Pelvic pain means pain low in your abdomen, around or between your hip bones. It can have several causes in early pregnancy. Some are less serious, but symptoms alone cannot reliably tell you what is happening.
Go to the nearest emergency department now for severe or worsening pelvic pain, shoulder-tip pain, dizziness or fainting, or pain with heavy bleeding. Call 000 if you collapse, feel too unwell to travel safely, or have severe pain or heavy bleeding. Do not drive yourself if you feel faint.
For new, persistent or recurring pelvic pain, contact your doctor or maternity team promptly for advice, even without bleeding. If pain is one-sided, comes with spotting, fever or feeling unwell, seek urgent assessment rather than waiting for a routine appointment.
Why early pregnancy pain needs attention
Early pregnancy can involve mild cramps, constipation or discomfort as your body changes. Pain may also come from a urinary infection, an ovarian problem, miscarriage or an ectopic pregnancy. The location and severity can overlap.
Do not assume pain is normal stretching, implantation or “just pregnancy”. If you are not sure whether you are pregnant but pregnancy is possible, tell the clinician. A home test should not delay emergency care.
Ectopic pregnancy: an important cause to rule out
An ectopic pregnancy grows outside the uterus, most often in a fallopian tube. It cannot develop normally and may cause life-threatening internal bleeding if it ruptures.
Symptoms can include lower abdominal pain, sometimes on one side, vaginal spotting or bleeding, shoulder-tip pain, dizziness or faintness. You may not have every symptom, and a lack of visible bleeding does not rule it out.
Shoulder-tip pain can be referred pain from irritation inside the abdomen. It is different from an explanation such as a strained shoulder muscle, but you should not try to diagnose the difference at home when you have pregnancy-related concerns.
Our ectopic pregnancy guide explains diagnosis and treatment. If you have warning symptoms, seek care now.
What else can cause pelvic pain?
- Miscarriage: cramps and bleeding can occur, although pain or bleeding alone cannot confirm a miscarriage. Many people with early symptoms have an ongoing pregnancy.
- Urinary infection: lower discomfort may come with burning when you wee, urgency or needing to go more often. In pregnancy, these symptoms need medical assessment. Fever or back/flank pain requires urgent advice.
- Bowel symptoms: constipation and trapped wind can cause discomfort, but should not be assumed to explain severe or persistent pain.
- Ovarian or other abdominal conditions: a cyst, twisting of an ovary or appendicitis can require urgent care, particularly with sudden or severe pain.
The aim of assessment is to work out the cause, rather than asking you to match your pain to a list. For more on bleeding, see bleeding in early pregnancy.
How will I be assessed?
Your clinician will ask where the pain is, when it started, whether it comes and goes, and whether you have bleeding, shoulder pain, bowel or urinary symptoms. They will also ask about pregnancy dates and any previous ectopic pregnancy or fertility treatment.
Assessment may include checking your pulse and blood pressure, examining your abdomen, a urine test, pregnancy-hormone blood tests and an ultrasound. An ultrasound through the vagina can give clearer information in early pregnancy. Your clinician should explain it and seek your consent.
Very early on, a scan may not yet show where the pregnancy is. This is sometimes called a pregnancy of unknown location. It needs a follow-up plan because an ectopic pregnancy has not necessarily been excluded. Repeat scans or blood tests may be arranged.
Before leaving, ask:
- Do we know where the pregnancy is and what is causing the pain?
- When and where are my next tests?
- Who will explain the results?
- What symptoms mean I should return immediately?
Return urgently if symptoms worsen, even if you have already been seen or have a repeat test booked.
Is this the same as pelvic girdle pain?
Pelvic girdle pain involves the joints and supporting structures around the pelvis. It can affect the pubic area, lower back, buttocks or groin and may be worse when walking, climbing stairs or turning in bed.
It needs an individual assessment. Movement-related pain does not automatically exclude another cause, especially early in pregnancy. Once urgent causes have been considered, a physiotherapist with pregnancy experience can help with movement strategies, suitable exercises and whether a support belt might help.
Comfort measures after you have a care plan
Follow the advice you receive for the cause of your pain. For assessed musculoskeletal discomfort, pacing activities, taking shorter walks and sitting to get dressed may reduce strain. Avoid pushing through painful movements.
Ask your doctor or pharmacist about pain relief suitable for your pregnancy. Do not start anti-inflammatory tablets, creams, herbal products or a new exercise programme to mask unexplained pain. A belt, massage or rest is not a substitute for checking warning symptoms.
Waiting for answers can be stressful. You can ask someone to come with you, request an interpreter and ask the team to explain the plan again.
Sources and further reading
- The Royal Women’s Hospital: Pain and bleeding in early pregnancy
- Healthdirect: Ectopic pregnancy
- The Royal Women’s Hospital: Pregnancy-related pelvic girdle pain
This is general information for Australian readers. New or concerning pelvic pain needs assessment by a health professional.