Written by IUS London Clinical Team · Published July 2026
Pelvic Pain in Women: When Should You Get a Scan?
Pelvic pain is one of the most common reasons women seek medical advice, yet it is also one of the most frequently dismissed. If you have been experiencing aching, cramping, or sharp discomfort in your lower abdomen — whether it comes and goes, or sits as a constant background presence — you deserve a clear answer, not a wait-and-see approach.
This article explains the most common causes of pelvic pain in women and when a private pelvic ultrasound scan is the right next step.
⚠ When Pelvic Pain Needs Urgent Assessment
Some symptoms require immediate medical attention. If you experience any of the following, go to A&E or call 999 — do not wait for a scan appointment:
- Sudden, severe pelvic pain that comes on without warning
- Pain accompanied by fever, chills, or vomiting
- Shoulder-tip pain alongside pelvic pain (a sign of internal bleeding)
- A positive pregnancy test with one-sided pelvic pain (possible ectopic pregnancy)
- Heavy vaginal bleeding with severe cramping
A scan can follow once you have been assessed and stabilised — but urgent clinical evaluation comes first.
What Causes Pelvic Pain in Women?
The pelvis contains the uterus, ovaries, fallopian tubes, bladder, and bowel. Pain in this region can originate from any of these structures, which is why the same symptom — a dull ache on the left side, for example — can have very different causes in different women.
Ovarian Cysts
Ovarian cysts are fluid-filled sacs that form on or within the ovaries. Most are benign and resolve on their own, but a cyst that grows, twists (torsion), or ruptures can cause significant pain. The pain is often described as a dull, intermittent ache on one side of the pelvis, sometimes worsening around ovulation or during a period.
Transvaginal ultrasound is the gold-standard imaging tool for identifying and characterising ovarian cysts. It determines the cyst size, internal structure, and whether it has features that require further investigation. Learn more about symptoms of ovarian cysts.
Endometriosis
Endometriosis occurs when tissue similar to the uterine lining grows outside the uterus — on the ovaries, fallopian tubes, or pelvic lining. It causes chronic pelvic pain, painful periods (dysmenorrhea), pain during sex (dyspareunia), and, in some cases, difficulty conceiving.
Diagnosis is notoriously delayed. In the UK, the average time from first symptoms to confirmed diagnosis is approximately 8 years. Transvaginal ultrasound can identify ovarian endometriomas (sometimes called “chocolate cysts”) and features of deep infiltrating endometriosis with high diagnostic accuracy — sensitivity up to 96% for deep disease when performed by a specialist [1].
If your periods have always been painful and you have been told this is normal, a targeted pelvic ultrasound can provide the objective evidence you need to access specialist care.
Pelvic Inflammatory Disease (PID)
PID is an infection of the upper reproductive tract — the uterus, fallopian tubes, and ovaries — usually caused by sexually transmitted bacteria. It presents with pelvic pain, abnormal vaginal discharge, and sometimes fever. Untreated PID can cause scarring of the fallopian tubes, increasing the risk of ectopic pregnancy and infertility.
Ultrasound can identify features of PID, including thickened, fluid-filled fallopian tubes (hydrosalpinx) and free fluid in the pelvis. If PID is suspected, prompt antibiotic treatment is required.
Uterine Fibroids
Fibroids are non-cancerous growths within the muscular wall of the uterus. They are extremely common — affecting up to 70% of women by the age of 50 — and often cause no symptoms. When they do, the most frequent complaints are heavy periods, pelvic pressure, and a dull aching sensation in the lower abdomen. Ultrasound identifies fibroids accurately, mapping their size, number, and position within the uterus.
Adenomyosis
Adenomyosis occurs when the uterine lining grows into the muscular wall of the uterus itself. It causes a heavy, tender, enlarged uterus and is a common source of severe dysmenorrhea and pelvic pain in women in their 30s and 40s. Modern transvaginal ultrasound, using both 2D and 3D imaging, can diagnose adenomyosis non-invasively with high accuracy [2].
Urinary Tract Infections
A UTI affecting the bladder or kidneys can produce lower abdominal and pelvic pain alongside urinary symptoms — frequency, burning, or urgency. If your pelvic pain is accompanied by any urinary changes, a UTI should be considered and treated promptly.
How Pelvic Pain is Assessed
A thorough assessment begins with your history. A clinician — or, in the case of a private ultrasound appointment, a consultant sonographer — will ask about when the pain started and how it has changed, whether it is related to your menstrual cycle, sexual activity, or bowel movements, any associated symptoms (bleeding, discharge, urinary changes, bloating), and your reproductive history and any previous diagnoses.
This history guides the scan. At IUS London, the assessment typically combines a transabdominal scan (with a full bladder) and a transvaginal scan (with an empty bladder) in a single appointment. The transvaginal approach provides significantly higher resolution images of the uterus and ovaries, and is the recommended first-line imaging modality for pelvic pain according to the American College of Radiology's 2023 Appropriateness Criteria [3].
The scan assesses the uterus (size, shape, endometrial thickness, myometrial texture), both ovaries (size, follicle count, any cysts or masses), the fallopian tubes (if visible), and any free fluid in the pelvis.
📋 From Our Practice at IUS London
A pattern we encounter regularly involves women who have been living with intermittent pelvic pain for months — sometimes years — and have been reassured by their GP without any imaging being arranged. When we perform a transvaginal scan, we frequently identify a simple ovarian cyst, an endometrioma, or features of adenomyosis that explain their symptoms entirely.
The scan does not always find something serious. Often, the most valuable outcome is a normal result — confirmation that the uterus and ovaries appear healthy, that there is no mass or free fluid, and that the pain is unlikely to have a sinister gynaecological cause. For a woman who has been anxious about her symptoms for months, that reassurance is clinically meaningful.
When we do identify a finding that requires follow-up — a complex cyst, features of endometriosis, or a significantly enlarged fibroid — we provide a same-day written report that the patient can take directly to her GP or gynaecologist, removing the delay between imaging and specialist referral.
What a Pelvic Ultrasound Can and Cannot Tell You
| What ultrasound can identify | What requires further investigation |
|---|---|
| Ovarian cysts (simple and complex) | Microscopic endometriosis (requires laparoscopy) |
| Endometriomas (chocolate cysts) | Histological diagnosis of adenomyosis |
| Uterine fibroids (size, location, number) | Tubal patency (requires HyCoSy or HSG) |
| Adenomyosis features | Biochemical causes of pain (e.g. raised CA-125) |
| Free fluid in the pelvis | Bowel or musculoskeletal sources of pain |
| Features consistent with PID | Confirmed PID diagnosis (requires swabs) |
Ultrasound is a powerful first-line tool, but it works alongside — not instead of — clinical assessment and, where needed, further investigation.
When Should You Book a Private Pelvic Ultrasound?
You do not need a GP referral to book a private pelvic ultrasound at IUS London. A scan is appropriate if:
- You have had pelvic pain for more than two weeks with no clear explanation
- Your periods have become significantly more painful
- You have been told you may have an ovarian cyst and want it monitored
- You have symptoms that suggest endometriosis and want an objective assessment
- You have been trying to conceive and want to check your pelvic anatomy
- You have had a previous gynaecological condition and want a follow-up scan
If your pain is sudden and severe, or accompanied by the red-flag symptoms listed at the top of this article, seek urgent medical care first.
Book a Private Pelvic Ultrasound in London
Same-day appointments in Kensington. Full written report on the day. No GP referral needed.
You may also find these helpful: Symptoms of Ovarian Cysts | Abdominal and Pelvic Ultrasound
References
- Moïse, A., et al. (2025). Endometriosis and Infertility: Gynecological Examination Practical Guide. Journal of Clinical Medicine. https://consensus.app/papers/details/e0316032d0a95c5fbbca011d7e190019/
- Chapron, C., et al. (2020). Diagnosing adenomyosis: an integrated clinical and imaging approach. Human Reproduction Update. https://consensus.app/papers/details/cc3ab6a8a2465dd4ac34aa0967db57fe/
- Brook, O., et al. (2024). ACR Appropriateness Criteria® Acute Pelvic Pain in the Reproductive Age Group: 2023 Update. Journal of the American College of Radiology. https://consensus.app/papers/details/d8ae3b406a525179bf3adf511f9d9c78/
