Most days you don’t hear a peep from your ovaries. But when things are not so business as usual, ovary pain is not only a bit shocking, but also stressful — so, what does it mean?

Your ovaries are those two tiny oval-shaped organs posted up in both sides of your lower pelvis. As you probably remember from health class, your ovaries are big players with your period, reproduction, and are your body’s major source of the hormones estrogen and progesterone.

Ovaries are kind of legendary and every month, one follicle levels up into an egg and is dropped from one of the ovaries (aka ovulation). And, rarely, eggs might be released from both ovaries at once (and if they’re both fertilized, you get twins).

Usually, if you experience ovary pain, it’s related to your period. But other times, ovary pain may be a symptom of a stealthy, underlying condition.

Since you probably don’t have full-time work as an ovary whisperer, let’s take a look at some culprits behind those ovary pains.

Not-so-fun fact: Ovulation pain is called mittelschmerz, which originates from the German words for “pain” and “middle” referencing mid-cycle pain. (OK, OK, makes sense.)

An egg’s journey to freedom from an ovary happens on or around day 14 of a typical menstrual cycle. Most of us have no clue this is happening and feel nothing at all. But some of us will notice a pretty intense pain on one or both sides of the body.

This can last anywhere from a few minutes to hours. It’s also possible that bleeding, nausea, and increased egg-white cervical fluid (aka super fertile discharge) tag along as well.

Treatment: Unfortunately, there’s no treatment available for ovulation pain, though you can ease the symptoms with a heating pad and over-the-counter (OTC) pain relievers. Some may choose to take birth control that prevents ovulation and it’s side effects.

You may also notice recurring pains around the ovary zone while you’re on your period.

Period cramps can be pretty severe (hello, Captain Obvious). And, it’s possible that the intense pelvic pain you feel is really just your period pains acting a fool, and not your ovary at all.

Treatment: You know the drill. OTC meds like ibuprofen or acetaminophen and home remedies like heating pads are period pain go-to’s.

These little sacs can pop up on your ovary at any time. Ovarian cysts are typically filled with a harmless liquid (though they can also be solid) and odds are, if you have one or two, you won’t even notice.

But other times, they come in like a wrecking ball, giving you pain in your pelvis, thighs, and lower back. You may especially notice this pelvic pain during sex or your period.

Other symptoms:

  • nausea/vomiting
  • pooping pains
  • achy breasts
  • fullness in your belly
  • bladder pressure/peeing more often

Treatment: Your doc may suggest going on birth control pills to help prevent cyst formation going forward. As long as cysts are not causing pain and don’t look suspicious for cancer, they can be observed through serial transvaginal ultrasounds. If the cysts rapidly grow in size or are large, appear suspicious, or cause pain, then surgery may be considered.

If you have endometriosis, tissue similar to that lining the inside of your uterus (aka the endometrium) grows outside the uterus.

Usually, the endometrium sheds each month during your cycle. But, when it grows on the outside of your uterus, it gets trapped and can develop adhesions and scar tissue. When this tissue covers your ovaries, it can cause some gnarly pain.

Other symptoms:

  • nausea
  • diarrhea
  • constipation
  • fatigue
  • pain during sex, periods, or while going #2
  • extreme bleeding

Treatment: There are home medical, and surgical options to help ease endometriosis symptoms and deal with possible complications. Your doc will probably try out standard treatment options like prescribing birth control, but may decide surgery is necessary if things don’t get better.

Pelvic inflammatory disease (PID) — most common in women ages 15 to 25 — affects the ovaries, uterus, and fallopian tubes. The American Sexual Health Association has pegged it as the leading cause of infertility for women in the United States.

This infection of reproductive organs and genital tract can sprout up on its own or be sexually transmitted. Your doc can diagnose PID during a pelvic exam and labs.

It’s possible to have PID without any symptoms or have your PID symptoms confused with other conditions like ovarian cysts, ectopic pregnancy, or appendicitis.

Other symptoms:

  • pelvis pain
  • pain during sex
  • burning when you pee
  • nausea/vomiting
  • irregular bleeding
  • change in vaginal discharge
  • fever, chills

Treatment: Usually your doc will prescribe antibiotics or antimicrobial agents to do the trick, but you may need an extra round of treatment to clear it up completely.

Pain after you’ve had surgery on your ovaries (or if you’ve totally removed them), could point to ovarian remnant syndrome (ORS).

ORS is a result of leftover tissue from surgery, thanks to a slew of variables during surgery like adhesions, bleeding, anatomic variations, or simply incomplete removal during surgery.

Pelvic pain or noticing a pelvic mass are the most common symptoms. Symptoms can also be similar to those of endometriosis and are usually experienced within 5 years after ovarian surgery.

Treatment: Surgery may be necessary to get rid of the tissue or hormone therapy to stifle ovulation.

Here’s the deal: the ovary is attached to the abdominal wall by just a wafer-thin ligament. This is where blood vessels and nerves that supply the ovary pass through. If that ligament gets bent out of shape or twisted, it’s not impossible for it to tie itself into a knot.

Ovarian torsion is even more likely if there’s already a cyst on said ovary. That’s because the cyst makes the ovary heavier and prone to shifting.

Other symptoms:

  • severe ovarian/lower abdomen pain
  • nausea/vomiting
  • cramping

Treatment: Ovarian torsions are def a medical emergency that need treatment STAT. Otherwise, the ovary may die from blood loss.

Fibroids are noncancerous nodules that pop up on the uterus’ lining or wall — usually symptom free. Most won’t even know they’re there, but for some, fibroid pain can be intense as hell.

Fibroids can also lead to heavy period bleeding and extended periods. They can also trigger:

Treatment: It’s possible to manage fibroid pain with home remedies like heating pads, warm compresses, massage, or OTC pain meds. Bleeding can often be managed with birth control pills or other hormones.

Consider some lifestyle changes too, like eating a whole food diet and stress reducing activities like yoga, meditation, or acupuncture. If these don’t work, surgery may be an option.

It’s easy to hit the panic button when ovary pain flares up, and the dreaded C word definitely comes to mind. But how common is ovarian cancer anyway?

Roughly 11 out of 100,000 women are affected by ovarian cancer. The average diagnosis age is usually around 63 years old. So if you’re 20- or 30-something, your odds are low this is the cause of your ovary pain.

However, people with a family history of breast or ovarian cancer, or have the BRCA gene mutation should be monitored carefully and talk to their doctor about their risks. You’re higher risk for the BRCA mutation if you’re of Ashkenazi Jewish ancestry.

An ovarian tumor also doesn’t automatically mean its cancer. Benign tumors happen in about half the population of women who have irregular periods and about 30 percent of women with traditional periods.

Other symptoms:

  • weight loss
  • pelvic pain
  • fullness while eating
  • belly bloat or swelling
  • changes in poop habits
  • peeing frequently

Treatment: If the ovarian tumor is benign, most docs will keep an eye on it before deciding if it needs removed or not. If it’s cancerous, your doctor will determine how to proceed. Early detection is the best approach, so if you’re truly worried, visit your doc.

An ectopic pregnancy is when a fertilized egg attaches somewhere else instead of inside the uterus.

When this happens, it’s usually in the fallopian tubes — you’ve maybe heard the term “tubal pregnancy” before. According to the American Academy of Family Physicians (AAFP), about 1 out of every 50 pregnancies is ectopic.

Other symptoms:

  • stabbing or sharp pain in pelvis, belly, shoulder, and neck (varying in intensity, may come and go)
  • vaginal bleeding
  • gastric symptoms
  • dizziness or fainting

Treatment: If you suspect you have an ectopic pregnancy call your doctor ASAP. It can be life threatening if left untreated. An ectopic pregnancy may need surgically removed or you may require medication with close monitoring to stop the growth of cells.

It’s possible to think your pain is happening on your ovary while, in reality it’s really popping off in another nearby local.

Here are some common conditions that you could mistake for ovary pains:

Appendicitis: This pain is near the belly button or sometimes on your right side (which you may think is your right ovary).

Constipation: The rule of thumb with this crowd pleaser? If you’ve had less than three bowel movements in the last week, it’s probably constipation babe.

Kidney stones: This pain can be so incredibly intense and mostly located on your back, side, or near your ribs.

Urinary tract infection: Pain located in the center of your pelvis can be a UTI.

Your doc can rule out those serious conditions like endometriosis and PID, both of which can result in infertility issues if they keep thriving. Plus, both a ruptured ovarian cyst, ectopic pregnancy, and appendicitis have the potential to be life-threatening. It’s worth the trip.

It’s likely your ovary pain is related to your cycle, but it can also be confused with something as silly (but painful) as constipation. It could also be an underlying symptom of a more serious condition.

For the less-than-super-serious conditions, OTC pain relievers or home remedies may do the trick. But when it comes to your reproductive organs, it’s best to have your doc perform a pelvic exam anyway, to get you both a clean bill of health and peace of mind.