Pulling in the lower abdomen in the woman

Especially a large number of young women regularly suffer from pulling pain in the abdomen. These pains occur monthly during menstrual bleeding and are the result of the contractions of the uterus, which during this period sheds the lining of the uterus. Some women experience them as very strong, others have hardly any problems.

Regular sport and exercise, which is also continued during menstruation, can help to relieve the intensity of the pain through relaxation. Correspondingly, relaxation exercises, especially yoga, can also achieve very good pain-reducing results. During menstruation, warmth helps to relax the cramped lower abdomen, for example with the help of a hot water bottle, thereby relieving the pain.

If the pain is severe, anti-cramping medication such as Buscopan® can be used. Modern contraceptives, such as the contraceptive pill, can often significantly reduce the abdominal pain associated with menstruation. If the pulling pain in the lower abdomen is extremely severe and can hardly be tolerated even with medication, a disease, especially endometriosis, should also be considered.

In this disease, the lining of the uterus is not only located in the uterus, as in healthy women, but is also scattered in the body on other organs, especially the ovaries. In addition, the mucous membrane is often also located within the uterine musculature. The endometriosis lesions, like the normal uterine lining, are subject to the hormonal cycle of the woman and therefore bleed once a month during menstruation.

Why women with endometriosis suffer from extremely severe, often pulling lower abdominal pain that goes beyond the usual level of period pain has not yet been fully clarified. In addition to the severe cramping, pulling pain in the lower abdomen, some women also have blood in their urine and/or stool if there are endometriosis lesions in the bladder or intestine. If the menstrual bleeding does not occur, those affected are free of symptoms.

This is the case, for example, during pregnancy or during or after the menopause. In addition, a long cycle with one pill in consultation with the gynecologist treating the patient can provide relief, as menstrual bleeding only occurs every 3 months. The misplaced lining of the uterus, especially in the muscular wall of the uterus, can lead to adhesions and scarring.

One of the most serious complications of endometriosis, also for these reasons, is the difficulty in becoming pregnant, in extreme cases even infertility. In these cases, it is recommended to have the endometriosis lesions removed in a minor operation. Inflammation of the female reproductive organs, which are located in the lower abdomen, can also lead to sometimes severe, pulling pain in this area.

In this case, the inflammation usually affects the ovary and fallopian tubes. Sexually transmitted pathogens, especially Chlamydia, are often the cause of the so-called pelvic inflammatory disease. In the beginning, the vagina is usually affected by the bacterial inflammation, which is perceived as less disturbing by many women.

If left untreated, the bacteria rise through the uterus to the fallopian tubes and ovaries and infect them, which leads to the severe, including pulling, unilateral lower abdominal pain. In addition to the pain, fever, a foul-smelling vaginal discharge and nausea with vomiting frequently occur. According to the cause, young, sexually active women are particularly affected.

Many partner changes and unprotected sexual intercourse increase the probability of infection.In most cases, antibiotic therapy is useful and important, as the disease can lead to infertility if left untreated. About 20-40% of women are able to “feel” their ovulation. In these cases, this is often expressed by a one-sided pulling in the lower abdomen, which is colloquially referred to as a Mittelschmerz.

The name “Mittelschmerz” (middle pain) comes from the fact that the pain does not necessarily occur immediately with ovulation, but a few days later, usually in the middle of the menstrual cycle. Women who do not use contraception are most fertile at this time. Women feel the pulling, sometimes cramping pain in the lower abdomen on the side from which the still unfertilized egg has passed from the ovary into the fallopian tube after one month of maturation.

The duration of the pulling pain varies from woman to woman and can last from minutes to two days. Why pain occurs during ovulation is not yet fully understood. If the pulling pain in the lower abdomen is very strong, local heat, for example from a hot water bottle, can help.

Many women experience occasional pulling lower abdominal pain during pregnancy. However, this is not automatically a bad sign. A common cause is the growing uterus during pregnancy.

As the womb grows, the ligaments to which the uterus is “attached” in the lower abdomen are increasingly stretched, which can cause the pulling pain in this area. This stretching can occur throughout the entire pregnancy, as the uterus grows steadily, especially in the first months of pregnancy, and is intensified in some women by the increasing movements of the child and the resulting further strain on the uterine ligaments. However, it is typical for this pain not to last continuously over a long period of time or to increase significantly in intensity.

If one of these two points is the case and other symptoms occur in addition to the pulling lower abdominal pain, such as nausea with vomiting, diarrhea, abdominal cramps with or without bleeding and/or fever, a gynecologist should be consulted without hesitation in order not to risk miscarriage or premature birth. If the pregnancy is not very far advanced, such severe, unilateral and pulling pain in the lower abdomen can be a sign of an ectopic pregnancy, if the pregnancy test is positive and/or menstruation is absent. In this case, surgical removal of the misplaced fertilized egg is essential.

Since the fallopian tube, unlike the uterus, does not grow with the embryo, it is highly probable that the embryo will rupture during the course of the weeks of pregnancy, at the latest around the 8th week of pregnancy. This is a life-threatening complication for those affected due to the subsequent massive bleeding into the abdomen. The fertilized egg and the resulting embryo is not viable when implanted in the fallopian tube.