Women’s health centre

Ovarian pain: Possible causes, diagnosis and treatment

The ovaries are an important part of the female reproductive system. Their job is two-fold. They release one egg each month for possible fertilisation. At the same time they produce the hormones which develop the lining of the uterus (womb), making it ready to receive a fertilised egg.

A number of different conditions, from cysts to tumours, 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 tummy button -- and pelvis. It's important to have any pelvic pain checked out by your GP or obstetrician/gynaecologist. Several different conditions can cause this pain.

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 and lasts for several months.

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 don't notice it. Or pain in the ovaries can be so severe that it interferes with your daily life.

The methods your GP uses to diagnose ovarian pain will vary, depending on the suspected cause. Your GP will take your medical history, carry out a physical examination, and ask you questions about the pain. These questions might include:

• Where do you feel the pain?
• When did it start?
• How often do you feel pain?
• How does it feel -- mild, burning, aching, sharp?
• Does anything make the pain worse - for example, intercourse - or better?
• How does the pain affect your day-to-day life?

Diagnostic tests, such as ultrasound and other types of imaging, can help to identify the cause of the pain. Here is a summary of some possible causes of ovarian pain and how they are diagnosed and treated.

Cause of ovarian pain: 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. They can, however, create a dull ache or a sharp pain if one twists, ruptures, or grows large.

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 examination. This examination may reveal a lump in the pelvic area.
• Ultrasound. This scan uses sound waves to create an image of the ovaries. It helps the doctor determine the size and location of the cyst.
• Blood Test. A blood test may be done to check for the CA125 protein, which can indicate if there is a risk of cancer from the cyst.

Treatment of ovarian cysts

• Watchful waiting. Most ovarian cysts will go away on their own. If you don't have any troublesome symptoms, especially if you haven't yet gone through the menopause, your GP may advocate "watchful waiting." The doctor won't treat you but you will be checked periodically to see if there has been any change in the cyst.
• Laparoscopy. This is a form of surgery that uses small incisions and a tiny, lighted camera on the end of a plastic tube that's inserted into the abdomen. A surgeon can use tools on the end of the tube to remove some cysts. This technique works for smaller cysts. Larger cysts, may need to be removed through a larger incision in the abdomen. This is done with a technique called laparotomy.
• Birth control pills. Contraceptive pills may relieve the pain from ovarian cysts. They prevent ovulation which, in turn, reduces the formation of new cysts