What Is Round Ligament Pain

When people refer to “round ligaments,” they generally mean round ligaments of the uterus. Another round ligament, the round ligament of the liver, is what remains of the umbilical vein. This blood vessel carries blood from the placenta to the fetus in the womb. In adults, it doesn’t have a function.

Round Ligament

The round ligament is a rope-like band of connective tissue. Two round ligaments support the uterus. During pregnancy, the round ligaments stretch as the uterus grows. Other conditions, including endometriosis and varicose veins, can also affect the round ligaments.

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Overview

What is the round ligament?

The round ligaments are rope-like bands of connective tissue that support the uterus (womb). The scientific term for this round ligament is the gubernaculum.

There are two round ligaments of the uterus, one on either side. Each is about 4 inches (10 centimeters) long.

When people refer to “round ligaments,” they generally mean round ligaments of the uterus. Another round ligament, the round ligament of the liver, is what remains of the umbilical vein. This blood vessel carries blood from the placenta to the fetus in the womb. In adults, it doesn’t have a function.

What are ligaments?

Ligaments are strong bands of fibers interconnected in strong, cordlike ropes. Typically, ligaments attach bones in a joint. In places like the elbow, ankle or knee, strong ligaments make crisscross connections that help stabilize the joint.

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Other ligaments, like the round ligament, help support internal organs. Rather than connecting bones to stabilize a joint, the round ligament supports the uterus.

Do men have round ligaments?

All fetuses begin developing the same way. Later in pregnancy, sex differences appear. Male fetuses do have round ligaments. As the sex organs form, the round ligament in a baby boy moves down into the scrotum (sac outside the body that holds the testicles).

Function

What is the purpose of the round ligament?

The round ligaments support and anchor the uterus. During pregnancy, the round ligaments stretch. They get wider and longer to support the growing uterus.

Anatomy

Where is the round ligament located?

There are two round ligaments, one on each side of the uterus. The uterus is a hollow, pear-shaped organ in the pelvis (bowl-shaped area of bone that connects your torso and legs). During pregnancy, a developing baby grows in the uterus. The muscular uterus can expand as the baby grows.

Several structures come off of the top corners of the uterus and briefly run together: the round ligament, the Fallopian tube and the ligament that holds the ovaries close to the uterus. From there, the ligament enters the abdominal wall and travels through groin (in the inguinal canal), and eventually inserts into the labia. This is often why women experience round ligament pain in the groin, or as vaginal tugging.

Conditions and Disorders

What conditions affect the round ligament?

Several conditions can affect the round ligaments during a woman’s reproductive years. These include:

• Endometriosis: This condition causes cells similar to the uterine lining to grow outside of the uterus. In some cases, endometriosis develops in or on the round ligaments. Endometriosis can lead to pelvic pain, disrupted menstrual cycles and infertility.
• Round ligament pain:Round ligament pain is a common pregnancy symptom as ligaments stretch and contract. It can start in the second trimester of pregnancy (after 13 weeks). You may experience sharp pain in the hips, abdomen or groin (the area between your stomach and thighs).
• Round ligament varicosity (RLV):Varicose veins can develop in the veins of the round ligament during pregnancy, most often the second trimester. RLV can cause pain and swelling. People sometimes mistake the condition for a hernia. Your healthcare provider should monitor RLV throughout your pregnancy. It generally resolves on its own after you deliver your baby.

Why does pregnancy cause round ligament pain?

During pregnancy, the uterus grows and expands to accommodate a developing baby. The uterus starts about the size of an orange. By the end of a pregnancy, it is about the size of a watermelon.

The round ligaments also expand to support the uterus as it gets bigger and heavier throughout pregnancy. As the ligaments stretch to hold up the expanded uterus, you may experience round ligament pain.

Care

How can I keep my round ligaments healthy?

During pregnancy, it may help to do gentle stretches of the pelvis and hips. If you experience round ligament pain, stop doing the movement that triggered the pain and rest until it goes away.

When should I call my doctor?

You should call your provider or seek emergency care if you experience severe round ligament pain that lasts more than a couple of minutes along with:

• Cramping.
• Fever or chills.
• Nausea or vomiting.
• Vaginal bleeding.

A note from Cleveland Clinic

The round ligaments help support your uterus. During pregnancy, they stretch and can become painful. Talk to your healthcare provider about how to recognize round ligament pain during pregnancy. They can show you gentle stretches to help keep the round ligaments healthy.

Last reviewed by a Cleveland Clinic medical professional on 07/20/2021.

References

• American Pregnancy Association. Round Ligament Pain During Pregnancy. (https://americanpregnancy.org/healthy-pregnancy/pregnancy-complications/round-ligament-pain-during-pregnancy-1001/) Accessed 8/31/2021.
• American Pregnancy Association. Uterus Size During Pregnancy. (https://americanpregnancy.org/healthy-pregnancy/pregnancy-health-wellness/uterus-size-during-pregnancy-5539/) Accessed 8/31/2021.
• Attah AA, Hutson JM. The anatomy of the female gubernaculum is different from the male. (https://pubmed.ncbi.nlm.nih.gov/2025193/) Aust N Z J Surg. 1991 May;61(5):380-4. Accessed 8/31/2021.
• InformedHealth.org. What Are Ligaments? (https://www.ncbi.nlm.nih.gov/books/NBK525790/) Accessed 8/31/2021.
• Ng C, Wong GT. Round Ligament Varicosity Presenting as an Irreducible Inguinal Mass in a Postpartum Woman. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6712551/) J Clin Imaging Sci. 2019;9:28. Accessed 8/31/2021.
• Radiopaedia. Round ligament of the uterus. (https://radiopaedia.org/articles/round-ligament-of-the-uterus?lang=us) Accessed 8/31/2021.
• Stat Pearls. Anatomy, Abdomen and Pelvis, Uterus Round Ligament. (https://www.statpearls.com/ArticleLibrary/viewarticle/30898) Accessed 8/31/2021.

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What Is Round Ligament Pain?

Heather M. Jones is a freelance writer with a focus on health, parenting, disability, and feminism.

Updated on April 06, 2021

Monique Rainford, MD, is board-certified in obstetrics-gynecology, and currently serves as an Assistant Clinical Professor at Yale Medicine. She is the former chief of obstetrics-gynecology at Yale Health.

Table of Contents
Table of Contents

Occurring in 10% to 20% of pregnancies, round ligament pain (RLP) is a common cause of discomfort in pregnancy.

Usually beginning at the end of the first trimester or the start of the second trimester, RLP can feel like a brief sharp pain in the lower abdomen or groin on one or both sides, or it can be a longer-lasting dull ache.

RLP is not usually dangerous for mother or baby, but can have similar symptoms to other conditions that are more serious, so pain during pregnancy should not automatically be dismissed as RLP.

Symptoms

The symptoms of RLP include:

• A sudden, brief, sharp pain on one or both sides on the lower abdomen or hip area
• Pain on one or both sides of the lower abdomen that comes on suddenly with movement or changing positions
• Discomfort in the lower abdomen on one or both sides
• Pain or discomfort that goes down into the groin
• A dull ache on one or both sides of the lower abdomen

RLP can be triggered by:

• Walking
• Standing up quickly or other sudden movement
• Rolling over in bed
• Coughing
• Sneezing
• Laughing
• Getting out of bed, out of the bath, or up from a chair
• An active day

When to Call Your Healthcare Provider

While round ligament pain is not usually harmful, its symptoms can be similar to other conditions that are.

Call your healthcare provider if you experience:

• Fever or chills
• Intense pain or cramping
• Bleeding
• Unusual vaginal discharge
• Premature contractions
• Painful urination
• Cloudy or foul-smelling urine
• Nausea or vomiting with abdominal pain
• Lightheadedness or dizziness
• Difficulty walking
• Low back pain (especially if not previously experienced) and/or pressure in the pelvic area
• Pain that doesn’t subside with rest
• Long-lasting pain
• More than four contractions in an hour (even if they are not painful)
• Concern about any other symptoms

Diagnosis

Diagnosis for RLP is based mainly on symptoms, and sometimes a physical exam.

If other symptoms are present, such as bleeding, the healthcare provider may order or perform more testing, such as an ultrasound, to check for another cause for the pain and symptoms.

Causes

During pregnancy, the uterus grows from 70 g to 1,110 g. It changes from a pelvic organ into an intra-abdominal organ by about 12 weeks gestation. By 20 weeks gestation, the uterus can be felt at belly-button level. This is a lot of growth in a relatively short amount of time.

Attached at the top and sides of the uterus, extending to the bones of the pelvis, are two ligaments (one on each side). These ligaments support the uterus and stretch as the uterus grows.

When not during pregnancy, these ligaments are short, firm, and flexible. During pregnancy, they get softer, stretch, and become under tension as the uterus becomes bigger.

These ligaments tighten when the pregnant person moves, which causes temporary pain. This pain can be sharp and sudden with a movement such as getting out of bed, or it can be dull and achy, such as after a busy, active day.

Treatment

RLP will generally resolve on its own in the third trimester or after the baby is born. It does not usually require any specific treatment, but there are things that can be done to ease the pain and discomfort or prevent it from occurring. These include:

• Rest, both when there is pain and as a general habit
• Avoid strenuous activity or prolonged periods of activity
• Avoid rapid or repetitive movements
• Change positions slowly
• Take a warm (not hot) bath
• Use a maternity support belt
• Flex hips before coughing or sneezing
• Gently stretch
• Rest on one side with knees bent and pillows between the legs and under the belly for support
• Try to avoid specific movements that trigger RLP
• Keep active with moderate exercise (if deemed safe by a healthcare professional)
• Swim or do water exercises
• Avoid laying flat on the back
• For a sudden pain in the abdomen, bend forward to the point of pain to relieve tension and relax the tissue

If these do not provide relief, acetaminophen can be taken, if okayed by a healthcare provider.

Not All Medications Are Safe During Pregnancy

Acetaminophen is generally considered safe to take during pregnancy if necessary and advised by your healthcare provider, but other pain medications may not be.

Consult with your healthcare provider before taking any medication while pregnant or nursing.

A Word From Verywell

Round ligament pain is an uncomfortable but normal pregnancy experience in response to your growing uterus. It will usually go away on its own by the third trimester of pregnancy.

In the meantime, the discomfort can be managed with controlled movements, lots of rest, and acetaminophen if recommended by your healthcare provider.

If you are experiencing symptoms in addition to RLP, or are concerned, check in with your healthcare provider.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

1. Zachariah SK, Fenn M, Jacob K, Arthungal SA, Zachariah SA. Management of acute abdomen in pregnancy: current perspectives. International Journal of Women’s Health. 2019;11(February 8):119-134. doi:10.2147/IJWH.S151501
2. American Pregnancy Association. Round ligament pain during pregnancy.
3. Cicilet S. Acute groin pain in pregnancy: a case of round ligament varicocele. BJR Case Reports. 2017;3(3):20150517. doi:10.1259/bjrcr.20150517

By Heather Jones
Heather M. Jones is a freelance writer with a strong focus on health, parenting, disability, and feminism.