Gynaecological causes of abdominal pain

Gynaecological causes of abdominal pain may arise from conditions associated with pregnancy and the non-pregnant state. In the former, the presentation is usually as an emergency and the most important diagnosis is ectopic pregnancy. In women who are not pregnant, the most common emergencies associated with abdominal pain are acute pelvic inflammatory disease and complications of ovarian cysts. Less acute causes of abdominal pain include endometriosis, fibroids and chronic pelvic inflammatory disease. Women with acute abdominal pain due to gynaecological disease may present to surgeons, and the most useful investigations for possible gynaecological problems are sensitive pregnancy tests and pelvic ultrasonography. A negative pregnancy test effectively excludes an ongoing pregnancy. Gynaecological conditions may be encountered during surgery (particularly diagnostic laparoscopy) and gynaecologists must be involved in management decisions when a gynaecological abnormality is suspected preoperatively or if it is encountered intraoperatively. The most important cause of abdominal pain due to a gynaecological problem is ovarian cancer. This rarely presents acutely, but often gives rise to vague abdominal symptoms. The cancer has usually spread by the time of diagnosis, and clinicians should be particularly vigilant in postmenopausal women with vague abdominal symptoms.