Mittelschmerz: This condition is characterized by mid-cycle pain, which typically occurs around the time of ovulation, roughly 9-10 days before the next menstrual period. It's caused by the rupture of the follicle releasing the egg, leading to mild, temporary pain.

Ovulatory Cysts: These can form after ovulation and may cause pelvic pain. They are usually benign and resolve on their own.
Hormonal Changes: Fluctuations in hormone levels during the menstrual cycle can lead to cramping and discomfort, even before the period.
Irritable Bowel Syndrome (IBS): Symptoms of IBS can sometimes be confused with womb pains, especially if they coincide with the menstrual cycle.

Ectopic Pregnancy: Although less likely if the patient is expecting their period, an ectopic pregnancy can cause severe, sudden pain and is a medical emergency.
Appendicitis: Appendicitis can present with pelvic pain and must be ruled out, especially if the pain is severe, persistent, or accompanied by fever, nausea, or vomiting.
Ovarian Torsion: A rare but serious condition where the ovary twists, cutting off its blood supply. It requires immediate medical attention.

Endometriosis: While more commonly associated with chronic pelvic pain and dysmenorrhea, endometriosis could potentially cause intermittent pain at any point in the cycle.
Adenomyosis: A condition where tissue similar to the lining inside the uterus grows into the muscular walls of the uterus, leading to pain and heavy bleeding.
Pelvic Inflammatory Disease (PID): An infection of the female reproductive organs that can cause chronic pain, but it's less likely to present for the first time as intermittent pain 9 days before a period without other symptoms.