Ovary Pain During Pregnancy: Causes, Treatment And Management

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Ovary pain during pregnancy can be due to several underlying conditions and often manifest as pelvic or abdominal pain. It is common during the early stages of pregnancy, especially in the first trimester (1). Irrespective of the symptoms and the trimester, consult your healthcare provider if you experience severe abdominal pain, specifically in the pelvic region, to rule out underlying morbidities.

This post will guide you through the causes, symptoms, diagnosis, and treatment of ovary pains during pregnancy.

Is Ovary Pain A Sign Of Implantation?

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Ovarian pain can be a sign of implantation if it arises from ovarian cysts (corpus luteumⁱA temporary endocrine gland that plays an essential role in ovulation and early pregnancy. cyst), which are common during pregnancy and help sustain it (2). This type of pain may also be accompanied by implantation bleeding. However, ovarian pain can also indicate an ectopic pregnancy, where the egg implants outside the uterus, such as in the fallopian tubesⁱMuscular, hollow ducts connecting the uterus with the ovaries to transport eggs during ovulation. or ovary (3) . Therefore, any stomach discomfort or abdominal pain during pregnancy should be reported to your healthcare provider.

What Are The Causes Of Ovarian Pain?

Although ovarian pain is common in pregnancy, its causes can vary and, sometimes, lead to other reproductive health conditions. The causes of ovarian pain include

1. Stretching of round ligament: During the second trimester of gestation, as the uterus begins to grow, the round ligaments that support the uterus stretch, causing cramping in the lower abdomen. The round ligaments are located on the sides of the uterus. The intensity of round ligament pain may range from acute to mild pain (4).

2. Accommodation changes: As the pregnancy progresses, you may experience pain in the pelvic region or ovaries as your body stretches or loosens the pelvic bones to accommodate the growing uterus and prepare for childbirth (5).
   

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3. Ectopic pregnancy: In this type of pregnancy, implantation occurs outside the uterus, mostly in the fallopian tube. Since the fallopian tubes are not meant to hold an embryo, complications arise, such as pain on either side of the uterus.

You may experience symptoms such as bleeding as the pregnancy progresses and should consult your healthcare provider (6).

4. Miscarriage: Miscarriage or spontaneous abortionⁱA natural loss of pregnancy before 20 weeks of gestation. is the loss of pregnancy due to abnormalities of the chromosomes, thyroid disorder, high sugar levels, etc., and can cause pelvic or ovarian pain.

Prenatal care is crucial to reduce the risk of miscarriage. Eight out of ten miscarriages occur in the first three months of pregnancy and are present with bleeding, lower back pain, lower abdominal pain, and cramps (6).

5. Ovarian rupture and torsion: This is among the most common causes of ovarian pain. Growing functional ovarian cysts can sometimes rupture, causing pain and bleeding in the ovaries. The weight of the ovarian cysts can also cause the ovaries to twist on the tissues surrounding them or the fallopian tubes, causing severe ovarian pain (6).

Quick fact

Conservative management is usually suggested for ovarian cysts during pregnancy. Laparoscopic surgeryⁱA minimally invasive keyhole surgery to treat abdominal and pelvic conditions. may be conducted in some cases without any adverse fetal outcome (16).

6. Appendicitis: The growing uterus leads to the appendix shifting higher in the abdomen naturally in every pregnant woman, making the diagnosis of appendicitisⁱA medical emergency identified by severe pain due to an inflamed or infected appendix. difficult. It requires prompt treatment and surgery if suggested (7).

7. Gallbladder problems: During pregnancy, hormonal changes can lead to gallbladder problems. Elevated hormone levels that may slow down or stop bile flow from the gallbladder, causing the bile to harden and resulting in gallbladder stones. Clinical manifestations may include itchiness, vomiting, jaundice, and severe pain in the abdomen (8).

8. Urinary tract infection (UTI): Pregnancy makes women more prone to UTIs since the increasing size and weight of the uterus, which is directly above the bladder, can block the flow of urine from the bladder.

Common symptoms include a burning sensation while peeing, pain in the bladder or lower abdomen, and blood in the urine (9).

Quick tip

Regular intake of unsweetened cranberry juice may help prevent UTI during pregnancy (9).

9. Fibroids: These are benign tumors of the uterus. They cause severe lower abdominal pain, which could indicate enlargement of the fibroidsⁱNon-cancerous tumors that are formed in or on the wall of the uterus. and cause fertility issues such as miscarriage, premature birth, and problems in implantation (10). According to the UT Southwestern Medical Center, approximately 76% of fibroids shrink after childbirth, with 36% of those diagnosed in early pregnancy resolving on their own.
   

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10. Kidney stones: The tendency to urinate frequently in pregnancy could make you drink less water. Dehydration may cause kidney stones. Common symptoms include blood in the urine, vomiting, and dizziness (11).

11. Placental abruption: This refers to the detachment of the placenta from the uterus before delivery. Placental abruption can be fatal and causes acute stomach pain and hardening of the stomach for long durations (4).

12. Preeclampsia: It is a pregnancy condition characterized by high blood pressure and protein in the urine, causing vomiting, nausea, and abdominal pressure (4).
13. Ovarian cancer: This is a rare phenomenon; usually, an ovarian mass or tumor is found during the early stage of pregnancy. However, with proper treatment, one can have a healthy pregnancy. Typical symptoms include pain in the lower abdomen, bloating, and fatigue (12).
14. Pelvic inflammatory disease (PID): This condition affects the ovaries, fallopian tubes and the uterus. It is usually caused by untreated sexually transmitted infections (STIs). Symptoms include pain in the lower abdomen, chills, and fever. Antibiotics and IV medication are generally used to treat PID (13).

How Is Ovarian Pain Diagnosed?

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The diagnosis for ovarian pain largely depends on the symptoms and causes and is made using the following diagnostic tools (14) (15):

1. Lab and blood tests: Vaginal swabs for bacterial culture and blood tests for white blood cell count may be carried out to detect any signs of the infection causing pelvic and ovarian pain.

2. Imaging: The most common imaging modality is an ultrasound scan, which helps visualize the abdominal and pelvic region. Your healthcare provider may also suggest an MRI, depending on the symptoms. This is particularly useful in detecting the root cause of pelvic pain.

3. Diagnostic laparoscopy: It may be performed for better visualization. A small cut is made in the abdomen and a tube fitted with a camera is inserted for either tissue extraction or surgery, depending on the type and cause of pain.

4. Differential diagnosis: An ultrasound scan is the first diagnostic tool utilized for most of the above-mentioned causes of ovarian pain. However, there are some exceptions.

• For UTI and kidney stone-related pain, urine analysis is carried out to test for UTI-causing bacteria.

• For pain caused by an ectopic pregnancy, ovarian cyst rupture, or torsion, a pelvic examination, such as pelvic ultrasound and diagnostic laparoscopy.

When Should You Seek Help?

Ovarian pain may suggest underlying complications if accompanied by severe or persistent symptoms. Hence, contact your healthcare provider if any of the following symptoms arise (4):

• Vomiting or nausea

• Vaginal discharge, bleeding, or spotting

• Fever with chills

• Persistent pains for long durations

• Dizziness

• Pain accompanied by breathing difficulty

Can Ovarian Pain Be Managed At Home?

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You could try these home remedies for ovary pain if your healthcare provider rules out any complications (6):

• Simple stretching exercises

• Prenatal yoga and meditation

• Sufficient water intake

• Ample rest to regain strength and ease fatigue

• Sitting with your knees close to the chest to minimize pressure

• Shifting positions often

What Are The Treatments For Ovarian Pain?

The treatments for ovarian pain may depend on the cause and symptoms of the pain.

• Medication: The medication prescribed would primarily depend on the cause and severity of the pain. Your gynecologist may prescribe certain pain relief medications for pain control during further investigations (7) (8) (11). For ectopic pregnancy, methotrexate may be injected into the body (3).
  Note: You can take medications only after consultation with your healthcare provider.

• Surgery: Ovarian pain due to ectopic pregnancy requires immediate surgery. In case of ovarian torsion, laparoscopic surgery or laparotomy may be performed. Cystoscopy may be carried out for kidney stones that do not dissolve naturally or with medication (6) (11).

Infographics: Conditions Leading To Pain In The Ovaries During Pregnancy

Ovarian pain in pregnancy can occur from either common changes such as stretching of the uterus or an underlying condition such as torsion or a rupture requiring immediate medical attention. This infographic will help you understand the different causes in a simpler and concise manner.

Illustration: Momjunction Design Team

Illustration: Ovary Pain During Pregnancy: Causes Treatment And Management

Image: Stable Diffusion/MomJunction Design Team

Pelvic pain in early pregnancy can be overwhelming. Learn about the symptoms, causes, and tips for relief in this informative video.

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Dr. Mona HardasMD

Dr. Mona Hardas is a practicing Ob/Gyn from Flint, Michigan, with over 20 years of experience in private practice. She is also actively involved in teaching medical students and residents as an associate clinical professor from MSU College of Human Medicine.

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  Dr. Alan Lindemann is an obstetrician and maternal mortality expert, who worked as a clinical associate professor at the University of ND. An alumnus of the University of ND and the University of Minnesota, he is a member of the American College of Obstetricians and Gynecologists and the American Medical Association.

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Aneesha holds a Bachelor's degree in Biotechnology from USTM, Meghalaya and Master’s degree in Applied Microbiology from VIT, Vellore. With two years of experience, she has worked on different research projects in the field of Food Sciences.

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Rebecca is a pregnancy writer and editor with a passion for delivering research-based and engaging content in areas of fertility, pregnancy, birth, and post-pregnancy. She did her graduation in Biotechnology and Genetics from Loyola Academy, Osmania University and obtained a certification in ‘Nutrition and Lifestyle in Pregnancy’ from Ludwig Maximilian University of Munich (LMU).

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