Gynaecological causes of abdominal pain may arise from conditions associated with pregnancy and the non-pregnant state. In the former, the presentation is usually as an emergency and the most important diagnosis is ectopic pregnancy. In women who are not pregnant, the most common emergencies associated with abdominal pain are acute pelvic inflammatory disease and complications of ovarian cysts. Less acute causes of abdominal pain include endometriosis, fibroids and chronic pelvic inflammatory disease. Women with acute abdominal pain due to gynaecological disease may present to surgeons, and the most useful investigations for possible gynaecological problems are sensitive pregnancy tests and pelvic ultrasonography.