Background: Most patients attending a gynecologist's OPD complain of abdominal pain. Diagnosing of pelvic pain in women can be challenging because many symptoms and signs are insensitive and non-specific. We conducted a study on middle-aged women excluding obstetric reasons, and analyzed the various causes of pain. Materials and methods: A study was conducted on 200 women in the reproductive age-group (20–45 years) attending a charitable hospital's outpatient department over a period of 10 months to analyze the causes of lower abdominal pain. Before starting this study, inclusion criteria were defined all patients who were pregnant, were excluded from the study. After primary consultation with a Gynecologist, a provisional diagnosis was made and the patients were treated accordingly. As per the nature of symptoms, the patient was later asked to consult a Surgeon. In case of urinary symptoms, patient was advised to test urine sample for ‘routine, microscopy’ and if required an ultrasound of the abdomen was done. Patients were asked to follow-up with the report. Observation: The commonest cause of hypogastric and pelvic pain was found to be pelvic inflammatory disease in majority (31%) of the population. This was succeeded by excessive bowel gas in 20% women. About 16% had urinary tract infection (UTI) whereas 14% suffered from gastrointestinal infection. The remaining 19% included other causes. In all, 30 patients required hospital admission more than 24 hours, i.e., 15% of our study population for complete treatment. Conclusion: A uniform definition of lower abdominal pain and standardized evaluation of participants are lacking across the literature. Our study reflects that out of the known factors responsible for abdominal pain, a new entity as ‘excessive colonic gas’ emerged. Besides the pelvic inflammatory disease and UTIs which are easily and commonly diagnosed, a significant number of patients concurrently suffered from excessive bowel gas, while a few (20%) had ‘gaseous distention of abdomen’ as the sole cause of abdominal pain. This may be attributed to the sedentary lifestyle and non-nutritious diet which have become an integral part of routine life. Therefore, we need to revise our differentials while managing many ‘non-specific’ underlying causes as well as adopt a healthy lifestyle modification to decrease the recurrence.