Hello, Lower middle abdominal pain may be due to any pathology in pelvic organs like uterus, fallopian tubes, ovary. A few causes of pelvic pain are pelvic inflammatory disease meaning inflammation of uterus and tubes, ovarian tumor, salphingitis or inflammation of tubes, adnexal tumors, endometriosis, adenomyosis, fibroids in uterus, or a growing cyst in the ovary. If you have other symptoms like fever, suppurative or foul smelling vaginal discharge, and irregular periods. You need to consult a gynecologist for detailed clinical examination and investigations if necessary and appropriate treatment. Take care. Hope I have answered your question. Let me know if I can assist you further. Regards, Dr. Pallavi M., Anesthesiologist