Pain in the ovaries
introduction
There are a variety of causes that can cause ovarian pain. Often these symptoms can occur in connection with the menstrual period, but serious reasons such as inflammation, tissue growth or tumors can also cause pain.
Causes of Ovarian Pain
There are a variety of causes that can lead to discomfort or pain in the ovaries, including:
- Cycle-related complaints
- Inflammation of the ovaries
- pregnancy
- Tissue growths
- Stem rotation
- cancer
- Ovarian thrombosis
- Psychosomatic complaints
Cycle-related ovarian pain
During a woman's monthly cycle, hormonal influences cause an egg cell and its surrounding follicle to mature. When ovulating mid-cycle, some women experience what is known as middle pain, which is caused by the rupture of the mature follicle.
They typically occur unilaterally in the currently active ovary. During the menstrual period, some women also experience pain in the ovaries, which is triggered by the contractions of the uterus.
Read more about this on our website Post-period ovarian pain and ovulation pain
pregnancy
During pregnancy, many women occasionally experience pulling in their ovaries. This can be caused by the baby's pressure on the pelvic organs.
However, greater pain in an ovary can also result from what is known as an ectopic pregnancy. The fertilized egg nests in the fallopian tube instead of in the uterus. This is dangerous and needs to be fixed as the fallopian tube can rupture once the embryo has grown too large.
Read more on the topic: Ovarian pain during pregnancy
Inflammation of the ovaries
The ovaries can also become inflamed. This is called adnexitis. This is caused by pathogens that have penetrated the vagina via the uterus and fallopian tubes into the ovaries.
The Adnexitis can lead to severe pain, which can also be very acute. In the Adnexitis it is the inflammation of the appendages, which means inflammation of the fallopian tubes (Tuba uterina) and ovary (Ovary). Such an inflammation can occur on one or both sides and is then associated with severe pain in the lower abdomen. If this acute inflammation does not heal properly or is not treated correctly, chronic adnexitis can develop. This is associated with recurring back pain and pain in the lower abdomen, especially during menstruation or sexual intercourse.
As a rule, chlamydia is the cause of this chronic inflammation. In most cases, patients complain of acute pelvic pain, which usually occurs on the sides. Often times, this pain occurs after menstrual bleeding. But there is also abdominal pain when ovulating. In some cases, adnexitis caused by chlamydia can be accompanied by inflammation of the liver (Perihepatitis) come. Then the patients also feel pain in the right upper abdomen. In this case, the liver enzymes are increased in laboratory chemistry.
The therapy is usually antibiotic and can be carried out on an outpatient basis. Only if major complications, such as peritonitis (Peritonitis), blood poisoning (sepsis) or abscess formation occur, the adnexitis must be treated surgically.
After an inflammation of the ovary has taken place, adhesions can occur. These can also lead to chronic pelvic pain, which occurs mainly during sexual intercourse. The therapy is very difficult here, as only an operation can help. However, this itself can cause new adhesions.
Read more about this on our website Adnexitis
Stem rotation
Such a twisting of the stem often occurs in the context of a cyst. This can develop benign and hormone-related, as well as be of tumorous origin. The cysts are usually filled with fluid and can be several centimeters in size. A fast and unfavorable movement can cause such a cyst to rotate on its suspension and thereby cut off the blood supply to the ovary. Such a twist of the stem leads to acute, severe pain on the affected side.
The only possible therapy is then the surgical restoration of the original anatomy and the eventual removal of the cyst.
The risk of such a twisting of the stem is the loss of function of the ovary and the associated sterility of the affected side.
Tissue growths
The tissues of the ovaries can also change, causing pain. One example is endometriosis. This means that the uterine lining is scattered in other organs, often in the ovaries. This mucous membrane is still subject to the cycle-related changes and sometimes causes severe, cramp-like symptoms. Benign changes such as cysts can also cause ovarian pain above a certain size. Cysts are usually filled with fluid or blood and in most cases regress on their own. However, sometimes they also need to be removed surgically.
Ovarian cancer (ovarian cancer)
At an advanced stage, ovarian cancer can also cause pain by infiltrating nerves. In the early stages, however, it usually does not cause any complaints. Therefore, ovarian cancer should not be considered primarily when it comes to ovarian pain, even if this diagnosis should of course be clarified by a doctor after excluding other causes.
Please also read our page about Ovarian cancer.
Ovarian vein thrombosis
Will the supplying vein of the ovary through a blood clot (thrombus) complete or incomplete lockedthis is known as Ovarian vein thrombosis. This creates an acute Lack of bloodassociated with severe, sudden, colicky pain. The pain is limited to the affected side and often occurs on the right side. In some cases it can high fever go hand in hand with this clinical picture. If the disease takes a septic course, there is danger to life. In most of the cases, this condition occurs 2 to 6 days after giving birth and can then use a Computed Tomography (CT) and appropriate laboratory tests. Treatment consists in the intravenous anticoagulant, for example with Heparin, and antibiotic therapy.
Read more causes for here Abdominal pain after childbirth.
Psychosomatic pain in the ovaries
Common complaints of psychosomatic illnesses are chronic pain. The term “psychosomatic” does not mean that the pain is not real. Rather, it means that psychological conflicts are expressed in physical symptoms such as pain.
Ovarian pain, which is perceived as lower abdominal pain, can also be of a psychosomatic nature. However, this is a diagnosis of exclusion. First, all physical causes, such as inflammation, cysts and tumors, are diagnosed.
Usually psychosomatic clinical pictures are only found and treated after such a somatic investigation. This can be a lengthy process, usually lasting several years, which often takes a lot of strength from those affected. Psychosomatic pain requires specialized, psychological or psychotherapeutic therapy and cannot be treated with conventional painkillers.
Does ovarian cysts also cause ovarian pain?
As a rule, ovarian cysts do not cause pain, especially if they are only a few centimeters tall. If they get bigger, however, they can trigger pain caused by pressure on the surrounding organs.
Ovarian cysts increase the size of the ovary and thus harbor a greater risk that the ovary will rotate on itself and thereby twist in the ligaments that hold it. The problem with this is that the blood vessels that supply the ovary run in the ligaments. They are pinched by twisting the ligaments, the ovary is cut off from the blood supply and dies. This causes severe, usually sudden pain and should be examined urgently by a gynecologist.
The cysts in the ovaries can develop in a number of ways. In most cases, cysts form in the ovaries because the follicles in which the eggs mature are too large. In rare cases, the lining of the uterus can also grow inside the ovary. As this tissue tends to cause bleeding, small bleeding may occur inside the cyst. As a result, the blood coagulates and turns brown. This is why these cysts are called chocolate cysts. There are also corpus luteum cysts, which arise from the part of the follicle that remains after ovulation. They are quite normal in the second half of the cycle and during pregnancy and do not usually cause pain.
Polycystic ovary - does the disease cause pain?
PCO is short for polycystic ovary. It is a condition in which the normal regulation of hormones in the body is disrupted. This can lead to some external and internal changes. Many follicles mature in the ovary, but the hormonal signal for ovulation is missing. Therefore, the follicles remain and can be seen as many small cysts on the ultrasound.
In addition, without ovulation, the second part of the cycle will not start and therefore menstrual bleeding may not occur. Since the ovary is enlarged by the large number of follicles, there is also a slightly increased risk of twisting. Typically, PCO does not usually cause ovarian pain.
Figure pain in the ovaries
Ovarian pain
- Ovary -
Ovary - Ureter -
Ureter - Large intestine, descending part -
Descending colon - Fallopian tubes -
Tuba uterina - Urinary bladder -
Vesica urinaria - Sheath -
vagina - Appendix -
Caecum
Appendix -
Appendix vermiformis - Liver -
Hepar
Causes of pain
in the ovaries:
A - cycle-related ovarian pain
(Maturation of an egg cell,
Ovulation, menstruation)
B - inflammation
(Adnexitis) - due
Pathogens
C - pregnancy
(Pressure of the baby,
Ectopic pregnancy)
D - tissue growth
(Endometriosis, cysts)
E - ovarian cancer
(Ovarian cancer) - malicious
(malignant) swelling of the ovaries
F - ovarian pain when coughing
(Pressure on the fabric)
G - back pain -
Diseases in the area
the ovaries
(e.g. lumbar spine)
You can find an overview of all Dr-Gumpert images at: medical illustrations
Localization of pain on the ovaries
Ovarian pain left
Left side ovarian pain can, like right-sided ovarian pain, be cycle-related, i.e. ovulation or menstrual bleeding.
Cycle-independent pain can go through Cysts, Inflammation or Tissue growths, as a Endometriosis be evoked. Malignant diseases such as ovarian cancer can also cause symptoms in the late stages. In the case of left-sided lower abdominal pain, the cause does not necessarily have to be in the ovary itself.
It can also be pain caused, for example, by a Inflammation in the intestines are conditional. Especially one Diverticulitis causes pain in the left lower abdomen. In diverticulitis, the Large intestine small bulges in the intestinal wall in which bowel movements can become lodged. This can inflame the intestines, which can cause pulling or burning pain.
The left-sided complaints can also be caused by a stone or one Inflammation in the left ureter be evoked.
Ovarian pain on the right
Right-sided pain in the area of the ovary can occur as a result of the cycle or changes in the ovarian tissue.
Due to the cycle, pain can arise during ovulation or menstruation. Regardless of this, right-sided ovarian pain, for example Cysts, these are benign, mostly fluid or blood-filled cavities in the tissue, or inflammations Tissue growths, as a Endometriosis be evoked.
Also malignant diseases like Ovarian cancer, should be considered as a differential diagnosis, but ovarian cancer does not cause symptoms until very late.
In the case of pain in the right lower abdomen, the ovaries do not necessarily have to be the cause. In the immediate vicinity is also the appendix of the Appendix (appendix), which can ignite, inf. Appendicitis. This can also cause pain that can be mistakenly misinterpreted as ovarian pain. There is also an inflammation of the right ureter or a Ureteral stone into consideration.
pain in the back
Diseases in the area of the ovaries can often lead to back pain, which is particularly localized in the area of the lumbar spine. The irritation of the ovarian tissue leads to the irritation of nerves running there, which can then also cause pain in their further course (projected pain).
Endometriosis is a common cause of precisely these symptoms. This is a condition in which cells in the lining of the uterus migrate to nearby organs, e.g. in the ovaries, fallopian tubes or in the abdomen.
However, the mucous membrane changes just as cycle-dependently as the normal uterine lining, which can cause severe pain. Chronic back pain also occurs.
An early symptom of endometriosis is irregular bleeding combined with cycle-dependent, cramp-like abdominal pain. You may also experience pain during intercourse, painful urination, and problems with bowel movements.
However, other causes can also be considered for back pain in the lumbar spine. So an inflammation of the organs of the small pelvis should be clarified, i.e. inflammation of the fallopian tubes, ovaries (Adnexitis) or the lining of the uterus (Endometritis).
Impaired blood flow to these areas can also cause back pain. The same applies to complaints caused by the muscles and ligaments surrounding the ovaries and uterus.
Furthermore, changes in the ovaries should be considered in the differential diagnosis. Large cysts or tumors can also cause back pain.
The uterus and ovaries are held in place in the woman's pelvis by various ligaments. These ligaments lead to the abdominal wall on the one hand, and to the back on the other. If symptoms occur in the area of these female sexual organs, the pain can therefore radiate to the abdomen and back. This is often felt during menstruation. The uterus contracts again and again in order to reject the mucous membrane. As a result, she simultaneously pulls on the ligaments that pull towards the back, causing back pain.
Temporal occurrence
Ovarian pain after ovulation
Ovarian pain at the time of ovulation is also called middle pain because it occurs in the middle of the menstrual cycle. Some women do not perceive it at all or only perceive it as a slight pulling, while others feel it as severe, cramp-like pain.
The intensity and duration of the pain varies from woman to woman and can last from a few minutes to several days.
Typically, middle pain occurs on one side, namely on the ovary, which is active in this cycle, and gives off the mature follicle. The exact cause of the middle pain has not yet been clarified. It is assumed that the maturing follicle leads to irritation of the ovarian tissue and the nerves there, which is intensified when the follicle bursts and can cause the typical symptoms.
Learn more about: Middle pain
In addition, leaking fluid can irritate the peritoneum and cause pain.
In some women, ovulation is also accompanied by light bleeding. Women who take birth control pills should not experience median pain because ovulation is suppressed by the contraceptive. Accordingly, no follicle can mature and the middle pain cannot arise.
Median pain, however, is not a reliable means of preventing or planning a pregnancy because, although it occurs around ovulation, it can be over before it actually occurs.
Read more on the topic: Signs of pregnancy
Basically, the middle pain is nothing to worry about. However, if the pain is very pronounced and lasts unusually long, a doctor should be consulted.
Read more about the topic here: Ovarian pain after ovulation
Ovarian pain in the second half of the cycle
The ovaries are very sensitive to the different phases of the female cycle. Although ovarian pain can theoretically occur at any point in the cycle, closer examination reveals that it is mainly observed in the second half of the cycle. This is due to the hormonal balance and the structural changes in the female sexual organs in the second half of the cycle.
During that time, which is defined as time between ovulation and the next menstruation, are increased hormones like progesterone and estrogen educated. The mucous membrane of the uterus transforms itself to accommodate a fertilized egg and the egg cell migrates in the fallopian tubes towards the uterus in the first week of the second half of the cycle. The wandering of the egg in the fallopian tube can often be misinterpreted as pain in the ovaries. The ovaries are also remodeled. Here the remains of the cracked egg are converted into so-called yellow bodies. All of these processes can cause ovarian pain in the second half of the cycle, especially in the first week after ovulation, which is mainly through the ovarian remodeling processes in the corpus luteum are conditional.
The further the cycle comes to an end, the less often and more pronounced ovarian pain occurs. Relaxing and calming measures such as Hot water bottles and bed rest. Only in a few cases is there a clinical picture that requires treatment behind slight pain in the second half of the cycle. However, if you regularly suffer from severe pain, it is advisable to consult a specialist.
Ovarian pain before your period
Pain in the abdomen before and during the period is also called menstrual pain. They typically appear 1-2 days before the onset of bleeding and can get worse during the bleeding.
The pain can vary in severity in every woman. Some women have no menstrual cramps at all, others have to lie in bed with nausea and severe pain. The pain occurs especially in very young and slim women, as well as childless women. If there is no other organic cause for the pain, it is also called primary dysmenorrhea.
The pain is caused by the spasmodic contraction of the uterus. These muscle contractions are triggered by certain messenger substances, the prostaglandins. However, these also cause pain as they irritate the nerves.
The abdominal pain can therefore also be located in the ovaries, although the primary cause of the pain is not there. The more the woman produces these messenger substances, the stronger the pain.
Emotional stress or psychological problems can also lead to pain during your period. In general, a clarification of possible other causes should be carried out, especially in women who suffer from very severe symptoms.
Endometriosis can also lead to similar symptoms depending on the cycle. Endometriosis is the lining of the uterus that has settled in other organs, e.g. in the ovaries or the abdomen, but nevertheless changes depending on the cycle. Compression of the foreign tissue can cause severe, cramp-like pain.
Women who have never had symptoms before or during their menstrual period, but then develop them as a result, should also speak to a gynecologist about this.
If the pain can be explained by another cause, e.g. by psychological stress or organic changes, it is called secondary dysmenorrhea.
Find out more about the topic here: Abdominal pain before your period
Ovarian pain after fertilization
The woman herself does not perceive fertilization as such. Therefore, no ovarian pain can occur after fertilization. However, many women notice their ovulation as a kind of pulling pain in the lower abdomen. Cramp-like pain is also often described. This so-called middle pain occurs immediately after ovulation and is one-sided. You can feel it in the ovary that was active in the cycle and is giving off the mature follicle. However, fertilization itself is painless.
Ovarian pain when coughing
At the to cough the pressure in the abdomen increases significantly for a short time, i.e. it will Pressure on the organs exercised. Some women feel a Tearing or a sharp pain in the abdomen in the area of the ovaries.
This is a very non-specific symptom and can have many causes. It is possible that the woman is in the days around her ovulation. During this time, the ovaries are easily irritated. If pressure is then exerted on the tissue when coughing, it can cause pain.
Even during the Menstrual period therefore, coughing can lead to ovarian pain.
Of course, other causes can also be causing the symptoms. For example, a pregnancy Be a trigger, but also changes in ovarian tissue, such as Cysts or inflammation are potential triggers.
If the pain becomes worse or persists for several days, a doctor should be seen who can then conduct a closer examination to determine the cause of the pain.
Postmenopausal ovarian pain
The Menopause denote the complex hormonal change of a woman after the last menstrual period.
After menopause occurs no ovulation and no menstrual period more on, ovarian activity is low. Therefore, postmenopausal ovarian pain should always be taken seriously, as many harmless causes of ovarian pain after menopause disappear. Painful ovulation or irritation from the hormone-related cycle-dependent restructuring of the ovaries no longer occurs. In old age there are reasons such as malignant neoplasms or inflammatory processes in the foreground. In the case of severe, sudden pain, a Stem rotation or one Ovarian vein thrombosis be considered.
Heat and pain relievers can relieve symptoms initially. If the pain in the ovaries does not go away after a few days or if it gets worse, it makes sense to see a specialist as soon as possible.
Please also read our page Menopausal ovarian pain.
Ovarian pain in pregnancy
Many women experience pain in the ovaries from time to time during pregnancy. This is not always a cause for concern, but it should be clarified with a pelvic exam.
During pregnancy, ovulation does not take place in the ovaries as usual, but hormones are still produced there.
Sometimes during this time cysts develop in the ovaries, benign cavities filled with blood or fluid that can cause pain when the tissue is compressed.
The cysts often recede on their own or they burst, which can lead to heavy bleeding. Sometimes the cysts also need to be removed by a doctor.
Severe pain in the ovaries in early pregnancy can also indicate a so-called ectopic pregnancy.
The fertilized egg does not implant itself in the uterus as usual, but remains in the fallopian tube on its way there and continues to develop there. This can cause severe pain and bleeding and must be corrected, otherwise the fallopian tubes may rupture.
A less common cause of temporary ovarian pain during pregnancy is irritation of the nerves that run there from the pressure the unborn child puts on the pelvis.
The organs are compressed by the child's own weight. Depending on the position of the child, this can lead to pain in different areas, e.g. also to temporarily sore ovaries.
In addition, the uterus and the surrounding tissue must first stretch and adapt to the growing child. By pulling on the connective tissue, nerves can also be irritated, which can cause pain.
However, persistent pain should be addressed to a gynecologist so that the cause can be determined promptly.
Read more on the topic: Ovarian pain during pregnancy
Related to medication
Ovarian pain despite pill
The contraceptive, popularly known as "the pill“Is called, unfolds its effect through the Preventing ovulation. Therefore, ovarian pain while taking the pill is usually not caused by ovulation. On the contrary, taking the pill is believed to be Relieves menstrual cramps become.
If pain occurs despite the pill, it can go through Mistake in taking Ovulated despite the pill, which causes abdominal pain in many women. Forgotten or irregularly taken pills can cause such a situation. With special intake schedules, the pain can also through long-term use of the hormone preparations arise. This can lead to painful intermenstrual bleeding. If the pain occurs for a long time or to an unacceptable extent, a doctor should be consulted.
- Forget the pill - what should be considered?
- Abdominal pain from the pill
If this is not the cause, ovarian pain may persist despite the pill Ovarian diseases to be triggered. This includes a variety of things like inflammatory processes (Adnexitis) or structural problems. So could Cysts, Vascular disease or Lumps stuck behind the pain. Therefore, the condition of the ovaries should be clarified if pain occurs despite the pill, although a harmless cause such as slight swelling or tension in the ovaries is often hidden behind the pain.
Ovarian pain after the morning-after pill
The morning-after pill is an emergency contraceptive that significantly reduces the likelihood of unwanted pregnancy after unprotected intercourse. Depending on the preparation, the pill can then be up to max. Still to be taken 3-5 days after intercourse.
However, a side effect of the morning-after pill is also known to be pain in the abdomen and ovaries. This ovarian pain can be very similar to that of menstrual cramps and may be spasmodic. This is because with the morning-after pill, relatively high doses of hormones are given that interfere with the sensitive hormone balance.
In addition to the pain, nausea and vomiting occur frequently after taking the morning-after pill. The pain shouldn't last much longer than one to three days, however. If ovarian pain persists, a specialist visit should follow. He can also advise on what to watch out for with the morning-after pill and how to proceed with the actual contraception afterwards.
As a rule, however, the morning-after pill is well tolerated and there is no significant ovarian pain.
Ovarian pain with clomiphene
Clomiphene is a drug used in gynecology to stimulate ovulation and treat irregularities in monthly bleeding. It increases blood levels of sex hormones, which are produced in the pituitary gland and ovaries. Women who do not ovulate can get one again on clomiphene.
Ovarian pain during ovulation was increased during treatment with clomiphene, but was less severe without the drug. The ovaries can also be prone to pain throughout the cycle, as clomiphene has a strong stimulating effect on the ovaries. Especially when these have not ovulated for a long time, the pain can intensify.
Mild ovarian pain while taking clomiphene can still be tolerated. However, if the pain becomes worse or occurs without interruption, a clarification by a gynecologist should be carried out to be on the safe side.
Read more about this under: Ovulation pain and clomiphene
Other accompanying symptoms
Ovarian pain can occur due to various causes. Often it is inflammation, ovarian cysts or an interruption in the blood supply (twisting of the stem) that lead to severe ovarian pain. Not only are pain typical symptoms of these clinical pictures, but other complaints can also point to the cause.
Many women experience inflammation of the ovaries during their lifetime. A slow onset of the disease is typical. The symptoms can vary depending on the pathogen. A common symptom is a fever. In an acute stage of inflammation, severe pain can be accompanied by vomiting, nausea and defensive tension in the abdominal muscles. In the chronic stage of the inflammation, the fever can flare up again and again, which subsides again in symptom-free phases. Concomitantly, symptoms of urination, constipation or diarrhea, purulent discharge and spotting can also occur. Pain during sexual intercourse is also not uncommon.
Ovarian cysts are usually only symptomatic of pain. More rarely, menstrual irregularities such as intermenstrual bleeding or spotting may occur. However, a dreaded complication is the so-called twisting of the stem of such a cyst. Pedunculated cysts can rotate on their own axis, thereby interrupting the blood supply. This clinical picture is characterized by the strongest pain up to shock.
When should you see a gynecologist?
It is particularly important to see a gynecologist if you experience sudden severe pain in the groin, which in some cases can also radiate into the labia.
Especially if ovarian cysts are known or the pain has occurred after jerky or rapid movements, the suspicion of a twisted ovary is obvious. As this cuts off the blood supply to the ovary and threatens to die, a quick diagnosis and, if necessary, direct treatment must be carried out.
In addition, the gynecologist should be consulted if pain in the ovary area persists for a long time or if it occurs irregularly and independently of the menstrual period. You should also discuss this with your gynecologist in the event of a missed menstrual period or persistent bleeding for several months.
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