Ovary Pain?

I’ve tried about 4 different titles for this and I’m still not sure where to land. I chose to land on the term most people use to describe this stabbing, twisting abdominal/pelvic pain that happens about halfway along the line between the belly button and the hip. And no, this isn’t appendicitis. While the famous McBurney’s point is in a very similar location, this has nothing to do with that.

For years, women have been coming to me and reporting that they have this pain - it can be right or left or both, though almost all women have a worse side. The pain is worse around their periods and because it’s off to the side of the uterus, it’s most often attributed to the ovary - and don’t get me started on what the ER does to perpetuate this myth. Because it tends to flare around the menstrual cycle and there is usually a corpus luteum haning around, the ovary often catches the blame, but is truly an innocent bystander. This pain is worsened by being on your feet all day and things like rolling over in bed at night. Often curling into a ball is the only thing that helps.

I think that on average patient’s see about 3 providers (and some many more) before they arrive to me. Many have had expensive imaging tests - CTs, MRIs, U/S, etc and almost none have had a good physical exam and a real explanation of that is going on. So, what is this mysterious pain that has nothing to do with the ovary? Well, if you were pregnant, we would call it round ligament pain - and I like to call it that outside of pregnancy too, because really, that is where the pain is coming from.

The round ligament comes off the front of the uterus and goes lateral and anterior to the abdominal wall where it takes a 90 degree turn, runs throught the inguinal canal and inserts in the lateral vagina/labial area. While inguinal hernias are far less common in women than men, this can also happen at the same time and also becomes a much more concerning condition. You’ll usually know if this is the case because you will get a new bulge - kind of like a testicle, which a woman should never develop, especially after straining and moving patio furniture inside hours before a hurricane hits. So, if you’ve struggled with this for a long time, but suddenly the pain is worse than it has ever been and you start vomiting and there is a new weird testicle like structure in your labia, your next stop should be the ER.

If the area around the round ligament insertion in the abdominal wall becomes loosened or pulled, you can start to get these sensations with the activities described above. So, what makes it worse - obesity/rapid weight gain, anything that increases intraabdominal pressure (pregnancy, constipation, bloating), standing for long periods, pelvic organ prolapse and twisting/bending.

What makes it better? Yes, there are some things that make it better and no, none of them are quick fixes. Once you get checked out and we make the appropriate diagonsis because occasionally a space occupying lesion like a fibroid or a dermoid cyst can create similar symptoms, you can follow these helpful tips.

Step 1 - reverse any underlying condition - if overweight, loose weight, if constipated, treat that.

Step 2 - support the abdominal wall - you can do this with a girdle, spanx, high waisted tight leggings or other support garments.

Step 3 - core strengthening - yoga and pilates are the most helpful exercises you can do. Focus on pelvic floor strenthening as well. Pelvic floor physical therapy can also be really helpful. Check out this website from an amazing local provider https://waist2waste.com/ .

Step 4 - potential surgical management. Sometimes we ultimately need a hysterectomy or you could have adhesions and scar tissue from things like endometriosis or prior Cesarean deliveries that are contributing and the only way to reverse that is surgery. A word of warning though, if we skip steps 1-3, that week spot may still remain and while the ligament will withdraw and not be pulled on, if there is a weak spot around it, you can still get pressure in the inguinal area causing some of these symptoms, though it would be unusual for them to be as bad as presurgery.

So, set free the innocent and stop blaming the ovary for the weird one side stabbing pain when you roll over in bed tonight.