Is My Pain From an Ovarian Cyst or Appendicitis?

Ovarian cysts don't always cause symptoms and are usually not dangerous. But when an ovarian cyst ruptures, the pain is similar to that of acute appendicitis.

Your right ovary and your appendix are close neighbors in the abdomen. That makes it hard to pinpoint the problem based on pain alone.

This article discusses the similarities and differences between ovarian cysts and appendicitis.

Location of Ovaries vs. Appendix

The right ovary and the appendix are in the lower right quadrant of the abdomen. Your ovaries are about the size and shape of an almond. They rest on each side of the uterus, right below the opening of the fallopian tubes.

Not far away lies your appendix. It's a thin, 3- to 4-inch tube attached to the large intestine, also known as the colon.

There Are Many Abdominal and Pelvic Pain Causes

Ovarian cysts are relatively common in women of reproductive age. And acute appendicitis is the most common cause of non-gynecologic pelvic pain.

A lot is going on in your abdomen, which makes a diagnosis quite challenging. Some other causes of right-sided abdominal pain include:

• Gastrointestinal issues, such as irritable bowel syndrome (IBS) and constipation
• Gynecologic issues, such as ectopic pregnancy, pelvic inflammatory disease (PID), and uterine conditions, including menstrual cramps and endometriosis
• Urological issues, such as urinary tract infection (UTI) and kidney stones

Abdominal pain can also be due to:

• Vascular and cardiac problems
• Respiratory problems
• Musculoskeletal conditions
  

Right-Sided Pain: A Ruptured Ovarian Cyst or Appendicitis?

Right-sided abdominal pain could signal a ruptured ovarian cyst or appendicitis.

Overlapping Symptoms

A ruptured ovarian cyst and an inflamed appendix can both cause:

• Pain in the lower right abdomen
• Abdominal bloating
• Nausea, vomiting
• Fever

Distinct Symptoms 

While pain from an ovarian cyst may come and go, pain from a ruptured ovarian cyst is likely to be sudden and sharp. In addition to the lower abdomen, you might also have pain in your lower back. Other symptoms may include vaginal spotting or bleeding and feeling dizzy or faint.

Pain from appendicitis will likely start near the belly button, then move to your lower right side. In some people, it begins in the lower abdomen. The pain worsens when you breathe deeply, touch it, cough, or sneeze. Other symptoms of appendicitis may include:

• Upset stomach
• Loss of appetite
• Constipation or diarrhea
  

Less Commonly, Both Can Occur 

It's not common, but the lifetime risk of having acute appendicitis and symptoms of ovarian cysts at the same time is about 6.7% to 7%.

There are case reports of acute appendicitis occurring along with the following:

• Ruptured endometrioma (an ovarian cyst that stems from endometriosis)
• Giant ovarian cyst
• Hemorrhagic (bleeding) ovarian cyst

When to Seek Immediate Medical Attention

A ruptured ovarian cyst and appendicitis both need medical care. Signs that you should seek immediate assistance are:

• Sudden or severe abdominal pain
• Fever
• Vomiting
• Dizziness, weakness
• Rapid breathing
• Heavy bleeding
  

Complications From Ovarian Cysts 

In some cases, a ruptured ovarian cyst may cause severe blood loss, a life-threatening event.

Advocating for Yourself in the ER

Abdominal pain is one of the most common reasons people visit the emergency room (ER). But even in the busiest ER, your pain is important. Some ways to advocate for yourself in the ER include:

• Build support: Bring a family member or friend to help ask questions and check on progress.
• Be clear and concise: Explain why this is an emergency, your pain level, other symptoms, and what concerns you most.
• Give details: Mention if you've already been diagnosed with an ovarian cyst or had them in the past. Be prepared to report other health conditions and any medicines you take.
• Don't fear embarrassment: Report symptoms such as vaginal bleeding, pain during sex, and urinary and bowel problems.
  
• Push back on dismissals: Firmly disagree if someone tells you it's "in your head." You know your body better than anyone, and you deserve better answers.
• Be vocal: Ask questions and ask for clarification if you don't understand the answer.
• Notify providers: If you have a primary care physician or appropriate specialist, notify them that you're in the ER and why. Plan a follow-up visit now.

Diagnostic Process

There are many possible causes of abdominal pain, so it can take time to get answers. Your healthcare provider will likely start by asking about your symptoms and medical history and then perform a physical examination. To help determine the cause of abdominal pain, you may need:

• Imaging tests such as ultrasound, CT (computed tomography) scan, MRI (magnetic resonance imaging)
• Pregnancy test
• Blood tests and urine tests to check infections and other causes of pain
• Vaginal culture to check for pelvic infection
  

Appendicitis Recovery 

A burst appendix can lead to a potentially deadly peritonitis infection, so appendectomy is almost always recommended. Surgery methods include traditional surgery and laparoscopy. If your appendix has already burst, you'll need a shunt for a few days to help drain fluids and prevent infection from spreading.

If your appendix didn't burst, recovery should take a few days. Recovery from a burst appendix will take a little longer. You'll also need to take antibiotics.

Antibiotics vs. Surgery

Sometimes, your provider will recommend treatment with antibiotics instead of surgery. Research suggests that 40% of those treated conservatively will need surgery within five years.

Treating with antibiotics over surgery is generally not recommended for:

• Children
• Older adults
• Pregnant people
• People who are immunocompromised
• People who have developed sepsis (serious condition in which the body has an extreme response to an infection)

Not All Ovarian Cysts Rupture

Ovarian cysts don't always cause symptoms, so you may not even realize you have one. Simple ovarian cysts often clear up on their own. It's unclear why some cysts rupture and others do not, but they may be more likely to break open during sexual activity or strenuous exercise.

Surgery isn't always necessary. Your healthcare provider may recommend pain medications and watchful waiting.

Treatment for Ones That Do

Treatment for a ruptured ovarian cyst may require hospitalization, intravenous (IV) fluids, and pain medications.

If there's a lot of internal bleeding, you may need emergency surgery. The surgeon can do this with a traditional incision or laparoscopically. The surgeon will remove excess fluids and blood clots. Once bleeding is under control, they can remove the cyst or the entire ovary.

Summary

Most ovarian cysts are harmless and may not cause symptoms. A ruptured ovarian cyst can cause sudden, severe pain. Because the right ovary and the appendix are close together, it's hard to tell where the pain originates. There are also many other reasons you might have abdominal pain.

If you have unexplained abdominal pain, consult with a healthcare provider. If the pain is severe or accompanied by other symptoms, vomiting, fever, or unusual bleeding, get to an emergency room as soon as possible. Ruptured ovarian cysts and appendicitis require immediate medical attention.