Perimenopause Ovary Pain: Causes and Treatment

Ovarian pain is felt in the lower abdomen, pelvis, and lower back. It may be persistent, come and go, be dull, or progress to sharp bursts of pain. 

Perimenopause is the time leading up to menopause. Menopause is when a person has no longer had a menstrual period for 12 consecutive months. During perimenopause, ovarian pain may originate from the reproductive system. For example, the cause could be pregnancy, ovulation, menstruation (period), endometriosis, ovarian cysts, uterine fibroids, or pelvic inflammatory disease (PID). 

This article also includes causes outside the reproductive system that can result in similar pain and symptoms. Here you will find information about diagnosis, testing, treatment, and prevention of ovarian pain during perimenopause. 

Common Causes

Ovarian pain, abdominal pain, and other sources of pelvic pain are often hard to differentiate. Symptoms that accompany it may help narrow down the cause. While this list is not exhaustive, the following are common causes. 

Ovulation

Ovulation usually occurs once a month, when one of the ovaries releases an egg. If the egg is not fertilized and thus not resulting in pregnancy, the uterine lining is shed about 14–16 days later. This shedding is what causes bleeding during a menstrual period. 

Ovulation pain is also known as mittelschmerz, or mid-cycle pain. It is usually located on one side of the pelvis and ranges in intensity. At times it is described as a dull pain, but it may also be a sudden, sharp pain. You may experience headaches, stomach problems, or malaise (general feeling of not being well) during ovulation.

Menstrual Pain

Menstrual cramping (dysmenorrhea) may occur or may worsen during perimenopause. Worse cramping may be from changes in hormones or one of the other causes listed below. 

Endometriosis

Endometrial tissue usually develops inside the uterus and is shed during a monthly period. When this tissue grows outside of the uterus, it is called endometriosis. This endometrial tissue outside the uterus still reacts to hormonal changes, causing bleeding inside the pelvis. This can cause severe cramping and heavy menstrual flow.

Uterine Fibroids

Uterine fibroids are noncancerous tumors located in the uterus and may cause heavy bleeding with worse cramping. 

Ovarian Cysts

Ovarian cysts are fluid-filled masses that grow on one or both ovaries. Some go undetected and are absorbed back into the body. Larger ovarian cysts can cause pain on either or both sides. This pain is usually described as a dull ache but may progress to a sharp pain if it ruptures or twists, cutting off its blood supply, a condition called ovarian torsion. Complications of ovarian cysts may cause symptoms similar to appendicitis. 

Enlarged cysts may also cause symptoms such as:

• Fullness in the abdomen 
• Irregular periods
• Painful sex
• Changes in bowel or urinary habits
• Painful periods

Pelvic Inflammatory Disease (PID)

Pelvic inflammatory disease (PID) is an infection in the female reproductive organs. One cause of PID is sexually transmitted diseases (STDs), such as chlamydia and gonorrhea. PID is often accompanied by:

• Lower abdominal or pelvic pain
• Fever
• Unusual vaginal discharge 
• Foul-smelling vaginal discharge 
• Pain or bleeding during sex
• Burning while peeing
• Bleeding between periods

Ectopic Pregnancy

An ectopic pregnancy happens when a fertilized egg implants outside of the uterus. Unfortunately, the fetus cannot survive, and it is a life-threatening emergency for the mother, as well. You may feel severe cramping on both sides of the lower abdomen along with shoulder pain, dizziness, weakness, and large amounts of internal or vaginal bleeding.

Rare Causes

Ovarian Torsion

Ovarian torsion is when an ovary gets twisted and its blood supply is cut off, causing severe pelvic pain, usually on one side. It’s often accompanied by nausea and vomiting and requires emergency surgery. 

Ovarian Cancer

Ovarian pain from ovarian cancer is rare. It is more severe and persistent than pain from a menstrual cycle. Symptoms may also include vaginal bleeding, bloating, feeling full quickly, and urinary urgency or frequency.

Polycystic Ovary Syndrome (PCOS)

PCOS is a condition in which the ovaries produce extra androgens, which are considered male sex hormones, although women have them too. PCOS can cause ovarian cysts or prevent ovulation. People with PCOS often experience irregular periods, weight gain, infertility, and excess body hair.

Ovarian Remnant Syndrome

Ovarian remnant syndrome (ORS) occurs when leftover ovarian tissue is present after an oophorectomy (surgery to remove one or both ovaries). It can delay menopause and cause cyclic or constant pelvic pain. Symptoms of ORS also include painful sex, urination, and bowel movements.

When to See a Doctor 

Call your doctor if you are experiencing any of the following:

• Increased period pain or menstrual flow: If you have heavier menstrual flow or period pain that worsens or lasts longer than the first two days and does not improve with treatment 
• Pregnancy: If you suspect you are pregnant or have had an at-home positive pregnancy test
• Vaginal bleeding after menopause: If vaginal bleeding occurs after menopause 
• Pelvic pain: If you are experiencing any type of pelvic pain

When to Seek Emergency Medical Attention

Seek emergency medical attention when you have sharp pelvic pain, especially pain on one side, or if you are experiencing any of the following in addition to this pain:

• Vaginal bleeding
• Blood in the urine
• Nausea or vomiting
• Dizziness or fainting
• Low blood pressure
• Shoulder pain
• Rectal pressure
• Fever (over 100.4 degrees)
• Pregnancy
• Have an IUD (intrauterine device, used for contraception) or have had a tubal ligation (tubes tied)
• Dark or black stool
• Vomiting blood
• Chest pain or difficulty breathing

Pain Thresholds

When communicating your pain level, using a guide such as the numeric pain scale here may be helpful, with zero indicating no pain and 10 being the worst pain ever experienced:

• Mild pain: Mild pain is usually between a level one and three. It’s there, it’s annoying, but you adapt, and it doesn’t disrupt your daily activities. 
• Moderate pain: Moderate pain is usually between a level four and ten. It disrupts your daily activities and makes it more difficult to complete tasks such as going to work.
• Severe pain: Severe pain ranges from level seven to 10. It keeps you from your normal activities and disrupts sleep, social events, or physical activities. You may not be able to speak, or it may cause you to moan or cry. Level 10 is the worst pain possible and feels unbearable.
  

Diagnosis

Self-Checks/At-Home Testing 

• Period tracker: Tracking your period helps you notice if the pain is during ovulation or before your period, and it helps you recognize missed periods.
• Over-the-counter test kits: At-home urine tests can check for urinary tract infections (UTIs), pregnancy, and ovulation. Call your doctor if they indicate you have a UTI or are pregnant. 
• Symptom tracker: Communicating symptoms that come along with ovarian pain can help the healthcare team with your diagnosis.

History and Physical Examination

A detailed history and physical are essential in diagnosing the root cause of pain. The healthcare team may ask you questions about your pain, medical history, sexual activity, and menstrual periods. They may also perform a pelvic exam, Pap smear, and sexually transmitted disease (STD) screening. 

Labs and Tests 

• Blood or urine tests: Ruling out pregnancy through urine or blood tests is a crucial first step because perimenopausal people can still become pregnant. Blood and urine tests may also check for concerns such as infection.
• Vaginal or cervical swabs for testing: This test involves taking a sample from the vagina or cervix to see what microorganisms are present. 

Imaging 

• X-rays: X-rays use electromagnetic energy to produce images of bones and internal organs.
• Ultrasound: An ultrasound, or sonography, is a noninvasive technique that most people associate with monitoring a baby during pregnancy. It is also helpful in viewing other parts of the abdomen and pelvis. 
• Transvaginal utlrasound: A transvaginal ultrasound provides good images of the ovaries, endometrial lining, and uterus.
• Computed tomography scan (CT scan): This technique is often called a CAT scan and combines X-rays and the computer to provide detailed images.
• Magnetic resonance imaging (MRI): An MRI uses a strong magnetic field to produce a two- or three-dimensional detailed image of an internal structure.

Laparoscopy

Laparoscopic surgery may be used as a diagnostic tool to visualize your internal organs if imaging results are not clear. 

Differential Diagnosis 

It can be tricky to diagnosis the underlying cause of pelvic or abdominal pain because that area of your body is also home to the bladder, kidneys, intestines, and appendix. Your healthcare provider will use a detective-like process called a differential diagnosis to ensure the correct diagnosis. 

Providers begin with a history and physical that provides clues about what to do next. They may order diagnostic tests such as urine and blood tests. These tests may point them in the direction of common causes such as pregnancy, UTIs, STDs, and appendicitis. If they need to evaluate further, they may order imaging tests, perform advanced testing, or refer you to a specialist.

Your healthcare provider will piece the history, physical, and diagnostic tests together like a puzzle to look for the root cause of your symptoms. 

The following are conditions that can cause pain that mimics ovary pain. Depending on your symptoms, your healthcare provider may want to run tests to rule out problems in these nonreproductive organs. 

Problems in the Urinary System

In addition to pelvic, abdominal, or lower back pain, infections in the urinary system may cause:

• Frequent or painful urination
• Blood in the urine
• Urinary urgency
• Red or cloudy urine 
• Fever or chills
• Nausea or vomiting
• Back or flank pain

Kidney stones create a sharp, cramping pain in the lower back and sides that may move to the lower abdomen. This type of pain comes on suddenly and comes in waves.

Uncomplicated UTIs, kidney infections, and kidney stones are usually diagnosed through imaging, urine, and blood testing. More complex conditions affecting the urinary tract may require advanced testing and treatment from a urologist. 

Gastrointestinal (GI) System

Gastrointestinal (GI) diseases such as irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), or parasitic GI infections may cause abdominal cramping. Women are at higher risk of IBS, and the symptoms often get worse around a period. Other symptoms include bloating, gas, alternating diarrhea and constipation, and mucus in the stool.

Sometimes GI diagnoses are made through blood tests, stool samples, and imaging, however, some may be diagnosed by ruling out other causes. 

Appendicitis

Appendicitis, or inflammation of the appendix, can cause severe abdominal pain. Symptoms usually come on suddenly, change, and get worse. It often hurts worse when you cough, sneeze, or move. It may also cause:

• Fever
• Swollen abdomen
• Constipation or diarrhea
• Lack of appetite
• Nausea and vomiting 
• Inability to pass gas

Appendicitis is usually diagnosed through blood work that tests for infection and imaging.

Treatment 

Treatment is based on the underlying cause of the pain. It may include one or a combination of the following.

Lifestyle Treatment Options 

Healthy lifestyle changes such as a nutritious diet, exercise, rest, relaxation, and stress reduction can help with some conditions such as PCOS and menstrual cramps.

At-Home Treatments

If you are experiencing mild pain from ovulation or your menstrual period, home treatments might include:

• A heating pad or hot water bottle for 20 minutes
• Heat wraps or patches (made especially for menstrual pain)
• Warm bath or shower
• Deep breathing
• Gentle massage of the abdomen
• Plenty of water to reduce overall inflammation
• Lidocaine (numbing) patches (for the lower abdomen or back)

More severe conditions may require prescription medicine or surgery. 

Doctor-Led Treatments

Depending on the cause of your pain, your doctor may recommend one or more of the following treatment methods:

• Over-the-counter (OTC) medications: If menstrual cramping or ovulation is the underlying cause, OTC nonsteroidal anti-inflammatory drugs (NSAIDs) such Advil or Motrin (ibuprofen) or Aleve (naproxen sodium) may help. Tylenol (acetaminophen), a non-NSAID may also help, especially if you can't take NSAIDS. If a yeast infection is a problem, the doctor may recommend an OTC antifungal cream. 
• Birth control: The doctor may prescribe birth control pills for painful menstrual cycles or painful ovulation to prevent ovulation and regulate your period.
• Prescription pain medication: Pain not controlled by NSAIDs may require a prescription for stronger pain medication. 
• Antibiotics: Underlying conditions such as PID, UTIs, kidney infections, and appendicitis require antibiotics. 
• Diflucan (fluconazole): Diflucan is an oral medication used to treat yeast infections. 
• Vaginal estrogen: Vaginal estrogen may be prescribed for perimenopausal and menopausal people to slow down vaginal tissue thinning, decreasing the risk of UTIs. 
• Surgery: Underlying problems such as endometriosis, fibroids, and ovarian remnant syndrome (ORS) may require surgery. An ectopic pregnancy, ovarian torsion, or a ruptured appendix will require emergency surgery.

Complementary and Alternative Medicine (CAM) 

Massage, aromatherapy, and herbal therapy may help with menstrual pain.

Acupuncture is popular in treating many health concerns. However, there is not enough science to support its use for menstrual pain. There are preliminary findings that show acupressure, a self-treatment, may provide relief.

Studies show that heat, yoga, and transcutaneous electrical nerve stimulation (TENS) work well for menstrual pain.

Prevention 

Many conditions, such as a ruptured ovarian cyst, are random. It is not known why they occur or how to prevent them. 

Maintaining a healthy diet and exercising can help you lose weight and regulate insulin more efficiently. These healthy habits may decrease the risk of developing PCOS.

Risk factors for ectopic pregnancy include:

• A history of PID 
• Tubal ligation (tubes tied for contraception)
• Endometriosis
• STDs
• IUDs 
• Being 35 or older
• Smoking

If a UTI or kidney infection is the culprit, here are a few tips to help reduce the chance of bacteria entering the urinary tract:

• Empty your bladder more often, at least every four hours during the day
• Urinate after sexual activity
• Drink more water 
• Practice safer wiping and cleaning (wipe front to back, avoid irritating feminine products, and wash with water only in that area)
• Ask your doctor if your form of contraceptive could be the problem (for instance, diaphragms or spermicides may increase your risk)

A Word From Verywell

Perimenopause brings on changes in your body, such as period irregularities, increased menstrual cramps, heavier blood flow, and ovulation pain. These changes can be unpleasant, interrupt your daily life, and may even be debilitating. Don’t be embarrassed to talk to your healthcare provider about any of your symptoms. There could be an underlying cause that needs treatment or symptoms that can be managed.