Differential Diagnosis of Pelvic Pain after Menstrual Period

The differential diagnosis for pelvic pain after a menstrual period can be categorized into several groups based on the likelihood and potential impact of the conditions.

• Single Most Likely Diagnosis

  • Ovulation Pain (Mittelschmerz): This condition occurs in some women during ovulation, typically midway through the menstrual cycle, and is characterized by a sharp, stabbing pain on one side of the pelvis. It's a common cause of pelvic pain that is not related to menstrual bleeding but can occur after the menstrual period, depending on the timing of ovulation.

• Other Likely Diagnoses

  • Endometriosis: A condition where tissue similar to the lining inside the uterus grows outside of it, leading to pain, especially after menstruation. The pain can persist after the menstrual period due to inflammation and scarring.
  • Adenomyosis: Similar to endometriosis but involves tissue growing into the muscular wall of the uterus, leading to painful periods and pelvic pain that can extend beyond the menstrual period.
  • Pelvic Inflammatory Disease (PID): An infection of the female reproductive organs that can cause pelvic pain, which may not be strictly related to the menstrual cycle but can be exacerbated by it.
  • Ovarian Cysts: These can cause pelvic pain, especially if they rupture or twist, and the pain can occur at any time, including after the menstrual period.

• Do Not Miss Diagnoses

  • Ectopic Pregnancy: Although less likely if the patient is not pregnant, an ectopic pregnancy can present with pelvic pain and must be considered, especially if there's a chance of pregnancy. It's a medical emergency.
  • Appendicitis: While not directly related to the menstrual cycle, appendicitis can cause severe pelvic pain and is a surgical emergency.
  • Ovarian Torsion: A condition where the ovary twists around its ligaments, cutting off blood supply. It's rare but requires immediate medical attention.

• Rare Diagnoses

  • Chronic Pelvic Pain Syndromes: Conditions like pelvic floor dysfunction or pudendal neuralgia, which can cause chronic pain and may not have a clear relationship to the menstrual cycle.
  • Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease or ulcerative colitis can cause pelvic pain among other symptoms, and while not directly related to menstruation, can be considered in the differential diagnosis of chronic pelvic pain.