A pinch on the right side of your lower abdomen that makes you wince, a tugging sensation that comes and goes, or perhaps a more obvious pain that worries you. If you're looking to understand why your right (or left) ovary is causing you pain, you've come to the right place. The good news? In the vast majority of cases, this pain is benign and related to your menstrual cycle. But how do you know if it's just ovulation or something that requires a consultation? Let's explore the main causes and the warning signs you shouldn't ignore.
The main thing to remember
- 40% of women experience ovarian pain during ovulation (Mittelschmerz)
- The pain is usually on one side only (right or left depending on which ovary is ovulating)
- It typically lasts a few hours to 2-3 days Pigmentation
- Sudden, severe pain with nausea/vomiting = consult urgently
- Right ovary ≠ left ovary in terms of meaning (same possible causes)
Where Does This Pain Come From? Quick Anatomy
Before we talk about the causes, let's put things in perspective. Your ovaries are two small glands (of the taille almond-shaped, about 3-4 cm) located on either side of your uterus, connected by the fallopian tubes.
These organs perform two major functions in your reproductive system, the release of an egg each month during ovulation, and the production of female hormones (estrogen and progesterone).
Important point on location
A pain in right iliac fossa (lower right of the abdomen) can come from the right ovary, but also from other organs in this area: the appendix, the intestine, the right kidney, or the bladder. This is why it is sometimes difficult to precisely identify the origin of the pain without a medical examination.
The 8 Main Causes of Ovarian Pain
1. Ovulation (Mittelschmerz): The No. 1 and Benign Cause
frequency: Affects approximately 40% of women of childbearing age
Mittelschmerz (German for "middle pain") is by far the most common cause of ovarian pain. It's a perfectly harmless pain that occurs around the time of ovulation, about 14 days before your next period.
Why does it hurt?
During ovulation, the follicle containing the egg swells and then ruptures to release the egg. This rupture releases fluid and some blood into the abdominal cavity, which can irritate the peritoneum (the membrane that surrounds your organs). In addition, the LH surge causes contractions of the smooth muscles around the ovary via prostaglandins, which generates pain.
Good to know: Experiencing mittelschmerz doesn't mean you're more fertile than those who don't. It simply means you're more sensitive to internal sensations.
2. Functional Ovarian Cyst
frequency: Very common, most women develop cysts at some point in their lives
An ovarian cyst is a small, fluid-filled sac that forms on the ovary. functional cysts are benign and appear naturally during the menstrual cycle. There are two types:
- Follicular cyst : when the follicle does not release the egg and continues to grow
- Corpus luteum cyst : when the follicle after ovulation fills with fluid
90% of ovarian cysts disappear spontaneously in 1 to 3 menstrual cycles without treatment.
Ovarian cyst manifests itself in different ways depending on its taille and its location. In particular, you may experience certain characteristic symptoms.
- Dull pain on one side of the lower abdomen
- Feeling of pelvic heaviness or pressure
- Pain during intercourse
- bloating
- If the cyst ruptures: sudden, intense pain (usually mild but painful)
3. Ovarian Torsion: The Urgency to Recognize
frequency: Rare but serious
Ovarian torsion occurs when the ovary twists on itself, cutting off its blood supply. It is a medical emergency which requires rapid surgery to save the ovary.
Recognize a medical emergency - Seek medical help immediately if you observe:
- Sudden, severe pain on one side of the lower abdomen
- Nausea and vomiting important
- Pain that does not respond to usual painkillers
- Possible fever
- Feeling of general malaise
Action: Call 15 or go to the emergency room immediately. Every hour counts to preserve the ovary.
4. Endometriosis: Chronic and Cyclical Pain
frequency: Affects approximately 10% of women of childbearing age
Endometriosis is characterized by the presence of endometrial-like tissue (the lining of the uterus) outside the uterus—including on the ovaries. This tissue reacts to menstrual hormones, causing inflammation and pain. Women with the condition commonly report these symptoms.
- Chronic pelvic pain, often severe
- Very painful periods (dysmenorrhea)
- Pain during ovulation
- Pain during or after intercourse
- Pain when defecating or urinating (depending on the location)
- Chronic fatigue, sometimes digestive problems
5. Polycystic Ovary Syndrome (PCOS)
frequency: 5 to 10% of women of childbearing age
Le PCOS is a hormonal disorder characterized by the presence of numerous small cysts on the ovaries and a hormonal imbalance (excess androgens). Ovarian pain related to PCOS varies from one woman to another. Other symptoms may give you clues.
- Irregular cycles or absence of periods
- Persistent acne
- Excessive hair growth (hirsutism)
- Weight gain or difficulty losing weight
- Fertility problems
6. Pregnancy (Normal or Ectopic)
Normal pregnancy: During early pregnancy, some women experience mild pelvic pain related to embryo implantation or stretching of the ligaments that support the uterus. This pain is usually mild and transient.
Ectopic pregnancy: an emergency situation
In 1 to 2% of pregnancies, the embryo implants outside the uterus, most often in a fallopian tube (but sometimes on an ovary). This is a vital emergency.
You should recognize these characteristic manifestations: severe pain on one side + late period + positive pregnancy test + abnormal vaginal bleeding + dizziness or malaise. → Emergency immediately.
7. Pelvic Infections (Salpingitis)
frequency: Usually caused by an untreated STI (chlamydia, gonorrhea)
Salpingitis is an infection of the fallopian tubes that can spread to the ovaries. If left untreated, it can cause abscesses and compromise fertility. It manifests itself through several characteristic signs.
- Progressive bilateral (both sides) pelvic pain
- Fever and chills
- Abnormal vaginal discharge (odor, color)
- Pain during intercourse
- Burning urine
8. Other Causes to Consider
- Appendicitis : For the right ovary! The pain often begins around the navel and then migrates to the lower right ovary. It is accompanied by fever, nausea, and loss of appetite. Surgical emergency.
- Intestinal disorders : Irritable bowel syndrome, severe constipation, diverticulitis
- Urinary infection or kidney stone
- Pain after sex : May be due to intense stimulation, vaginal dryness, or infection
- Side effects of the IUD : Some women experience pelvic pain after insertion.
Right Ovary vs Left Ovary: Is There a Difference?
Many women look for a specific "meaning" depending on whether it is the right or left ovary that is hurting. The reality is simple: both ovaries can suffer from the same problems (cyst, ovulation, endometriosis, etc.).
The only peculiarity of the right ovary
Pain in the right iliac fossa can be confused with appendicitis. If you have severe pain on the right side accompanied by fever, severe nausea, loss of appetite and the pain increases when you cough or move your right leg → think about appendicitis and consult quickly.
Why does the pain change sides? Each month, your ovaries alternate (randomly) egg release. If the right ovary ovulates this month, you'll experience mittelschmerz on the right. The following month, it may be on the left.
Ovarian Pain and Pregnancy: What You Need to Know
A frequently asked question: Is ovarian pain a sign of pregnancy?
Short answer: Not directly. Ovarian pain alone is not a reliable sign of pregnancy.
However:
- Some pregnant women experience mild pelvic pain in early pregnancy due to implantation or stretching of ligaments
- These pains are generally accompanied byother signs of pregnancy : late period, tender breasts, nausea, fatigue
- If you have a late period + pelvic pain, take a pregnancy test
Manage your menstrual pain with peace of mind
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Severe or Persistent Pain: When Should You Make an Appointment?
Most ovarian pain is benign and does not require emergency care. However, some situations require prompt, even immediate, medical attention.
How to Relieve Benign Ovarian Pain?
When your pain is related to ovulation or a small benign cyst, several approaches can provide real relief.
What can give you quick relief
- Heat : Hot water bottle or hot bath on the lower abdomen to relax the muscles
- Anti-inflammatories : Ibuprofen or naproxen (block prostaglandins)
- Repos : Lie in the fetal position (knees bent) to relieve pressure
- hydration : Drink enough water
- Avoid intense physical exertion during the following hours
To prevent and reduce pain in the long term
- Hormonal contraception : The contraceptive pill blocks ovulation, thus eliminating mittelschmerz
- Cycle tracking : Note your pain to identify patterns and anticipate
- Anti-inflammatory diet : Omega-3, fruits and vegetables rich in antioxidants
- Stress management : Stress can amplify the perception of pain
- regular exercise : Improves blood circulation and reduces inflammation
Diagnosis: What Tests Can Your Doctor Prescribe?
When your doctor considers it necessary to investigate your pain, several tests can help identify the precise cause.
- Pelvic exam : Manual palpation to detect tenderness or a mass
- Pelvic ultrasound : Key examination to visualize the ovaries, detect cysts, measure their taille
- Blood test : Hormone assays, infection markers, pregnancy test (beta-hCG)
- IRM : For complex cases or suspicion of endometriosis
- Laparoscopy : Minimally invasive exploratory surgery, rarely necessary unless severe endometriosis is suspected
The Essentials to Remember
Pain in the right (or left) ovary is most often benign and related to ovulation (mittelschmerz) or a small functional cyst that will disappear on its own. Approximately 40% of women experience this pain at least occasionally.
Reassuring features : Pain lasting a few hours to 2-3 days maximum, mild to moderate intensity, occurs in the middle of the cycle, no fever or worrying associated symptoms.
When to worry Sudden, severe pain, nausea/vomiting, fever, pain lasting more than 3 days, worsening symptoms, or anything that seems abnormal. In these cases, seek medical help promptly. Your instincts count - if something doesn't feel right, don't hesitate to seek medical advice.
Sources & Scientific References
- Mittelschmerz. (2023). StatPearls. NCBI Bookshelf. Full article
- Marinho AO, et al. (1982). Ovulation side and occurrence of mittelschmerz in spontaneous and induced ovarian cycles. British Medical Journal, 284 (6316), 632. PubMed
- Cleveland Clinic. (2023). Ovulation Pain (Mittelschmerz): Causes & Treatment. Paper
- Hatipoglu S, Hatipoglu F, Abdullayev R. (2014). Acute right lower abdominal pain in women of reproductive age: clinical clues. World Journal of Gastroenterology, 20 (14), 4043-4049.
- Ameli.fr. Ovarian cysts: symptoms, diagnosis, and progression. Official Source
- Mayo Clinic. (2024). Mittelschmerz - Symptoms and causes. Paper
- Allodocteurs. (2021). Ovarian cysts: is it serious, doctor? Paper
Medical Warning: This article is for informational purposes only and is not a substitute for professional medical advice. If you experience persistent, severe pain, or any other concerning symptoms, consult a healthcare professional.
