During early pregnancy, the uterus is much smaller than it will be in the second and third trimesters. Therefore, pain in this part of the body is unlikely to be due to pressure from the uterus pushing on other organs or the fatigue of excess weight in the uterus.
Uterus pain, however, remains one of the most common symptoms in early pregnancy. In this article, we look at the possible causes, which include changes to the muscles and hormones.
The most common causes of uterus pain in early pregnancy include:
Round ligament pain
Round ligament pain is one possible cause of uterus pain in early pregnancy.
Round ligament pain happens because the uterus is growing, and the ligaments that support it must shift to accommodate the growth. This pain is usually a sharp, stabbing sensation that can happen on one or both sides of the uterus. It may be sudden and usually only lasts a few seconds.
In many cases, round ligament pain appears without warning. Some women notice more pain when they cough or sneeze or when they roll over or change position in bed. The pain can also occur when a pregnant woman moves from a sitting to a standing position.
Although it can be uncomfortable, round ligament pain is not dangerous or a sign that anything is wrong.
Pelvic floor pain
Many women experience pelvic floor pain during pregnancy. Symptoms can appear early on, especially in a second pregnancy. A stretching uterus is one cause of the pain, but hormonal changes can also affect how the muscles of the pelvic floor feel and behave.
The sensations of pelvic floor pain vary, and a woman might feel them near her uterus or in her bladder, vagina, back, or abdomen.
Some women with pelvic floor pain have a history of pelvic floor injuries, such as tearing or an episiotomy during childbirth. Many have weak pelvic floor muscles, which can cause additional symptoms, such as bladder leakage when jumping or sneezing.
Pelvic floor pain will not hurt the developing fetus, but it can get worse as the pregnancy progresses.
Early in pregnancy, many women experience cramping that feels similar to menstrual cramps. The expanding uterus or rising progesterone levels may be responsible for this symptom.
Some women worry that cramping is a sign of pregnancy loss. Severe cramping that gets steadily worse over many hours may warn of a pregnancy loss, especially if there is bleeding. For many pregnant women, however, cramping is a temporary discomfort and not a sign of a problem.
Less common causes
Other possible causes of uterus pain during early pregnancy include:
Ovarian torsion happens when an ovary or fallopian tube twists around the tissues supporting it. In some women, this happens following an ovarian cyst, but in others, there are no previous symptoms or warning signs.
Although pregnancy does not cause ovarian torsion, it can occur during pregnancy. Ovarian torsion is a medical emergency because it can cut off the blood supply and destroy the ovary. The ovary may rupture, which can lead to life threatening bleeding. Prompt emergency treatment is important for the survival of both the woman and the developing fetus.
Ovarian torsion causes sudden, sharp, overwhelming pain that may get steadily worse. The pain does not go away or get better with massage. For some women, the pain is intense enough to cause vomiting or fainting.
Women over 35 are more at risk of an ectopic pregnancy.
An ectopic pregnancy happens when an egg implants and grows somewhere other than the uterus — usually in the fallopian tubes. Factors that increase the risk of ectopic pregnancy include:
- being over the age of 35 years
- previous pelvic surgery
- being a smoker
- a history of ectopic pregnancy or pelvic inflammatory diseases
- sexually transmitted infections (STIs)
- in vitro fertilization (IVF)
An ectopic pregnancy is not viable. If it continues to grow, it may damage organs or cause life threatening bleeding.
Once a pregnancy implants in the uterus, it will not move to another location. If an ultrasound confirms that the fetus is developing in the uterus, a woman does not need to worry about ectopic pregnancy.
Other causes of pain
Numerous health issues, many of which do not have a direct association with pregnancy, can cause pain in the abdomen when a woman is pregnant.
Some pregnant women may think that their uterus is higher in the abdomen than it actually is and, thereby, mistake other forms of abdominal pain for uterus pain.
Below are some other potential causes of abdominal pain during pregnancy and their symptoms:
- Liver pain from gallstones or other liver problems, which can cause aching pain in the upper right abdomen, sometimes along with dark urine.
- Kidney pain from a kidney infection or kidney stones, which typically cause intense pain in the mid-to-upper back, painful urinating, and a fever.
- Bladder pain from a bladder infection, which may lead to pain in the bladder or abdomen and pain or difficulty urinating.
A pregnant woman may also mistake gastrointestinal pain for uterus pain. Constipation is a common pregnancy complaint that can cause a range of sensations in the stomach, including sharp or shooting pains.
Treatments and home remedies
The right treatment depends on the cause of the pain. Women who experience normal early pregnancy aches and pains, such as those that are due to pelvic floor discomfort or round ligament pain, may find relief by:
- shifting the knees toward the chest to reduce pressure on the uterus
- frequently changing position
- massaging the affected area or surrounding muscles gently
- using over-the-counter pain relievers under the supervision of a healthcare professional
- eating more fiber and remaining hydrated to prevent constipation
- getting plenty of rest to reduce muscle fatigue
A healthcare professional must end an ectopic pregnancy, either surgically or using medication.
Surgery can treat ovarian torsion. In some cases, the surgeon will be able to save the ovary, but in others, this organ may require removal.
When to see a doctor
A woman should talk to a doctor if she experiences any intense cramping during pregnancy.
A woman should see a healthcare professional at least once during her first trimester to confirm the pregnancy, assess its viability, and ensure that the fetus is growing in the uterus. This appointment provides a good opportunity to discuss aches and pains and to ask what is and is not normal.
A pregnant woman should call a doctor about uterus pain if:
- there is intense cramping
- the pain gets much worse
- abdominal pain occurs alongside blood in the stool
- there are signs of liver problems, such as upper right abdominal pain
She should go to the emergency room if:
- there is heavy bleeding, similar to a period
- the pain is unbearable or comes on suddenly and does not go away
- symptoms include a fever
- there is blood in the urine
- there are symptoms of a kidney stone, such as intense back pain and cramping
For most women, uterus pain in early pregnancy is a temporary discomfort that comes and goes. The pain may change as the pregnancy progresses. Some women find that it gets better. Others notice an improvement during the second trimester and then an increase in pain as the uterus expands in the third trimester.
When pain is intense or occurs alongside other symptoms, it is important to see a healthcare professional.