A pair of ovaries is an important part of the female reproductive system. The shape and size of each ovary are like an almond. It plays a very significant role in secreting female sex hormone, oestrogens, and in the formation and release of an egg for possible fertilization. Due to a wide range of activities to be performed in every menstrual cycle, the ovary goes through a lot of changes. Even a small problem in one function can lead to a chain of reactions leading to fertility and other reproductive system issues. These continuous functions of ovaries can make them vulnerable to problems like pain in ovaries, cysts, tumor, etc.
Pain in Ovaries
Ovaries are located in the lower abdomen, on either side of the uterus in the pelvic region. It has been observed that many women experience pain in their lower abdomen and pelvic region. In majority of cases, the reason of the pain lies behind the problems in the ovaries. A number of conditions such as occurrence of cysts, tumours, or pelvic inflammation diseases cause pain in the ovaries. Hence, persistent lower abdominal pain should not be ignored and women should consult gynecologist to know the cause of pain and to start with the treatment.
The pain in ovaries may be acute or chronic. The pain which is experienced quickly and persists for hours or few days is called as acute pain. In contrast, chronic pain develops gradually and remains for some months.
In some cases, it is continuous while in others, it is observed to be intermittent. Pain in ovaries or ovarian pain (OP) may be mild and go unnoticed. At times, it may get worse and interfere with daily activities (exercise or urinating).
What Can Cause Pain in Ovaries?
The pain in ovaries can be caused due to any of the following reasons:
- Ovulation as a Cause of Pain in Ovaries: During the mid-menstrual cycle, one might experience mild pain in ovaries which could be due to ovulation. There isn’t anything to worry about this as it is absolutely normal.
- Pain in Ovaries Caused Due to Ovarian Cysts: Cyst is any fluid filled sac. Cyst can develop anywhere in the body. Sometimes cyst/s develops in the ovaries during menstrual cycle. During a menstrual cycle, a follicle grows in the ovary, in which an egg or ova develop. This egg is released from the follicle to undergo fertilization. However, sometimes the follicle fails to break open to release the egg and keeps on growing to form Follicular cysts, which remain for 1-3 months. While at other times, the follicle does not dissolve after releasing the egg and forms corpus luteum cysts. There are two types of functional cysts – Follicle cysts and Corpus luteum cysts. They are called functional cysts since they are formed when the ovaries are in their normal functional state. Although most of these cysts are gone within few days, some persists grow to a large size and may bleed or twist the ovary and cause pain in ovaries.
- Pain in Ovaries Caused Due to Ovarian Tumors: The exact causative agent of ovarian tumor is not known. There is a genetic mutation in the cells of ovary, which changes a normal cell into an abnormal cell, which has abnormal growth characteristics. It grows rapidly and forms a mass of cells called as tumor. In initial stages, it is restricted to the ovaries, however in later stages it spreads to the other parts of the pelvic region, which causes pain in the ovaries and abdomen. The tumors could be either benign or malignant. Ovarian cancer commonly occurs in women above the age of 40 years and it is common in the age group of above 55 years. The risk is also high in women with family history of breast or ovarian cancer or who have never been pregnant. Presence of ovarian cancer can lead to pain in ovaries.
- Pain in Ovaries Caused Due to Endometriosis: Endometrium is the inner lining of the uterus. Every month the ovary produces an egg to be released in order to fertilize. During this time, the endometrium becomes thick in order to harbor and nourish the fetus. When the egg is not fertilized, the endometrium is shed in the form of bleeding called as menstruation. However, in some women this endometrium is not shed properly, rather it backflows through the fallopian tube to the abdominal cavity and grows elsewhere i.e. on fallopian tubes, ovaries, bowel and bladder and in rare cases in distant places in the body such as face or hand joints. This medical condition is called as Endometriosis. As the blood is sticky, every month during menstruation the woman feels intense pain even in the organs where the endometrium tissue has grown giving rise to pain in ovaries, fallopian tubes, and bowel, etc.
- Pelvic Inflammatory Diseases (PID) as a Cause for Pain in Ovaries: In some cases, the pelvic region gets infected due to the presence of sexually transmitted infections caused by Chlamydias and Gonorrhoea. If this infection spreads, then it can affect fallopian tubes, ovaries and uterus which lead to the pain in them. Pelvic inflammatory disease can also be a result of infections post childbirth, abortion, and any other pelvic procedure that is not done properly in a sanitized and hygienic condition.
- Pain in Ovaries due to Ovary Remnant Syndrome: Surgical procedures for removal of uterus and ovaries are called as hysterectomy and oophorectomy. In very rare cases, during surgery a small piece of ovary remains behind which grows to develop painful cysts. This can lead to pain in ovaries.
Symptoms or Characteristics of Pain in Ovaries
The symptoms or characteristics of pain in ovaries varies according to its causes. Following is the list of symptoms as per the cause:
- Symptoms or Characteristics of Pain in Ovaries due to Ovulation: This is characterized by a mild cramping pain in ovaries that lasts for only a few minutes to hours.
- Symptoms of Pain in Ovaries Due to Ovarian Cysts: Generally presence of cysts does not cause any pain in ovaries. However, in some cases pain is experienced, when it becomes large, it bleeds and breaks open. The characteristics of pain in ovaries due to cysts are observed to be:
- Irregular periods. Changes in menstrual cycle are more common with corpus luteum cysts.
- Pain before or after beginning of periods
- Pain during intercourse
- Bloating or swelling in the abdomen
- Sudden and severe pelvic pain which is associated with nausea and vomiting. It’s a sign of torsion or twisting of the ovary or rupture of a cyst with internal bleeding.
- Associated Symptoms with Pain in Ovaries due to Ovarian Tumors
- Symptoms Accompanied with Pain in Ovaries as a Result of Endometriosis
- Painful periods and painful menstrual cramps
- Heavy periods
- Pain during intercourse
- Characteristics of Pain in Ovaries caused by Pelvic Inflammatory Disease
- Irregular periods
- Pain during intercourse
- Vaginal discharge with smell
- Difficulty in urinating
- Symptoms of Pain in Ovaries due to Ovary Remnant Syndrome
- Pain during intercourse
- Difficulty in urinating
How is Pain in Ovaries Diagnosed?
The doctor does physical examination and enquires about the timing with regards to menstrual cycle, position and type of pain along with the medical/family history. Following the physical examination, depending on the type of causes, different diagnostic tests are used:
- Diagnosis of Pain in Ovaries due to Ovulation: Generally, the doctor asks the timing of the pain with regards to the menstrual cycle to identify this pain and no further investigation is required. This type of pain happens during the mid-cycle i.e., from the 11th-16th day of the menstrual cycle and lasts only for a few minutes to hours. In case the pain is more, an ultrasound is advised.
- Diagnosis for Pain in Ovaries due to Ovarian Cysts: Ovarian cysts are diagnosed using an ultrasound. This technology uses sound waves to create an image of the ovaries which allows understanding the size, location and content of the cysts.
- For Diagnosis of Pain in Ovaries as a Result of Ovarian Tumor: Advanced imaging technology such as MRI, CT scan and PET scan is used. These detect the presence and location of the tumor in the ovaries. For diagnosing the type of tumor, benign or malignant further tests like tissues biopsy is required. In addition, blood tests are performed to detect CA-125 protein which is secreted by the ovarian cancer cells in blood. If this protein gets detected then it is an indication that woman suffers from ovarian cancer. The advanced imaging techniques also helps in detecting if the cancer has spread to other organs of the body.
- To Diagnose Pain in Ovaries due to Endometriosis: Ultrasound and MRI scan are used. At times, Laparoscopy is performed using a lighted scope, which is inserted into the tiny hole of the abdomen to allow doctor to visualize ovaries and the severity of endometriosis.
- Pain in Ovaries due to PID is diagnosed by ultrasound, laparoscopy, blood and urine tests.
- Pain in Ovaries as a Result of Ovarian Remnant Syndrome is diagnosed using ultrasound, CT scan and MRI scan, which helps to create image of the remaining pieces of ovarian tissue.
How is Pain in Ovaries Treated?
The pain in ovaries is treated according to its cause as follows:
- Pain in ovaries due to ovulation is normal and there is nothing to be done for it as it lasts only for a few minutes to hours and subsides.
- Treatment for Pain in Ovaries Due to Ovarian Cysts: The treatment for ovarian cyst is not done right away; instead the doctor waits and observes the condition closely, since most of the times they go away on their own within one or two menstrual cycles. If it doesn’t go, then further treatment is done. In some cases, laparoscopy is performed to remove small cysts while in case of large sized cysts laparotomy is done. Birth control pills are given to relieve the pain from ovarian cysts, which in turn also reduces the formation of new cysts and also at times shrinks the existing ones.
- Treatment for Pain in Ovaries in case of Ovarian Tumors: The large invasive tumors are treated with surgery. The adjacent parts such as fallopian tubes, uterus and lymph nodes are also surgically resected if the woman is nearing the menopausal age, menopausal or if the tumor is cancerous. This is followed by chemotherapy if the tumor is cancerous. Postoperative chemotherapy is a combination therapy with a platinum compound and a Taxane (eg carboplatin and paclitaxel). In case of early stage ovarian cancers, less invasive surgery is done.
- Treatment of Pain in Ovaries as a Result of Endometriosis: This is done by means of pain medications such as ibuprofen, which relieves the pain of endometriosis. The doctor also prescribes birth control pills to prevent the monthly built up of uterine tissue on the ovaries and other areas. Hormonal therapy in form of Gonadotropin Releasing Hormone agonist (GnRH agonist) which reduces the amount of hormone estrogen and slows down the growth of endometriosis and limits its symptoms. Among the surgical procedures, Laparoscopy and Laparotomy are performed to remove endometrium tissues present on the ovaries and other places. When this condition is extensive, hysterectomy is performed to remove uterus and at times even the ovaries.
- Treatment for Pain in Ovaries for Pelvic Inflammatory Diseases: This is treated by means of antibiotics to treat the infections by killing the causative agents.
- Treatment for Ovary Remnant Syndrome to Reduce Pain in Ovaries: This includes Laparotomy or laparoscopy, as these surgical procedures are done to remove the remaining piece or pieces of ovary causing pain.
Complications of Pain in Ovaries
When pain in ovaries is caused due to presence of cysts and endometriosis, complications have been observed. In case of cysts they can bleed, break open, twist and show signs or changes as that of cancer. While in case of endometriosis it leads to infertility, chronic pelvic pain and disruption of involved organ systems (ruptured cysts). Cancer itself is a life-threatening condition irrespective of the place of occurrence in the body.
An increasing number of women experience pain in ovaries, which occurs due to a number of causes. If the cause gets detected correctly, then imparting appropriate treatment for pain in ovaries becomes easy. This in turn allows women to live a better life in future. The pain in ovaries during mid-menstrual cycle could be due to ovulation which has nothing to worry about. However, the pain must not be ignored as it can also indicate serious issues with the ovaries like cancer and hence medical advice must be taken at the earliest.