It is not uncommon to experience pain arising from the ovaries, especially around the time of ovulation. Usually it is a mild discomfort but some women do experience pain despite not having any disease or disorder for the area. In the diseased state it is often difficult to isolate ovarian pain from pain arising in surrounding structures. However, the presence of other gynecological symptoms may infer that pain felt in the region of the ovaries may indeed be from the ovaries or from another female reproductive organ. Sometimes this may be due to serious and even life-threatening diseases. Therefore persistent ovarian pain, or ovarian pain that is worsening with/without other symptoms should be investigated.
Meaning of Ovarian Pain
Ovarian pain simply means that there is pain originating from one or both ovaries. It is often one-sided, arising from either the right or left ovary. The fallopian tubes may or may not be involved, as with adjacent parts of the female reproductive organs. It is possible that pain arising from some pathology in the fallopian tubes may be the origin of the pain and not the ovaries itself. Fallopian tube pain is as difficult to isolate as ovarian pain when there are no other symptoms. However, many women are familiar with ovarian-related pain and discomfort due to ovulation and are able to identify it as being an ovary-related problem.
Ovarian Pain Location
The ovaries are located on either side of the uterus. The fallopian tubes connect the ovaries to the uterus to allow for egg cells released from the ovary to enter the uterus. There are several pairs of ligaments that also connect the ovary to the uterus and pelvic wall and support it in its position. It is easier to identify the location of the ovaries based on the position of the uterus. In women who are not pregnant, the uterus is located slightly above and behind the bladder. Behind the uterus lies the rectum.
Since the ovaries are on either side of the uterus, pain will obviously be felt in this area which means on either side of the midline. Most women will describe it as lower abdominal pain, and it is usually one-sided. However, it is not always as simple to isolate. Sometimes the pain can be felt closer to the what we refer to as the hip bones, which is actually the bony protrusion of the pelvic girdle. It is usually a deep lying pain as compared to abdominal muscle pain or bladder discomfort.
Signs and Symptoms
Ovarian pain is a symptom itself, and not a disease. Other symptoms may also arise which can prove useful in indicating that the pain is arising from the ovaries or other female reproductive organs. These concomitant symptoms may include:
- Vaginal bleeding, whether relating to menstruation or not. It may be heavy, light, spotting or sometimes the menstrual period may be absent altogether.
- Vaginal discharge that may range in color (clear, white, yellow, green or brown), viscosity (thick mucoid or thin watery) and may also have an offensive odor (fishy, rotting or putrid odor).
- Hormonal disturbances resulting in symptoms like breast tenderness or abnormal hair growth in women.
- Nausea and/or vomiting particularly worse in the morning may be a sign of pregnancy (morning sickness).
- Burning and itching of the vagina or vulva.
Left or Right Ovary Pain
The pain is more often one-sided – it may be isolated to or worse on the left side or the right side. This one-sided pain usually indicates which ovary is diseased. However, it is also possible that the pain may not be related to the ovaries or fallopian tubes. The side where the pain occurs may therefore be significant in isolating non-gynecological causes of the pain.
It depends on the surrounding organs, particularly the parts of the gastrointestinal tract. Left ovary pain may instead be due to problems with the descending or sigmoid colon while right ovary pain may be rather be appendicitis. For possible causes, refer to left lower abdominal pain and right lower abdominal pain.
Causes of Ovarian Pain
Pain when the ovary releases and egg is a common ovulation symptom. It is known as mittelschmerz or commonly as mid-cycle pain. because it occurs around the middle of two periods. This is the most common cause of ovarian pain although it is not obvious for every women. Mittelschmerz may be described as mild discomfort or cramping pain. It lasts for a few days at most but period pain may occur a short while thereafter.
An ectopic pregnancy is where a fertilized egg implants within the fallopian tubes or elsewhere instead of the uterus. It should be considered among the common causes in women of reproductive age, particularly when the one-sided pain is severe and there is a history of recent intercourse. If an ectopic pregnancy is left untreated it can be life-threatening. Early treatment may not be able to save the current pregnancy but it will not affect future chances of falling pregnant.
Viruses, bacteria, fungi or protozoa may cause infections of the ovaries and surrounding organs.
- Oophoritis refers to inflammation of the ovaries and salpingitis is inflammation of the fallopian tubes. Both these conditions usually occur together. It is usually due to an infection although it may occur with other causes like trauma and autoimmune conditions.
- Pelvic inflammatory disease (PID) is the term for infection of the female reproductive organs and not specifically the ovaries. It is often due to a sexually transmitted infection (STI).
- Abscess is a collection of pus. In terms of ovarian pain it may occur in the ovary (ovarian abscess) and often extends into the fallopian tubes or it may be elsewhere in the pelvic cavity (pelvic abscess).
A number of abnormalities in cell growth can give rise to masses within or around the ovaries.
- Tumors are abnormal growths that occur in the ovary or other female reproductive organs. These growths can be benign (non-cancerous) or malignant (cancerous). Ovarian cancer is the most common cause of cancer death from any type of cancer affecting the female reproductive organs.
- Cysts are thin-walled cavities containing fluid. Although cysts may develop in the ovaries at some point or the other during life, most resolve on its own and never cause any symptoms. Polycystic ovarian syndrome (PCOS) is a condition where there are multiple cysts in the ovaries along with hormonal imbalances and it is often difficult to fall pregnant.
- Endometriosis is where the inner tissue of the uterus (endometrium) grows outside of the uterus. The ovaries is one of the more common sites where this endometrial tissue can implant. This tissue responds to the hormonal changes in the menstrual cycle in the same way as the tissue normally inside the uterus.
- Scar tissue may form with inflammatory conditions and even after surgery. Although it may not cause any problems, scar tissue can affect normal functioning in a number of ways where pain may arise.
Injury to the ovaries may occur through a number of different ways. Mechanical injury may occur with surgery, a blow to the pelvis or with penetrating injuries. An important electromagnetic cause that needs to be considered is radiation exposure. It is more likely to occur with radiation therapy to the pelvis. It is important to note that injury to the ovaries cannot occur with sexual intercourse and is unlikely to occur with diagnostic investigations involving the female reproductive organs, or with surgical procedures to the uterus, cervix or vagina.