Causes of Ovary Pain and Treatment Options

The ovaries, located on each side of a woman's pelvis, are responsible for producing and releasing eggs needed for fertilization. It's perhaps not surprising, then, that the most common causes of what people consider ovary pain, which is often felt in the lower abdomen, pelvis, or lower back, are related to ovulation and menstruation. However, a gynecological problem like endometriosis or pelvic inflammatory disease, or even a medical condition affecting your digestive or urinary system can be to blame. This can make the diagnosis tricky.

It's important to know about the variety of conditions that can be responsible for how you are feeling. Some may warrant your concern, while others may relieve it.

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

Some women experience ovarian pain mid-cycle during ovulation, when an egg is released from the ovary, instead of during menstruation. Known as mittelschmerz pain, it may be uncomfortable but is harmless.

An ovarian cyst is a benign growth, usually filled with fluid, that may cause pain, discomfort, bleeding, menstrual irregularities, or no symptoms at all. Ovarian cysts are common and 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 urgent medical treatment, like a large cyst that ruptures or bursts. This may cause sudden, sharp, and severe one-sided pelvic pain.

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, fallopian tubes, or on 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 woman's period or while having sex. Endometriosis may also lead to infertility due to adhesion (scar tissue) formation.

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 and warrants emergency treatment.

PID is an infection that may affect one or more reproductive organs including the uterus, ovaries, fallopian tubes, and vagina. This serious condition is often caused by a sexually transmitted infection and may lead to pain in various regions of the pelvis, including one or both ovaries, that is often worse with sex.

Besides pain, women with PID may experience fevers, chills, an abnormal vaginal discharge and/or bleeding, as well as symptoms that mimic that of a urinary tract infection, like burning with urination.

Uterine fibroids are benign growths that arise from the lining of the uterus. Besides pelvic discomfort or pressure, a woman with fibroids may experience abnormal uterine bleeding, back pain, constipation (if a fibroid is pressing on the bowel), urinary difficulties (if the fibroid is pressing on the bladder), and infertility.

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.

Although ovarian cancer can cause ovary pain, it is not common. In fact, the disease often doesn't cause any symptoms or, if it does, they are more subtle ones like bloating, feeling full without eating much, and urinary urgency or frequency.

This is an unusual condition that can result if you have had surgery to take out your ovaries and some tissue was not completely removed. This could happen if you have endometriosis and there was a small area of endometrial or ovarian tissue that was not visualized during your surgery or that expanded after your procedure, for example.

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) to these areas.

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

You should see your doctor 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, be sure to seek out 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 
• Bleeding after menopause
• Blood in your urine
• Fevers, chills, night sweats, nausea, or vomiting

Diagnosing the cause of your ovary pain isn't straightforward, as issues with other reproductive organs, like your uterus or 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 doctor for ovarian pain, the first thing she will do is perform a medical history and physical examination.

During your medical history, your doctor will ask you 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.

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

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

For ovarian pain, your doctor will examine your abdomen and lower back and sides. In addition to inspecting and pressing on these areas to check for tenderness, your doctor 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.

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 an infection. Likewise, for PID, your doctor 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).

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

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

Gastrointestinal issues, like constipation or even more serious conditions, like appendicitis or diverticulitis, can result in pain or discomfort that can be mistaken for ovarian pain.

If your doctor suspects a gastrointestinal problem instead of a pelvic problem (for example, if your pregnancy and pelvic exam are normal, and your abdominal exam reveals focal tenderness), she will proceed with appropriate tests. For example, a CT scan of the abdomen can diagnose appendicitis and diverticulitis. Often, a clinical history and digital rectal exam can diagnose constipation.

Likewise, a urinary tract infection (UTI) or kidney stone can cause pain that feels like ovarian pain. These conditions can often be ruled out fairly early with a normal urinalysis—that is, one that reveals 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.

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

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.

Depending on your diagnosis, your doctor may recommend or prescribe medication.

For example, if simple 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. Be sure to talk to your doctor before taking an NSAID; women with bleeding disorders, an aspirin allergy, kidney or liver disease, or stomach problems should not take these drugs. Besides NSAIDs, birth control methods like the Pill, patch, ring, or the intrauterine device can also decrease menstrual cramps.

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

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.

On a final note, it's common for women who experience ovary pain to be concerned about 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 physician.

In addition, be sure 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.