Possible Causes of Ovarian Pain

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Most women have experienced symptoms of pain or discomfort that could be considered pelvic or ovarian pain. There are many causes of this type of pain, including ovulation and menstruation, or a medical problem such as endometriosis or polycystic ovary syndrome (PCOS). Often, women who experience these symptoms are concerned about ovarian cancer. While ovarian pain can be indicative of the disease, it's not typically, and other possible causes are far more likely. It's important not to ignore ovary pain and to be evaluated by a physician.

Common Causes

Women have two ovaries, one on each side of the lower pelvic region, and they are symmetrical and should be the same size. Ovarian pain or discomfort can involve one or both sides, though that does not necessarily correlate with the severity or cause of the pain.

It can be difficult to distinguish ovarian pain from pain involving the urinary system or the colon, or other issues, in part because the ovaries are located in the same general area as other organs. That said, some women are successful in doing so, especially if the issue causing the pain is known and recurrent.

Because of the possibility that your ovary pain might involve something other than your ovary all together, it's important to know about the variety of conditions that can be responsible for how you are feeling.

  • Menstrual cycle: Women may experience pain or discomfort in one or both ovaries on certain days during a normal menstrual cycle. The pain can be mild, signaling to a woman that she will have her period in a few days, or it may be severe, prompting the need for medication. Some women experience ovarian pain during ovulation when an egg is released from the ovary, rather than around the time of menstruation. This harmless symptom is called mittelschmerz, German for "middle pain," and it occurs halfway through a menstrual cycle.
  • Ovarian cysts: A cyst is a benign growth, usually filled with fluid, that may cause pain, discomfort, bleeding, menstrual irregularities, or no symptoms at all. It is hard to know if you have an ovarian cyst because symptoms that do occur are typically mild and the amount of bleeding, if present, is variable. Your doctor may identify a cyst on an imaging test done in response to the presentation of symptoms or for some other reason entirely. Cysts can develop at different points during the menstrual cycle. Follicular cysts are formed if an egg is not released during ovulation, and corpus luteum cysts develop if the corpus luteum (egg sac) does not dissolve as it should right after ovulation. Small ovarian cysts may improve on their own, but some require interventional treatment.
  • Polycystic ovary syndrome (PCOS): Often associated with irregular periods or intermittently heavy bleeding, PCOS can cause ovarian pain or discomfort in addition to other symptoms caused by abnormal hormone production. Women who have PCOS have irregularities in hormone levels and cysts in the ovaries, which are eggs that have not fully developed. This condition typically causes more discomfort and menstrual irregularities than an ovarian cyst and can be diagnosed with imaging tests and blood tests that measure hormone levels.
  • Endometriosis: Endometriosis is a condition in which the endometrial lining of the uterus can develop in other areas of a woman's reproductive organs, like the ovaries and fallopian tubes. It often causes severe cyclical or episodic uterine or ovarian cramping pain and intermittent bleeding. Sometimes endometriosis causes an endometrial cyst on the ovaries. Your doctor can diagnose this with a gynecologic examination. This condition may last for years, even with treatment.
  • Pelvic inflammatory disease (PID): An infection that can begin with a urinary tract infection (UTI) or a sexually transmitted disease, PID can cause pain in various regions of the pelvis, including one or both ovaries. You might experience fevers, chills, and/or cloudy urine with a UTI or PID.
  • Constipation or gas:  Gastrointestinal issues can result in pain or discomfort that can be mistaken for ovarian pain and varies in severity, often improving on its own or after a bowel movement.
  • Referred pain: Pain in the pelvic region is notoriously non-specific. While it may seem like something is affecting your ovaries themselves, you might be experiencing pain as the result of another issue, such as a kidney stone or appendicitis.

Rare Causes

There are a few uncommon conditions that may cause ovarian pain. In general, your doctors can identify these conditions based on your physical examination and imaging tests.

  • Ovarian remnant syndrome: This is an unusual condition that can result if you have had surgery to remove your ovaries and some tissue was not completely removed. This could happen if you have endometriosis, for example, and there was a small area of endometrial or ovarian tissue that was not visualized during your surgery or that expanded after your procedure.
  • Ovarian torsion: This is an uncommon condition 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) to these areas. This is a medical, and possibly a surgical, emergency. 
  • Phantom pain: This refers to pain in an area that no longer exists. For example, a person who has had an amputation of the foot may continue to feel pain where that foot used to be. Similarly, you may continue to feel ovary pain even after your ovary has been removed. This is believed to be the result of persistent sensory nerve stimulation.
  • Dermoid cyst: This rare type of cyst forms in a woman before she is even born and is defined by hair, sweat glands, and other cells and tissues that get trapped in the skin. It causes pain, can be identified on an imaging test and must be surgically removed. Given its unique characteristics, many women worry that the cyst is actually an undeveloped fetus, which it is not.

During Pregnancy

In general, you should not experience severe cramping or ovarian pain during pregnancy. If you do, you should call your doctor as it could indicate an ectopic pregnancy. Moderate to severe ovary pain warrants emergency treatment.

An ectopic pregnancy is a pregnancy that takes place outside the uterus (where it is supposed to be) and is instead often in one of the fallopian tubes. Unfortunately, an ectopic pregnancy cannot survive due to the size and environment. Furthermore, it is a severe health risk to the mother, potentially leading to internal bleeding, infection, and death.

Relation to Ovarian Cancer

Again, though ovarian cancer can cause ovary pain, it is not common. In fact, the disease often doesn't cause any symptoms. In addition, ovarian cancer is a fairly rare form of cancer.  According to the National Cancer Institute, the disease is diagnosed in approximately 1 out of 10,000 women per year and causes death in about 1 out of 10,000 women per year.

All that said, it's important to keep up with your regular physicals and gynecological check-ups and to inform your doctor if ovary pain occurs so that a medical condition, ovarian cancer or otherwise, can be detected and treated in early stages when treatment is more likely to be successful.

For women concerned about ovarian cancer, here are some important facts worth noting:

  • The early stages of ovarian cancer can cause symptoms including pelvic or abdominal discomfortbloating, difficulty eating, feeling full, increased abdominal size, and urinary urgency or frequency.
  • In some women who have ovarian cancer, a mass or lump is felt during a routine pelvic examination. A mass can be a benign tumor growth, such as a cystadenoma, which is a noncancerous ovarian tumor. However, a mass is not always detectable in the early stages of ovarian cancer. Even when a mass is detected, it does not necessarily mean that you have ovarian cancer. 
  • Ovarian cancer is usually diagnosed with imaging tests. If there are indications that you may have cancer, your doctor will recommend that you have an ultrasound or a CT scan, which are imaging tests that can help assess the pelvic region, including your ovaries. 

When to See a Doctor

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

While the various causes of ovarian pain may have different features in terms of the characteristic type of pain and associated symptoms, it is better not to self-diagnose. For example, infections may be associated with fevers, but that's not a hard-and-fast rule. 

Signs that you should see your doctor include:

  • Pelvic pain daily for at least two to three weeks
  • Irregular bleeding, heavier or lighter bleeding, or increased or decreased bleeding with your periods
  • Blood in the urine
  • Fevers, chills, night sweats, nausea, or vomiting when you have your periods
  • Bleeding or cramping if you have missed a period or have tested positive on a pregnancy test 

Your doctor will take a medical history and do a physical examination, which will identify lumps, masses, and endometrial tissue. 

Because there can be a variety of medical causes for your pain, the next step may include further evaluation, such as imaging tests, hormone levels, or a biopsy, and you are likely to have a treatment plan shortly after your diagnosis. 

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