Why Do Ovaries Cramp During Period and Fibroids: What to Know

Why Do Ovaries Cramp During Period and Fibroids: What to Know

If you feel sharp, aching, or pulling sensations near your ovaries around your period, you are not alone. Many people describe “ovary cramps,” yet most menstrual cramps actually begin in the uterus. Still, conditions like uterine fibroids, endometriosis, and ovarian cysts can make pain feel localized to one or both sides of the pelvis. Understanding where this pain comes from—and when it signals something more—can help you seek the right care and relief.

Why “ovary” pain happens during your period

Menstrual cramps (dysmenorrhea) are primarily driven by prostaglandins—hormone-like chemicals that trigger the uterus to contract to shed its lining. High prostaglandin levels can increase pain, nausea, diarrhea, and headaches around menses. Even though the uterus sits centrally, pelvic nerves are shared, so pain can be felt on the right or left side and interpreted as ovarian pain.

Several factors can make cramps feel sharper or more lateral:

  • Referred pain from uterine contractions: Strong contractions can radiate to the lower abdomen, groin, and lower back, mimicking ovarian pain.
  • Endometriosis: Endometrial-like tissue can grow outside the uterus—on ovaries, fallopian tubes, or pelvic ligaments—causing inflammation and pain that often worsens with periods.
  • Ovarian cysts: Functional cysts related to the ovulatory cycle are common and often harmless, but some can stretch the ovarian capsule or rupture, leading to unilateral pain around or during menstruation.
  • Pelvic floor muscle tension: Muscles can tighten in response to pain, producing focal, side-specific aches.

Bottom line: even if it feels like the ovaries are “cramping,” the uterus is frequently the source, but coexisting conditions can localize or amplify pain.

How fibroids contribute to cramping and “ovary” pain

Uterine fibroids (leiomyomas) are noncancerous growths in or on the uterus. They are very common during reproductive years. Fibroids do not grow on the ovaries, but they can cause pain that feels like it sits near them.

Mechanisms include:

  • Heavier bleeding and more prostaglandins: Fibroids—especially those that distort the uterine cavity—often cause heavy periods. Heavier flow is associated with higher prostaglandin levels and stronger cramps.
  • Increased uterine size and pressure: Large or strategically located fibroids can stretch the uterus, press on pelvic nerves, and create unilateral pressure or aching.
  • Fibroid degeneration: When a fibroid outgrows its blood supply, it can undergo “degeneration,” leading to acute, sometimes sharp localized pain (often with tenderness on one side).
  • Contractions against obstruction: Submucosal fibroids that protrude into the cavity can make the uterus work harder to expel menstrual tissue, intensifying cramps.

If you notice period pain that is worsening over time, accompanied by heavier or longer bleeding, pelvic pressure, or urinary frequency, fibroids may be part of the picture.

Period pain vs. ovulation pain vs. emergencies

  • Period pain (dysmenorrhea): Starts just before or during bleeding; crampy, central, sometimes radiating to sides or back. Often improves with NSAIDs and heat.
  • Ovulation pain (mittelschmerz): A brief, one-sided twinge or ache mid-cycle (about 10–16 days before the next period). Typically mild to moderate and short-lived.
  • Seek urgent care if: Pain is sudden and severe, you have fever, fainting, vomiting, a positive pregnancy test or pregnancy possibility, pain with heavy vaginal bleeding (soaking a pad or tampon every hour for several hours), or more than mild pain on one side with nausea—these can signal ovarian torsion, ruptured cyst, ectopic pregnancy, or infection.

How clinicians evaluate pelvic or “ovary” cramps

Evaluation starts with your history: timing (cycle-related vs continuous), location (one or both sides), severity, bleeding patterns, associated symptoms (fever, gastrointestinal or urinary symptoms), and prior diagnoses (fibroids, endometriosis, cysts).

Your clinician may recommend:

  • Pelvic exam: Checks for uterine enlargement, focal tenderness, or masses.
  • Pregnancy test: To rule out ectopic pregnancy in those at risk.
  • Pelvic ultrasound: First-line imaging to identify fibroids, ovarian cysts, or other masses.
  • MRI: Sometimes used to map fibroids before procedures or to evaluate complex findings.
  • Labs: Blood count for anemia with heavy bleeding; tests for sexually transmitted infections if indicated.

Evidence-based relief and treatment options

Self-care and nonprescription options

  • NSAIDs (e.g., ibuprofen, naproxen): Reduce prostaglandins and are first-line for menstrual cramps. For best effect, start 24 hours before expected bleeding or at first cramp and take with food as directed.
  • Heat therapy: A heating pad or heat wrap can be as effective as some pain medicines for dysmenorrhea and is safe to use alongside NSAIDs.
  • Movement, sleep, and stress strategies: Light exercise, stretching, adequate sleep, and relaxation techniques can reduce muscle tension and pain perception.

Hormonal therapies

  • Combined estrogen-progestin methods: Pills, patch, or ring can lighten periods and lessen cramps; continuous dosing can reduce frequency of bleeding.
  • Progestin-only methods: The levonorgestrel-releasing intrauterine device (IUD) often reduces bleeding and cramping within months; progestin-only pills or injections may help some patients.

Fibroid-focused medical treatments

  • Tranexamic acid: A nonhormonal option taken only during menses to reduce heavy bleeding associated with fibroids (does not directly treat pain sources).
  • GnRH agonists (e.g., leuprolide): Temporarily shrink fibroids and reduce bleeding; typically used short-term due to hypoestrogenic side effects.
  • Oral GnRH antagonists with add-back therapy: FDA-approved combinations such as elagolix/estradiol/norethindrone (brand: Oriahnn) and relugolix/estradiol/norethindrone (brand: Myfembree) reduce heavy menstrual bleeding from fibroids. These are prescription therapies with specific eligibility, side effects, and duration limits—discuss with your clinician.

Procedures and surgery

  • Uterine artery embolization (UAE): Minimally invasive procedure that shrinks fibroids by blocking their blood supply; can reduce pain and bleeding while preserving the uterus.
  • MRI-guided focused ultrasound: Uses focused sound waves to ablate fibroid tissue in select candidates.
  • Myomectomy: Surgical removal of fibroids with preservation of the uterus; options include hysteroscopic (for submucosal), laparoscopic, or open approaches.
  • Hysterectomy: Definitive treatment that removes the uterus; eliminates fibroid-related pain and bleeding but is not appropriate for those wishing to carry a pregnancy.

For endometriosis-related pain overlapping with fibroids, treatments may include NSAIDs, hormonal suppression (including combined or progestin-only regimens), or surgical excision of endometriosis lesions. Ovarian cyst management depends on type and size; many functional cysts resolve on their own, but complex or persistent cysts warrant specialist care.

When to contact a clinician

  • Cramps that are suddenly much worse than usual or do not improve with NSAIDs and heat
  • Heavy bleeding that soaks through a pad or tampon every hour for several hours, passes large clots, or causes dizziness, fatigue, or shortness of breath
  • Fever, vomiting, or pain with urination or bowel movements
  • Pain that is strictly one-sided and severe, especially with nausea or vomiting (possible torsion or ruptured cyst)
  • Persistent pelvic pain lasting more than three months
  • Concern for pregnancy or a positive home pregnancy test

Key takeaways

  • What feels like “ovary” cramps during your period is often uterine in origin, but fibroids, endometriosis, and ovarian cysts can localize or intensify pain.
  • Fibroids contribute to heavier bleeding and stronger cramps and can cause acute side-specific pain when they degenerate.
  • Diagnosis typically involves history, exam, and ultrasound; treatment ranges from NSAIDs and hormonal therapies to fibroid-specific medications and procedures.
  • Seek urgent care for sudden severe pain, heavy bleeding, or pregnancy concerns.

This article is for general education and does not replace personalized medical advice. A clinician who knows your history can tailor evaluation and treatment to your goals, including fertility considerations.

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