Table of ContentsView AllTable of ContentsAbout PerimenopauseCommon CausesRare CausesWhen to Seek CareDiagnosisOther CausesTreatmentPrevention
Table of ContentsView All
View All
Table of Contents
About Perimenopause
Common Causes
Rare Causes
When to Seek Care
Diagnosis
Other Causes
Treatment
Prevention
Ovarian pain duringperimenopausecan be felt in the lower abdomen and pelvis. Sometimes, the pain may even be felt in the lower back. The pain may be persistent, come and go, be dull, or progress to sharp bursts of pain.
This article discusses some possible causes of pelvic and lower abdominal pain during perimenopause. It includes information about diagnosis and treatment, along with tips for preventing this type of pain during menopause.
Verywell / Jessica Olah
What Is Perimenopause?
Perimenopause means “around menopause” and is also known as the menopausal transition. Perimenopause usually begins a few years before menopause, when a woman has her last menstrual cycle.
The hormone estrogen plays a key role in regulating the menstrual cycle. During perimenopause, the ovaries start to produce less estrogen, causing the menstrual cycle to become erratic or irregular. About six months before menopause, estrogen drops significantly and periods become few and far between.
For most women, perimenopause starts around ages 40 to 44. However, perimenopause can start as early as the 30s, or as late as the 50s.
Common Causes of Ovary Pain During Perimenopause
Ovarian pain, abdominal pain, and other sources of pelvic pain can be hard to tell apart. Symptoms that accompany the pain may help narrow down the cause. While this list is not exhaustive, the following are common causes.
Ovulation
Ovulation pain is also known asmittelschmerz,ormid-cycle pain. It is usually located on one side of the pelvis and ranges in intensity.At times, it is described as a dull pain, but it may also be a sudden, sharp pain. You may experience headaches, stomach problems, ormalaise(general feeling of not being well) during ovulation.
What You Should Know About Ovaries
New Onset Ovulation Pain With PerimenopausePeople who have never experienced ovulation pain before may start to experience it during perimenopause due to a fluctuation in estrogen levels.
New Onset Ovulation Pain With Perimenopause
People who have never experienced ovulation pain before may start to experience it during perimenopause due to a fluctuation in estrogen levels.
Menstrual Pain
Menstrual cramping(dysmenorrhea) may occur or may worsen during perimenopause. Worse cramping may be from changes in hormones or one of the other causes listed below.
Endometriosis
Endometrial tissue usually develops inside the uterus and is shed during a monthly period. When this tissue grows outside of the uterus, it is calledendometriosis. This endometrial tissue outside the uterus still reacts to hormonal changes, causing bleeding inside the pelvis. This can cause severe cramping and heavy menstrual flow.
Uterine Fibroids
Uterine fibroidsare noncancerous tumors located in the uterus and may cause heavy bleeding with worse cramping.
Ovarian Cysts
Ovarian cysts are fluid-filled masses that grow on one or both ovaries. Some go undetected and are absorbed back into the body. Larger ovarian cysts can cause pain on either or both sides.
This pain is usually described as a dull ache, but may progress to a sharp pain if it ruptures or twists, cutting off its blood supply. This condition is called ovarian torsion. Complications of ovarian cysts may cause symptoms similar toappendicitis.
Enlarged cysts may also cause symptoms such as:
Ruptured Ovarian CystIf anovarian cystbleeds or bursts, it can cause sudden, severe pain along with bleeding, fever, nausea, vomiting, and dizziness. Ruptured ovarian cysts require immediate medical help.
Ruptured Ovarian Cyst
If anovarian cystbleeds or bursts, it can cause sudden, severe pain along with bleeding, fever, nausea, vomiting, and dizziness. Ruptured ovarian cysts require immediate medical help.
Can an Ovarian Cyst Be Cancerous?
Pelvic Inflammatory Disease (PID)
Long-Term Effects of PIDSome people with PID never experience symptoms, but the condition can still cause damage to reproductive organs. PID can result in infertility (trouble getting pregnant) or increase the risk of an ectopic pregnancy. The Centers for Disease Control and Prevention (CDC) recommends using latex condoms and screening for STDs in sexually active people with risk factors.
Long-Term Effects of PID
Some people with PID never experience symptoms, but the condition can still cause damage to reproductive organs. PID can result in infertility (trouble getting pregnant) or increase the risk of an ectopic pregnancy. The Centers for Disease Control and Prevention (CDC) recommends using latex condoms and screening for STDs in sexually active people with risk factors.
Pelvic Adhesions
A pelvic adhesion is a band of scar-like tissue that forms between two surfaces in the pelvic region, such as the uterus, ovaries, fallopian tubes, or bladder. The adhesion causes the two surfaces to stick together.
Pelvic adhesions may develop as a result of:
Ectopic Pregnancy
Anectopicpregnancyhappens when a fertilized egg implants outside of the uterus. Unfortunately, the fetus cannot survive, and it is a life-threatening emergency for the mother, as well.
You may feel cramping on one or both both sides of the lower abdomen or pelvis along with:
What Causes Stomach Pain During Pregnancy?
Rare Causes of Ovary Pain During Perimenopause
The following causes of ovarian pain during perimenopause are rare, but nonetheless important to be aware of.
Ovarian Torsion
Ovarian Cancer
Ovarian pain fromovarian canceris rare. It is more severe and persistent than pain from a menstrual cycle. Symptoms may also include:
Ovarian Cancer Risk StatisticsThe risk of ovarian cancer is rare at 1.3% of women. Those with a first-degree family member, such as a sister or mother, who have or had ovarian cancer have a slightly higher risk at 5%.
Ovarian Cancer Risk Statistics
The risk of ovarian cancer is rare at 1.3% of women. Those with a first-degree family member, such as a sister or mother, who have or had ovarian cancer have a slightly higher risk at 5%.
Polycystic Ovary Syndrome (PCOS)
PCOSis a condition in which the ovaries produce extra androgens, which are considered male sex hormones, although women have them too. PCOS can cause ovarian cysts or prevent ovulation. People with PCOS often experience irregular periods, weight gain, infertility, and excess body hair.
Do I Have PCOS? 9 Signs
Ovarian Remnant Syndrome
Ovarian remnant syndrome (ORS) occurs when leftover ovarian tissue is present after anoophorectomy(surgery to remove one or both ovaries). It can delay menopause and cause cyclic or constant pelvic pain. Symptoms of ORS also include painful sex, urination, and bowel movements.
When to See a Healthcare Provider
Call your healthcare provider if you are experiencing any of the following:
Is the Pain “Bad Enough” to Seek Help?If you are questioning if the pelvic pain you’re feeling is severe enough to warrant calling a healthcare provider, consider if the pain is:New or has changedGetting worse or worrying youDisrupting your daily lifeWorse during or after sexThat being said, regardless of the level of pain, a provider may help you find a solution as well as alleviate your worries.
Is the Pain “Bad Enough” to Seek Help?
If you are questioning if the pelvic pain you’re feeling is severe enough to warrant calling a healthcare provider, consider if the pain is:New or has changedGetting worse or worrying youDisrupting your daily lifeWorse during or after sexThat being said, regardless of the level of pain, a provider may help you find a solution as well as alleviate your worries.
If you are questioning if the pelvic pain you’re feeling is severe enough to warrant calling a healthcare provider, consider if the pain is:
That being said, regardless of the level of pain, a provider may help you find a solution as well as alleviate your worries.
When to Seek Emergency Medical Attention
Seek emergency medical attention when you have sharp pelvic pain, especially pain on one side, or if you are experiencing any of the following in addition to this pain:
10 Common Types of Pain Scales
Diagnosing Ovary Pain During Perimenopause
If you are concerned about pain in your lower abdomen, pelvis, lower back, or elsewhere, it’s best to see a healthcare provider—even, if only, for peace of mind.
If your pain is mild and you are not experiencing any other new or unusual symptoms, there are a few at-home tools you can use to help you recognize where your pain may be coming from.
These tools can also be helpful for your healthcare provider if you are evaluated.
Self-Checks/At-Home Testing
What to Include in a Symptom TrackerHere is information you should include:When and where the pain occursHow long it lastsDescriptors (sudden, recurrent, ongoing, severe, nagging, achy, cramping, sharp)If anything makes the pain go away or get worseIf the pain is related to your period, urination, or sexual activityStomach issuesPain relieved after bowel movementsMood orsleep problemsWeight gain
What to Include in a Symptom Tracker
Here is information you should include:When and where the pain occursHow long it lastsDescriptors (sudden, recurrent, ongoing, severe, nagging, achy, cramping, sharp)If anything makes the pain go away or get worseIf the pain is related to your period, urination, or sexual activityStomach issuesPain relieved after bowel movementsMood orsleep problemsWeight gain
Here is information you should include:
History and Physical Examination
A detailed history and physical are essential in diagnosing the root cause of pain. The healthcare team may ask you questions about your pain, medical history, sexual activity, and menstrual periods. They may also perform apelvic exam,Pap smear, andsexually transmitted disease (STD) screening.
Labs and Tests
Imaging
Laparoscopy
Laparoscopicsurgery may be used as a diagnostic tool to visualize your internal organs if imaging results are not clear.
Other Causes of Pain During Perimenopause
It can be tricky to diagnose the underlying cause of pelvic or abdominal pain because that area of your body is also home to the bladder, kidneys, intestines, and appendix. Your healthcare provider will use a detective-like process called adifferential diagnosis(ruling out other causes) to ensure the correct diagnosis.
Providers begin with a history and physical that provides clues about what to do next. They may order diagnostic tests such as urine and blood tests. These tests may point them in the direction of common causes such as pregnancy, UTIs, STDs, and appendicitis. If they need to evaluate further, they may order imaging tests, perform advanced testing, or refer you to a specialist.
Your healthcare provider will piece the history, physical, and diagnostic tests together like a puzzle to look for the root cause of your symptoms.
The following are conditions that can cause pain that mimics ovary pain. Depending on your symptoms, your healthcare provider may want to run tests to rule out problems in these non-reproductive organs.
Problems in the Urinary System
In addition to pelvic, abdominal, or lower back pain, infections in the urinary system may cause:
Kidney stones create a sharp, cramping pain in the lower back and sides that may move to the lower abdomen. This type of pain starts suddenly and comes in waves.
Uncomplicated UTIs, kidney infections, and kidney stones are usually diagnosed through imaging, urine, and blood testing. More complex conditions affecting the urinary tract may require advanced testing and treatment from aurologist.
What Causes Kidney Pain?
Gastrointestinal (GI) System
Gastrointestinal (GI) diseases such as irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), or parasitic GI infections may cause abdominal cramping. Women are at higher risk of IBS, and the symptoms often get worse around a period. Other symptoms include bloating, gas, alternating diarrhea and constipation, and mucus in the stool.
Why Is My Stomach Hurting?
Appendicitis
Appendicitis, or inflammation of the appendix, can cause severe abdominal pain. Symptoms usually come on suddenly, change, and get worse. It often hurts worse when you cough, sneeze, or move. It may also cause:
Appendicitis is usually diagnosed through blood work that tests for infection and imaging.
Migratory Abdominal PainAppendicitis frequently causes migratory abdominal pain, meaning the pain shifts from the belly button area to the lower-right abdomen. The pain usually gets worse when pressure is applied.
Migratory Abdominal Pain
Appendicitis frequently causes migratory abdominal pain, meaning the pain shifts from the belly button area to the lower-right abdomen. The pain usually gets worse when pressure is applied.
Treating Ovary Pain During Perimenopause
Treatment is based on the underlying cause of the pain. It may include one or a combination of the following.
Lifestyle Treatment Options
Healthy lifestyle changes such as a nutritious diet, exercise, rest, relaxation, and stress reduction can help with some conditions such as PCOS and menstrual cramps.
At-Home Treatments
If you are experiencing mild pain from ovulation or your menstrual period, home treatments might include:
More severe conditions may require prescription medicine or surgery.
Medications
Depending on the cause of your pain, your healthcare provider may recommend one or more of the following treatment methods:
Surgery
Underlying problems such as endometriosis, fibroids, pelvic adhesions, and ovarian remnant syndrome may require surgery. An ectopic pregnancy, ovarian torsion, or a ruptured appendix will require emergency surgery.
Ruptured Ovarian CystsSpecific types of ruptured ovarian cysts require surgery, but they are rare.
Ruptured Ovarian Cysts
Specific types of ruptured ovarian cysts require surgery, but they are rare.
Complementary and Alternative Medicine (CAM)
Massage, aromatherapy, and herbal therapy may help with menstrual pain.
Herbs for Menstrual Cramps
Acupunctureis popular in treating many health concerns. However, there is not enough science to support its use for menstrual pain. There are preliminary findings that showacupressure, a self-treatment, may provide relief.
Always check with your healthcare provider before trying OTC medications or alternative treatments. Some may be contraindicated with pregnancy, health conditions, or when taking certain medications.
9 Herbs to Relieve Menstrual Cramps
Many conditions, such as a ruptured ovarian cyst, are random. It is not known why they occur or how to prevent them.
Maintaining a healthy diet and exercising can help you lose weight and regulate insulin more efficiently. These healthy habits may decrease the risk of developing PCOS.
Risk factors for ectopic pregnancy include:
While you can’t control all of these factors, avoiding risky behaviors, such as having unprotected sex and smoking, can reduce some of the risks.
If a UTI or kidney infection is the culprit, here are a few tips to help reduce the chance of bacteria entering the urinary tract:
What Might Be Causing Your Ovary Pain
Summary
If you are experiencing pain in your pelvic area and are pregnant, or have other concerning symptoms like vaginal bleeding, vomiting, shoulder pain, or bloody stool, see a healthcare provider immediately for an evaluation.
29 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Takahashi T, Johnson K.Menopause.Medical Clinics of North America. 2015;99(3):521-534. doi:10.1016/j.mcna.2015.01.006
Mount Sinai.Menopause.
Mount Sinai.Mittelschmerz.
Chauhan S, More A, Chauhan V, Kathane A.Endometriosis: A review of clinical diagnosis, treatment, and pathogenesis.Cureus.2022 Sep;14(9):e28864. doi:10.7759/cureus.28864
Mount Sinai.Uterine fibroids.
UVA Health.Ovarian cyst.
Kapoor S, Saeed S, Balasubramaniam D.Paediatric cystic ovarian torsion masquerading appendicitis.BMJ Case Rep. 2021 Feb;14(2):e239188. doi:10.1136/bcr-2020-239188
Penn Medicine.Ovarian cyst.
Johns Hopkins Medicine.Management of ruptured ovarian cyst.
Centers for Disease Control and Prevention.Pelvic inflammatory disease (PID) - CDC fact sheet.
Center for Disease Control and Prevention (CDC).Pelvic inflammatory disease (PID) detailed fact sheet.
Johns Hopkins Medicine.Estrogen’s effect on the female body.
American College of Obstetricians and Gynecologists.Ectopic pregnancy.
Yale Medicine.Ovarian torsion.
Centers for Disease Control and Prevention.What are the symptoms of ovarian cancer?
University of Michigan Health.Family history and the risk for breast or ovarian cancer.
John Hopkins Medicine.Polycystic ovary syndrome (PCOS).
NIH: National Center for Advancing Translational Sciences - Genetic and Rare Diseases Information Center.Ovarian remnant syndrome.
John Hopkins Medicine.Is that burning sensation a urinary tract infection?.
Urology Care Foundation.What are kidney stones?
Pati G K, Kar C, Narayan J, et al.Irritable bowel syndrome and the menstrual cycle.Cureus.2021. doi:10.7759/cureus.12692
Johns Hopkins Medicine.Appendicitis.
Cedars Sinai.Not just a stomach ache, identifying appendicitis.
Phillips N, Bachmann G, Haefner H, Martens M, Stockdale C.Topical treatment of recurrent vulvovaginal candidiasis: An expert consensus.Women Health Rep (New Rochelle). 2022 Jan;3(1):38-42. doi:10.1089/whr.2021.0065
Rosenblum N.Update in female hormonal therapy: What the urologist should know.Rev Urol. 2020 Dec;22(4):182-185.
Khalasi JB, Beiranvand SP, and Bokaie M.Efficacy of Chamomile in the Treatment of Premenstrual Syndrome: A Systematic Review.JOP. 2019;22(4):204-209. doi:10.3831/KPI.2019.22.028
Bakhtshirin F, Abedi S, YusefiZoj P, Razmjooee D.The effect of aromatherapy massage with lavender oil on severity of primary dysmenorrhea in Arsanjan students.Iran J Nurs Midwifery Res. 2015;20(1):156-160. PMID: 25709705
Selçuk A, Yanikkerem E.Effect of acupressure on primary dysmenorrhea: Review of experimental studies.JAMS. 2021 Apr;14(2):33-49. doi:10.51507/j.jams.2021.14.2.33
John Hopkins Medicine.Pelvic Pain.
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