Ovarian Pain: Possible Causes, Diagnosis, and Treatments

The ovaries are an important part of the female reproductive system. Their job is twofold. They produce the hormones, including estrogen, that trigger menstruation. Their function is also to release at least one egg each month for possible fertilization.

A number of different conditions, from cysts to tumors, can cause ovarian pain. The ovaries are located in the lower abdomen. That means if you have ovarian pain, you'll most likely feel it in your lower abdomen -- below your belly button -- and pelvis. It's important to have any pelvic pain checked out by your regular doctor or obstetrician/gynecologist. Several different conditions can cause it.

Pain in the ovaries can either be acute or chronic. Acute ovarian pain comes on quickly (over a few minutes or days) and goes away in a short period of time. Chronic ovarian pain usually starts more gradually. Then it last for several months or longer.

Ovarian pain may be continuous. Or it may come and go. It may get worse with certain activities, such as exercise or urination. It can be so mild that you hardly notice it. Or pain in the ovaries can be so severe that it interferes with daily life.

The methods your doctor uses to diagnose ovarian pain will vary. They will be based on what the suspected cause might be. Regardless, your doctor will take a complete medical history, do a physical exam, and ask questions about your pain. The questions might include:

• Where are you feeling the pain?
• When did it start?
• How often do you feel pain?
• Does an activity make the pain better or worse?
• How does it feel -- mild, burning, achy, sharp?
• How does the pain affect your day-to-day life?

Diagnostic tests, such as ultrasound and other types of imaging, can zero in on the cause of the pain. Here is a rundown of some possible causes of ovarian pain and how they are diagnosed and treated.

Ovarian Cysts

Cysts are fluid-filled sacs that can form in the ovaries. They are very common in women, especially during the childbearing years. Often they form during the process of ovulation. It can happen when the egg is not released or when the sac -- follicle -- holding the egg doesn't dissolve after the egg is released. Ovarian cysts usually cause no symptoms and dissolve on their own. They can, though, create a dull ache or a sharp pain if the cyst is large and it ruptures.

Other symptoms of ovarian cysts:

• Irregular menstrual periods
• Pain during intercourse or bowel movements
• Nausea or vomiting
• Feeling full after eating a small amount
• Bloating

How ovarian cysts are diagnosed

• Pelvic exam. This exam may reveal a lump in the pelvic area.
• Ultrasound. This scan uses sound waves to create an image of the ovaries. This helps the doctor determine the size and location of a cyst.

Treatment of ovarian cysts

• Watchful waiting. Most ovarian cysts will go away on their own. If you don't have any bothersome symptoms, especially if you haven't yet gone through menopause, your doctor may advocate "watchful waiting." The doctor won't treat you. Instead, the doctor might check you periodically to see if there has been any change in your condition.
• Laparoscopy. This is a form of surgery that uses small incisions and a tiny, lighted camera on the end of a metal tube that's inserted into the abdomen to remove small cysts. Larger cysts may need to be removed through a bigger incision in the abdomen. This is done with a technique called laparotomy.
• Birth control pills.Birth control pills prevent ovulation. That, in turn, reduces the formation of new cysts.

Ovarian Tumors

Tumors can form in the ovaries, just as they form in other parts of the body. They can be either noncancerous (benign) or cancerous (malignant).

Other symptoms of ovarian tumors

• Bloating or pressure in the abdomen
• Urgent need to urinate
• Indigestion
• Diarrhea or constipation
• Loss of appetite/feeling full
• Unintentional weight loss or gain in the stomach area

How ovarian tumors are diagnosed

• Computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography(PET). These are detailed imaging scans that the doctor can use to find ovarian tumors. They allow the doctor to determine whether and how far the ovarian tumors have spread.
• CA-125. This is a blood test to look for a protein that tends to be higher in some (but not all) women with ovarian cancer. CA-125 isn't effective as a screening test for ovarian cancer. But it can be checked in women with symptoms that might be caused by ovarian cancer.
• Ultrasound may also aid in the diagnosis of ovarian tumors.

Treatment of ovarian tumors

• Laparotomy. This is surgery performed through an incision into the abdomen. The surgeon will remove as much of the tumor as possible. The removal of tumor tissue is called debulking. If the tumor is cancerous and has spread, the surgeon may also remove the ovaries, uterus, fallopian tubes, omentum (fatty tissue covering the intestines), and nearby lymph nodes. Laparoscopy and robotic surgery may also be used.
• Chemotherapy.Chemotherapy involves drugs given through a vein (IV), by mouth, or directly into the abdomen. The drugs kill cancer cells. Because they kill normal cells as well, chemotherapy medications can have side effects. These can include nausea and vomiting, hair loss, kidney damage, and increased risk of infection. These side effects should go away after the treatment is stopped.
• Radiation. This treatment uses high-energy X-rays to kill or shrink cancer cells. Radiation is either delivered from outside the body, or placed inside the body near the site of the tumor. This treatment also can cause side effects. These can include inflamed skin, nausea, diarrhea, and fatigue. Radiation is not often used to treat ovarian cancer.

Ovarian Pain Caused by Endometriosis

Every month, the lining of the uterus builds up in preparation to nourish a growing fetus. When an egg is not fertilized, that lining sheds and is released from the body via menstruation. In some women, tissue like the lining of the uterus develops elsewhere in the body. This tissue swells and bleeds each month. It has nowhere to shed, though, and may form scar tissue that can be very painful.

Other symptoms of endometriosis

• Painful periods
• Pain during intercourse
• Heavy menstrual periods
• Infertility
• Pain with bowel movements

How endometriosis is diagnosed

• Medical history and physical exam.
• Ultrasound and MRI. These scans may help the doctor to spot endometriosis, if there is an endometrioma, a benign cyst, on the ovary or ovaries.
• Laparoscopy. This procedure uses a thin lighted scope inserted into a tiny hole in the abdomen to allow the doctor to visualize the ovaries. The doctor may possibly remove a small sample of tissue for biopsy, a procedure in which the large lesions of endometriosis may also be removed.

Treatment of endometriosis

• Pain medications. Drugs such as ibuprofen (Advil, Motrin) can help relieve some of the discomfort of endometriosis.
• Birth control pills. The pill suppresses the monthly buildup of endometrial tissue on the ovaries and anywhere else the endometriosis may be in the abdomen and pelvis. This makes periods lighter and reduces the symptoms of endometriosis.
• Gonadotropin-releasing hormone agonists (GnRH agonists). These drugs reduce the amount of the hormone estrogen in the body. By slowing the growth of endometriosis, they limit its symptoms.
• Laparoscopy and laparotomy. These are surgical procedures that let the doctor remove endometriosis on the ovaries and other places. If the endometriosis is extensive, the doctor may recommend a hysterectomy. This procedure removes the uterus and sometimes also the ovaries and fallopian tubes. Learn more about laparoscopic surgery to treat endometriosis.

Pelvic Inflammatory Disease

Pelvic inflammatory disease (PID) is an infection in the ovaries, uterus, or fallopian tubes. It is most often caused by sexually transmitted diseases like gonorrhea or chlamydia. It is one of the most common causes of pelvic pain in women.

Other symptoms of PID

• Pain during intercourse
• Fever
• Vaginal discharge that may have a smell
• Irregular menstrual bleeding
• Diarrhea
• Vomiting
• Fatigue
• Difficulty urinating

How PID is diagnosed

• Pelvic exam. The exam will enable your doctor to look for any lumps, abnormal discharge, or tenderness in the pelvis.
• Blood and urine tests. These lab tests can help identify the infection. So can cultures of any discharge seen during a pelvic exam.
• Ultrasound. This test creates an image of the pelvic area so the doctor can see if the reproductive organs are enlarged. The doctor can also see if there is a pocket of infection known as an abscess.
• Laparoscopy. Occasionally this procedure, which uses a thin lighted scope inserted into a tiny hole in the abdomen, is used to confirm the diagnosis.

Treatment of PID

Antibiotics. These drugs are given by mouth or through an injection. They can kill the bacteria that are causing PID. If you are taking antibiotics for PID, your sexual partner or partners should also get treated. There is a high likelihood that your partner has the same sexually transmitted infection. Learn more about the treatments for pelvic inflammatory disease (PID).

Ovarian Remnant Syndrome

Surgery to remove the uterus and ovaries is known as hysterectomy and oophorectomy. A bilateral salping- oophorectomy is a procedure in which both fallopian tubes and ovaries are removed. In rare cases, a small piece of the ovary may accidentally be left behind. The remnant can grow and develop painful cysts.

Other symptoms of ovarian remnant syndrome

• Pain during intercourse
• Difficulty urinating

How ovarian remnant syndrome is diagnosed

Ultrasound, CT, and MRI. These scans create images of the area. They help the doctor locate the remaining piece of ovary tissue.

Treatment of ovarian remnant syndrome

Laparotomy or laparoscopy. These procedures are done to remove the remaining piece or pieces of ovary. Learn more about ovary removal surgery.

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