The complaint of abdominal pain in a premenopausal female is a challenging task for any medical provider faced with making an accurate diagnosis. The pathophysiology of women has to be considered when a female patient is presenting with a complaint of abdominal pain. Sometimes the diagnosis is easy to make, other times it can be elusive. The variance of a patient’s initial clinical presentation providers should trust their medical knowledge, their medical work up, and their instincts when making the final diagnosis. As always, the most life-threatening causes of the patient’s pain should be ruled out. Our article will provide medical providers a systematic approach for the assessment and diagnosis of abdominal pain in the premenopausal female.