Background: Acute pelvic pain can result from the gynecological, urological systems and/or gastrointestinal. Ultrasound can be used as an initial imaging modality in the evaluation of acute pelvic pain. To determine sonographic findings in females of reproductive age coming with acute pelvic pain. Objective: To determine Sonographic findings in females of reproductive age with acute pelvic pain. Methodology: Toshiba Xario ultrasound machine with a standard gray scale and Doppler ultrasound convex probe of 3.5 MHz-7.5 MHz or trans-vaginal probe of 5 MHz-7.5MHz is used. Both transvaginal and trans-abdominal probes were used in this study. The study was conducted at Ultrasound University Clinic, Township, Lahore. Data of 163 patients was collected through convenient sampling. Statistical software for social sciences (SPSS version 22.0) is used for the analysis of data. Results: A total of 163 patients were examined in the study. The age incidence of the cases in this study varied between 15 years to 45 years. The mean age of the patients in the study was 29.8712 years. The uterine fibroid is most commonly involved in acute pelvic pain and is seen in 30.1% cases followed by simple ovarian cyst in 20.2% cases, hemorrhagic cyst in 14.1% cases. 8.6% cases with pelvic pain have no abnormal sonographic findings. Adenomyosis, PID and endometrial polyp in 4.3% each. Endometrial hyperplasia in 3.1%. Follicular cyst, simple adnexal cyst and complex adnexal cyst in 1.8% each, followed by ovarian endometrioma in 0.6% cases and dermoid cyst in 0.6%. In obstetric patients of acute pelvic pain; RPOCs are most common, constituting 1.8% of total acute pelvic pain, molar pregnancy in 1.2%, ectopic pregnancy in 0.6% patients, subchorionic bleed in 0.6% cases. Conclusion: Ultrasound is a very good modality for acute pelvic pain, as it can easily diagnose and characterize the causes of pelvic pain. The wide availability, radiation free and cost effectiveness makes it a first line investigation in acute pelvic pain. In the present study, the most common cause of pelvic pain is uterine fibroid.