Pain in the lower right abdomen near the hip bone in women is one of those symptoms that can mean several very different things—from something minor like muscle strain to something urgent like appendicitis or an ectopic pregnancy. Location matters, but so does the character of the pain, when it started, and what else is going on in your body.
The most common causes of lower right abdominal pain near the hip in women include appendicitis, ovarian cysts, ovulation pain (mittelschmerz), ectopic pregnancy, a hip flexor strain, and issues with the right ovary or fallopian tube. Some of these need immediate attention; others resolve on their own.
Structures in the Lower Right Abdomen
Knowing what’s there helps narrow the cause:
| Structure | Type | Located There? |
|---|---|---|
| Appendix | Digestive | Yes |
| Right ovary | Reproductive | Yes |
| Right fallopian tube | Reproductive | Yes |
| Right ureter (connects kidney to bladder) | Urinary | Yes |
| Part of the large intestine (cecum) | Digestive | Yes |
| Hip flexor muscles and iliopsoas | Musculoskeletal | Yes |
| Inguinal lymph nodes | Lymphatic | Yes |
Most Likely Causes in Women
Appendicitis
This is the one you don’t want to miss. The appendix sits at the junction of the small and large intestine – right where this pain is often felt.
Appendicitis pain typically:
- Starts as a dull ache around the navel, then migrates to the lower right
- Worsens over hours
- Intensifies with movement, coughing, or pressing on the area
- Is accompanied by nausea, vomiting, and low-grade fever
If you suspect appendicitis – especially if the pain is steadily worsening – go to the emergency room. This is a surgical emergency.
Ovarian Cyst
Fluid-filled sacs on the ovary are extremely common and often cause no symptoms. But when they grow large or rupture, they cause sharp, sudden pain on one side of the lower abdomen – right where this pain is felt.
Signs that point to an ovarian cyst:
- Sudden, sharp pain that may come and go
- Bloating or a feeling of fullness in the pelvis
- Pain that worsens during your period or after sex
- Irregular menstrual cycles
A ruptured cyst can cause severe, sudden pain – seek medical attention promptly.
Ovulation Pain (Mittelschmerz)
About 20% of women feel a distinct pain during ovulation, occurring mid-cycle (around day 14 for a 28-day cycle). It’s felt on one side – whichever ovary is releasing the egg that month.
Mittelschmerz typically:
- Lasts a few minutes to a few hours (rarely more than a day or two)
- Is a dull ache, cramp, or sharp twinge on the right or left side
- Occurs predictably around the same time each month
- Is mild and doesn’t worsen
Ectopic Pregnancy
If there’s any possibility of pregnancy, lower right (or left) abdominal pain is a red flag. An ectopic pregnancy occurs when a fertilized egg implants in the fallopian tube instead of the uterus. As it grows, it can rupture the tube – a life-threatening emergency.
Warning signs:
- Sharp, stabbing pain on one side of the lower abdomen
- Vaginal bleeding (may be light or irregular)
- Shoulder pain (from internal bleeding irritating the diaphragm)
- Dizziness or fainting
If you are or might be pregnant and have one-sided lower abdominal pain – go to the ER immediately.
Pelvic Inflammatory Disease (PID)
PID is an infection of the reproductive organs, often caused by untreated STIs like chlamydia or gonorrhea. It causes lower abdominal and pelvic pain that can be one-sided, along with:
- Unusual or heavy discharge
- Fever and chills
- Pain during sex or urination
- Irregular periods
Endometriosis
In endometriosis, tissue similar to the uterine lining grows outside the uterus – including on or around the ovaries and fallopian tubes. This causes cyclical pelvic pain that can be severe, particularly during periods.
Muscle or Hip Flexor Strain
Not everything in this location is internal. The iliopsoas muscle – the primary hip flexor – runs through the lower right abdomen. Overuse, sudden movement, or strain can cause pain directly in this region that mimics internal pain.
This type of pain:
- Worsens with movement, especially lifting the leg or walking
- Eases with rest
- Has no digestive or menstrual connection
- May follow intense exercise or a sudden awkward movement
Kidney Stone
A stone passing through the right ureter causes severe, cramping pain that often radiates from the lower back into the lower right abdomen and groin.
Signs include:
- Waves of intense, cramping pain
- Blood in the urine
- Nausea
- Urgent or painful urination
Pain Character – What It Might Mean
| Type of Pain | Possible Cause |
|---|---|
| Sudden, severe, constant | Appendicitis, ruptured cyst, ectopic pregnancy |
| Comes in waves | Kidney stone, gas, muscle cramp |
| Dull ache mid-cycle | Ovulation pain |
| Worse during period | Endometriosis, ovarian cyst |
| After exercise | Muscle strain, hip flexor |
| With fever + discharge | PID, infection |
When to Go to the ER
Don’t wait if you have:
When to See a Doctor (Non-Emergency)
Schedule an appointment within 1-2 days if:
- Pain has lasted more than 3 days
- It’s mild but keeps recurring
- Your periods have become irregular alongside the pain
- You have bloating and pelvic heaviness regularly
Bottom Line
Lower right abdominal pain near the hip bone in women has a wide range of causes – from the harmless (ovulation pain, muscle strain) to the urgent (appendicitis, ectopic pregnancy). The pattern, timing, and accompanying symptoms are the most important clues. When in doubt, or if pain is severe and worsening, always seek medical evaluation. This is not a symptom to push through.
