Why Do I Have Ovary Pain?

On each side of the pelvis, there is an ovary. Ovaries produce and release eggs for fertilization. When someone has ovarian pain, the most common causes are typically related to ovulation and menstruation. You can feel ovarian pain in the lower abdomen, pelvis, or lower back.

While ovary pain is often related to the menstrual cycle, there are times when ovary pain can be caused by something else, like endometriosis or a sexually transmitted infection (STI). Sometimes medical conditions of the digestive or urinary system can also cause pain that feels like it is coming from the ovaries.

Getting an accurate diagnosis of what's causing the pain is important, as this determines treatment. If you have ovary pain, call your healthcare provider for an exam.

Keep reading to learn more about ovary pain, what causes it, and how it's diagnosed.

Common Causes

It's important to know about the variety of conditions that can be responsible for how you are feeling. Some may warrant a visit to your healthcare provider, while others may resolve quickly without treatment.

Menstrual Pain

Some may experience pain or discomfort in one or both ovaries on certain days during a normal menstrual cycle. This cramping pain that is experienced during or just before menstruation is called dysmenorrhea and is due to the release of prostaglandins—hormone-like substances that, among other things, contract muscles—from the uterus.

Mittelschmerz Pain

About 40% of menstruating people experience pain every time an egg is released from the ovary. Known as Mittelschmerz pain, it may be uncomfortable but is harmless.

The type of pain and the degree varies significantly from person to person, so the symptoms you feel may not be the same as another person’s symptoms.

Ovarian Cyst

An ovarian cyst is a benign growth, usually filled with fluid, that may cause pain, discomfort, bleeding, menstrual irregularities, or no symptoms. Ovarian cysts are common and can develop at different points during the menstrual cycle.

Follicular cysts form when a follicle does not release an egg during ovulation. Corpus luteum cysts develop if the empty follicle (called the corpus luteum) does not dissolve as it should right after ovulation.

Symptoms of an ovarian cyst can also include:

• Pelvic pain
• Dull ache in the lower back and thighs
• Pain during sex
• Difficulty emptying your bowel or bladder
• Breast tenderness
• Frequent urination
  

Endometriosis

Endometriosis is a condition in which the endometrial lining of the uterus can develop in other areas of the reproductive system, like the ovaries, fallopian tubes, or even the bladder.

Endometriosis often causes severe cyclical or episodic uterine or ovarian cramping pain and intermittent bleeding. The pain may be particularly intense during a period or while having sex. Endometriosis may also lead to infertility due to adhesion (scar tissue) formation.

Other symptoms can include digestive issues such as constipation, diarrhea, nausea, and bloating.

Ectopic Pregnancy

An ectopic pregnancy is a pregnancy that takes place outside the uterus, usually in one of the fallopian tubes. It may cause moderate to severe ovarian pain, often on one side of the abdomen, and warrants emergency treatment.

In addition to many of the symptoms of a typical pregnancy, symptoms of ectopic pregnancy can also include:

• Dizziness or weakness
• Low back pain
• Abnormal vaginal bleeding
• Shoulder tip pain
• Vomiting

Pain and vaginal bleeding are the first signs of ectopic pregnancy, but these symptoms also often occur early in a healthy pregnancy.

Pelvic Inflammatory Disease (PID)

PID is an infection that may affect one or more reproductive organs, including the uterus, ovaries, fallopian tubes, and vagina. A sexually transmitted infection often causes this serious condition. It may lead to pain in various regions of the pelvis, including one or both ovaries, which is usually worse with sex.

Besides pain, someone with PID may experience the following symptoms:

• Fever
• Abnormal vaginal discharge
• Bleeding between periods
• Increased urination

Uterine Fibroids

Uterine fibroids are benign growths that arise from the lining of the uterus. Besides pelvic discomfort or pressure, a person with fibroids may experience abnormal uterine bleeding, back pain, and infertility.

Rare Causes

There are a few uncommon conditions that may cause ovarian pain. Given the seriousness of most of these, it's important not to ignore these symptoms, no matter the likelihood of these issues.

Ovarian Cancer

Although ovarian cancer can cause lower abdominal pain, it is not common. The disease often doesn't cause any symptoms or, if it does, they are more subtle ones like bloating, feeling full without eating much, pressure in the lower back, pain during intercourse, and urinary urgency or frequency.

Changes in your menstrual cycle that could cause pain or discomfort can also be a symptom of ovarian cancer. While ovarian pain can be indicative of the disease, it's not typical, and other possible causes are far more likely. Even so, it's important not to ignore ovary pain and to be evaluated by a healthcare provider.

Ovarian Remnant Syndrome

Ovarian remnant syndrome (ORS) is an unusual condition that occurs when ovarian tissue is left behind following an oophorectomy (the surgical removal of one or both ovaries).

Symptoms can also include:

• Pain during sex
• Painful or burning urination
• Pelvic pain (cyclic or constant)
• Urinary and bowel problems
  

Ovarian Torsion

This is an uncommon condition but a surgical emergency in which one of the fallopian tubes becomes twisted, potentially interrupting its blood supply and that of the ovary. This condition can cause severe and sudden pain due to ischemia (lack of blood flow) in these areas.

While the pain, nausea, and vomiting typically come on suddenly, it can also be preceded by several days or weeks of slight cramping.

Phantom Ovary Pain

With phantom ovary pain, a person continues to experience what seems like ovarian pain even after one or both ovaries have been removed. This is believed to be the result of persistent sensory nerve stimulation.

Referred Pain

Referred pain describes pain that feels like it is coming from one part of the body when it is actually coming from somewhere else. For example, pain originating from other organs such as the kidneys may cause pain that feels like it is coming from the ovaries.

When to See a Healthcare Provider

You should see your healthcare provider if you have new or different symptoms in the pelvic region, either with your period or in between periods.

More specifically, if you experience any of these symptoms, seek medical care:

• Persistent or severe pelvic pain
• Menstrual cycles that are longer than 38 days or shorter than 24 days
• Periods that last longer than seven days
• Menstrual bleeding that soaks through one or more tampons or pads every hour for several hours in a row
• Menstrual flow with blood clots that are a quarter size or larger
• Bleeding or spotting between periods
• Bleeding after menopause
• Bleeding during or after sex
• Bleeding or cramping if you have missed a period or have tested positive on a pregnancy test 
• Blood in your urine
• Fevers, chills, night sweats, nausea, or vomiting

Diagnosis

Diagnosing the cause of your ovary pain isn't straightforward, as issues with other reproductive organs, like your uterus, cervix, or even other body systems, may be at play. (The ovaries are located in the same general area as many other organs.)

If you see your healthcare provider for ovarian pain, the first thing they will do is take a medical history and perform a physical examination.

Medical and Sexual History

During your medical history, your healthcare provider will ask several questions about your pain, like when it started, how it feels, what makes it better and worse, and whether or not you have other symptoms like vaginal bleeding, vaginal discharge, or fever.

They will also ask you whether you have ever been diagnosed with a gynecological condition, such as endometriosis or uterine fibroids, and if you have ever undergone abdominal or pelvic surgery.

Your healthcare provider may also inquire about your sexual history, like how many partners you have or whether you have ever had a sexually transmitted infection.

Physical Examination

For ovarian pain, your healthcare provider will examine your abdomen, lower back, and sides. In addition to inspecting and pressing on these areas to check for tenderness, your healthcare provider will also perform a pelvic exam.

During the pelvic exam, samples of your vaginal fluid or from your cervix may be taken via a Pap smear to evaluate for infection or abnormal cells.

Labs and Blood Tests

A variety of tests may be ordered to confirm or discount a diagnosis, perhaps the most important one being a pregnancy test to rule out ectopic pregnancy.

Besides a pregnancy test, a urinalysis may be ordered to check for blood or infection. Likewise, for PID, your healthcare provider may order inflammatory blood markers, like C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR), or a complete blood count to check for an elevated white blood cell count (a sign of infection).

Imaging

Because there can be a variety of medical causes for your pain, do not be surprised if your healthcare provider orders imaging tests, such as a pelvic ultrasound or a computed tomography (CT) scan of your abdomen and pelvis.

Pelvic Laparoscopy

A pelvic laparoscopy is a surgical procedure sometimes used to determine what is causing pelvic pain. During a pelvic laparoscopy, your healthcare provider may take a tissue sample (biopsy).

Differential Diagnoses

A number of other conditions can cause pain that may be mistaken for ovarian pain. Some of these conditions can be serious:

• Gastrointestinal issues can include constipation. If your pregnancy and pelvic exam are normal, and your abdominal exam reveals focal tenderness, appropriate tests will be ordered. For example, a clinical history and digital rectal exam can diagnose constipation.
• Appendicitis can cause intense pain in the lower abdomen that can be similar to the pain of a ruptured ovarian cyst. A CT scan can help differentiate between appendicitis and a ruptured ovary.
• Diverticulitis can result in pain or discomfort that can be mistaken for ovarian pain. A CT scan of the abdomen can help diagnose diverticulitis.
• Urinary tract infections (UTIs) or kidney stones can cause pain that feels like ovarian pain. These conditions can often be ruled out fairly early with a normal urinalysis revealing no signs of infection and no evidence of blood. A CT scan can be used to diagnose a kidney stone if one is still suspected.
  

Treatment

Once the cause of your ovary pain is determined, you and your healthcare provider can move forward with devising a treatment plan that may be as simple as a few lifestyle changes to more involved resolutions, like taking prescription medication or undergoing surgery.

Lifestyle Therapies

If your ovary pain is related to your monthly cycle, lifestyle changes like getting adequate sleep, exercising, using relaxation techniques, and applying a heating pad can often help soothe your discomfort.

Medications

Depending on your diagnosis, your healthcare provider may recommend or prescribe medication.

For example, if home remedies like heat and rest are not easing your menstrual cramps, a nonsteroidal anti-inflammatory (NSAID) drug, which decreases the prostaglandin levels in your body, often helps. Check with your healthcare provider before taking an NSAID. People with certain conditions like bleeding disorders, certain allergies or GI issues, or kidney or liver disease should avoid these drugs.

Birth control methods like the Pill, patch, ring, or an intrauterine device (IUD) can also decrease menstrual cramps.

Another gynecological condition that requires medication is pelvic inflammatory disease. If diagnosed with PID, your healthcare provider will prescribe antibiotics. In more severe cases, a person may need to be hospitalized and receive the antibiotics intravenously (through a vein).

Surgery

For emergent conditions, like ovarian torsion or ectopic pregnancy, surgery is warranted. Surgery is also often performed as part of the treatment of ovarian cancer and may be used to remove uterine fibroids or endometrial tissue in severe endometriosis.

Summary

When you have pain in your ovaries, you might immediately be worried about ovarian cancer, but there's no reason to jump to that conclusion. There are many different reasons for ovarian pain, including cysts, endometriosis, some STIs, and even general medical problems that can cause ovarian pain.

It's always a good idea to call your healthcare provider for an exam if you're having pain to determine the underlying cause.