Appendicitis symptoms in women are the same as in men: belly pain that often starts around the belly button and moves to the lower right side, along with loss of appetite, nausea or vomiting, and sometimes a fever. What’s different is that the appendix sits close to the ovaries, fallopian tubes and uterus, so appendicitis in women is easy to mistake for an ovarian cyst, an ectopic pregnancy, a urinary tract infection or period pain, and the other way around.
Get care now for severe or worsening belly pain. Appendicitis is a medical emergency, and so are ectopic pregnancy and a twisted ovary. MedlinePlus advises getting medical help right away for belly pain if you are pregnant or could be pregnant, for sudden sharp belly pain, or for a belly that is rigid and hard to the touch. Get emergency care right away for sudden, sharp lower belly pain with fainting, dizziness or shoulder pain. If you think it’s an emergency, call 911.
The video above describes the typical order of appendicitis symptoms: pain first around the belly button, nausea and vomiting an hour or two later, and then pain that moves down to the lower right side, where the appendix is. The video notes that appendicitis can come in many different forms. For the full guide, see Appendicitis Symptoms Explained.
What are the symptoms of appendicitis in women?
According to NIDDK, MedlinePlus and Cleveland Clinic, common symptoms include:
- belly pain that may start near the belly button and move lower and to the right
- pain that gets worse with walking, coughing, sneezing, deep breaths or sudden movements
- loss of appetite, nausea and vomiting
- a low fever
- constipation or diarrhea, or trouble passing gas
- a swollen belly
Cleveland Clinic lists a few later symptoms that can confuse the picture in women, such as needing to pee urgently or more often. That can make appendicitis look like a bladder infection.
Why is appendicitis harder to spot in women?
MedlinePlus says appendicitis can be hard to detect in women of childbearing age. Cleveland Clinic explains that the lower belly is close to the pelvic organs, so appendicitis symptoms can resemble pelvic conditions. Cleveland Clinic also says only about half of people with appendicitis have the classic pattern, so many cases don’t look textbook. For where the pain usually sits, see Where is your appendix?
Appendicitis vs. ovarian cyst, ectopic pregnancy and other causes
Several conditions can cause pain low on the right side in women. This table summarizes what the sources say. It can’t tell you which one you have; a doctor needs to examine you.
| Condition | Typical pain | Other clues | How doctors check |
|---|---|---|---|
| Appendicitis | Starts around the belly button, then moves to the lower right; gets steadily worse; worse with movement | Loss of appetite, nausea or vomiting after the pain starts, low fever | Exam, blood and urine tests, pregnancy test, ultrasound, CT or MRI |
| Ectopic pregnancy | Pain in the lower belly, pelvis or lower back; sudden, sharp pain if the tube bursts | Vaginal bleeding, dizziness or weakness; fainting or shoulder pain if it bursts | Urine pregnancy test, hCG blood test, ultrasound |
| Ovarian torsion (twisted ovary) | Sudden, severe pain, usually on one side; Cleveland Clinic says usually the right | Nausea and vomiting; sometimes crampy pain on and off beforehand | Transvaginal ultrasound that checks blood flow; confirmed with surgery |
| Ruptured ovarian cyst | Severe pain | Dizziness or weakness | Pregnancy test, pelvic exam, ultrasound |
| Pelvic inflammatory disease (PID) | Tender, sore or dull ache in the lower belly or pelvis; pain during sex | Unusual vaginal discharge, fever or chills, bleeding between periods | Pelvic exam, swab tests, urine test, sometimes ultrasound |
| Urinary tract infection (UTI) | Lower belly pain, or back pain under the ribs | Burning when peeing, peeing more often, cloudy or bloody urine | Urine test |
| Kidney stone | Pain in the side of the belly or lower back that can spread to the groin; comes and goes | Peeing often, cloudy urine | Urine test and imaging |
| Period pain | Cramps or an ache in the belly that can spread to the back and thighs | Starts just before or with your period; usually lasts up to 3 days | NHS says to get urgent advice if it’s severe, worse than usual, and painkillers don’t help |
The sources for each row are listed at the end. A few patterns stand out:
- Bleeding or a possible pregnancy points toward checking for ectopic pregnancy, which can be life-threatening if the tube bursts.
- Sudden, severe one-sided pain with vomiting can mean a twisted ovary, which Cleveland Clinic calls an emergency.
- Burning when you pee is more typical of a UTI, though NIDDK notes doctors still test urine to rule out a bladder infection or kidney stone.
- Pain that started at the belly button and moved is the classic sign of appendicitis.
Many of these can overlap, and more than one can need emergency care. Don’t try to decide on your own which it is.
Appendicitis during pregnancy
American Family Physician calls appendicitis the most common nonobstetric surgical emergency in pregnancy, meaning the most common emergency surgery not caused by the pregnancy itself. It can be harder to recognize:
- The pain may be higher. The American College of Surgeons says the appendix sits higher in the belly during pregnancy, so the pain may seem to come from the upper belly.
- Symptoms may be milder. The Merck Manual says pain may be less severe and the area less tender. NHS says people who are pregnant are more likely not to have the usual pain.
- Rupture risk is higher. The American College of Surgeons says the risk of a burst appendix is higher during pregnancy. NHS lists pregnancy complications among the problems a burst appendix can cause.
Any belly pain during pregnancy, or when you could be pregnant, needs medical help right away.
How doctors tell appendicitis apart from other causes
There’s no single test for appendicitis. NIDDK describes the steps doctors use, and several are aimed at ruling out other causes in women:
- Medical history. When the pain started, where it was at first, where it is now, and what other symptoms you have. Tell the doctor about your periods, any chance of pregnancy, vaginal bleeding or discharge, and pain when you pee.
- Physical exam. The doctor presses on the belly and checks whether certain leg movements cause pain. A pelvic exam may be done to check for problems with the reproductive organs.
- Pregnancy test. NIDDK says women get a pregnancy test. It helps rule ectopic pregnancy in or out and is needed before a CT scan, because the radiation can harm a fetus.
- Blood and urine tests. A high white blood cell count suggests infection. A urine test helps rule out a bladder infection or kidney stone.
- Ultrasound. It uses no radiation. NIDDK says it is the first imaging test for possible appendicitis in children, young adults and pregnant women. Ultrasound is also how doctors look for an ectopic pregnancy, ovarian cysts and a twisted ovary.
- MRI or CT. NIDDK calls MRI a safe, reliable alternative to CT that uses no X-rays. CT is common in adults. NIDDK says imaging can also show other causes of pain, including PID, kidney stones and problems with the reproductive organs.
NHS notes that no test can always show whether you have appendicitis, so doctors sometimes watch you for a few hours before deciding.
Why it matters: a burst appendix in women
A burst appendix can cause peritonitis, a dangerous infection of the lining of the belly, or an abscess. The Merck Manual adds that in women, a burst appendix can spread infection to the ovaries and fallopian tubes, and the scarring can cause infertility. Cleveland Clinic says an inflamed appendix can burst within 36 hours of the first symptoms. That’s why worsening belly pain should be checked the same day, not after you’ve waited to see if it passes. More on timing: Appendicitis timeline: how fast it progresses.
Go to the ER if
Get emergency care, or call 911, if you have:
- belly pain that started near the belly button and moved to the lower right side
- belly pain that keeps getting worse, or is worse with walking or coughing
- sudden, sharp or severe lower belly pain, especially with nausea and vomiting
- belly pain with fainting, dizziness, weakness or shoulder pain
- belly pain while pregnant, or when you could be pregnant
- a rigid, hard or very tender belly
- vomiting blood or blood in your stool, or trouble breathing
Don’t take medicine for belly pain before checking with a health care provider, and don’t drive yourself if the pain is severe.
Frequently asked questions
Where is appendix pain located in females?
Usually around the belly button at first, then in the lower right belly, the same as in males. During pregnancy, the pain may seem higher, closer to the upper belly.
Can appendicitis feel like period cramps?
It can be confused with them, since both cause lower belly pain. Period pain usually starts just before or with your period and lasts up to 3 days, according to NHS. Pain that moves to the lower right side, keeps getting worse, or comes with vomiting or fever needs prompt care.
How do I know if it’s my appendix or my ovary?
You can’t tell for sure at home. Appendicitis pain classically starts at the belly button and moves. A twisted ovary often causes sudden, severe pain on one side with vomiting. Both are emergencies, and doctors use a pregnancy test, a pelvic exam and an ultrasound to tell them apart.
Can a UTI be mistaken for appendicitis?
Yes. Cleveland Clinic lists urinary tract infections among the conditions that mimic appendicitis, and appendicitis can cause needing to pee urgently or often. A urine test helps sort it out.
Is appendicitis dangerous during pregnancy?
Yes. It is the most common nonobstetric surgical emergency in pregnancy, and the risk of rupture is higher. Get any belly pain in pregnancy checked right away.
Find a doctor
If you think you have appendicitis, go to the emergency room; don’t wait for an office appointment. An appendectomy is done by a general surgeon. General surgeons on Best Docs Network include Dr. Jason Harrison, Dr. Robert Santaella and Dr. Robert Pollard, all in Dallas-Fort Worth.
Sources
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK, NIH): Symptoms & Causes of Appendicitis
- NIDDK: Diagnosis of Appendicitis
- MedlinePlus (National Library of Medicine, NIH): Appendicitis
- MedlinePlus: Abdominal pain
- Cleveland Clinic: Appendicitis
- Cleveland Clinic: Ectopic Pregnancy
- Cleveland Clinic: Ovarian Torsion
- Cleveland Clinic: Ovarian Cysts
- Cleveland Clinic: Pelvic Inflammatory Disease (PID)
- Merck Manual Consumer Version: Appendicitis
- Merck Manual Consumer Version: Adnexal Torsion
- NHS: Appendicitis
- NHS: Kidney stones: symptoms
- NHS: Urinary tract infections (UTIs)
- NHS: Period pain
- American College of Surgeons: Appendectomy
- American Family Physician (American Academy of Family Physicians): Acute Appendicitis: Efficient Diagnosis and Management (2018)
This article is for general information only and is not medical advice. Talk with a qualified health professional about your own situation. If you think you may have a medical emergency, call 911.
