatory Disease (PID) is an infection of the upper reproductive tract — the uterus, fallopian tubes, and ovaries — most commonly caused by sexually transmitted bacteria such as Chlamydia or Gonorrhoea, though other bacteria can also be responsible. PID causes lower abdominal pain that is typically bilateral (felt on both sides), accompanied by fever, an unusual vaginal discharge, pain during intercourse, and sometimes irregular bleeding. PID is a serious condition that can cause permanent damage to the fallopian tubes, leading to infertility and an increased risk of ectopic pregnancy if left untreated. It requires prompt antibiotic treatment and should always be investigated properly with a swab and blood tests.

Ectopic Pregnancy — A Life-Threatening Emergency

Any woman of reproductive age who experiences sudden, severe, one-sided lower abdominal pain — particularly if she has missed a period, has a positive pregnancy test, or is at any possibility of pregnancy — must be evaluated urgently for ectopic pregnancy. An ectopic pregnancy occurs when a fertilised egg implants outside the uterus, most commonly in a fallopian tube. As it grows, it can cause the tube to rupture, leading to life-threatening internal bleeding. Symptoms include one-sided pelvic pain, shoulder tip pain (from blood irritating the diaphragm), vaginal bleeding, dizziness, and collapse. This is a medical emergency. If there is any possibility of ectopic pregnancy, please go to an emergency department without delay.

Red Flag Symptoms — When Lower Abdominal Pain Needs Urgent Medical Attention

Please seek emergency care immediately if your lower abdominal pain is accompanied by any of the following:

• Sudden, severe, or rapidly worsening pain — particularly if one-sided

• Fever above 38.5°C alongside pelvic pain

• Dizziness, fainting, or feeling of collapse

• Shoulder tip pain alongside lower abdominal pain (a sign of internal bleeding)

• A positive or suspected pregnancy alongside one-sided pain

• Nausea and vomiting alongside sudden severe pelvic pain

• Pain so severe that it is preventing you from standing or walking

When to Book a Gynaecological Appointment — Non-Emergency but Important

Outside of red flag situations, please book an appointment with your gynaecologist if: your period pain is consistently severe and disrupting your daily life; your pelvic pain occurs outside of your period; you have noticed pain during intercourse; you have pain alongside heavy or irregular bleeding; you have been trying to conceive and have pelvic pain; or any pelvic pain is new, worsening, or unexplained. Many conditions that cause pelvic pain — endometriosis, fibroids, ovarian cysts — are highly manageable when diagnosed and treated appropriately. The key is not waiting for pain to become unbearable before seeking help.

Your Pain Deserves a Proper Answer

Lower abdominal pain in women is never something to simply push through or normalise without understanding what is causing it. Your body is communicating — and it deserves a doctor who will listen carefully, investigate thoroughly, and give you a clear, honest answer.

At my clinic in Gurgaon — serving women from Palam Vihar, DLF, South City, Sector 22, Sector 23, and all of NCR — I take pelvic pain seriously at every stage of a woman's life. If you are experiencing lower abdominal pain that concerns you, please book your appointment today. You deserve answers, not just painkillers.

Pain is not a personality trait. It is a signal. Listen to it.

— Dr. Chetna Jain | Senior Gynaecologist & Obstetrician | Gurgaon, Haryana