A hysterectomy involves the removal of the uterus, but it does not always include the ovaries. The procedure to remove the ovaries is called an oophorectomy, and the decision to retain or remove them is separate, often based on a patient’s age and health history. When a woman undergoes a hysterectomy but keeps one or both ovaries, these organs remain hormonally active and capable of function. Consequently, ovaries can still hurt after a hysterectomy, as they continue to be susceptible to the same conditions that caused pain before the surgery. This retention can lead to post-surgical discomforts, ranging from cyclical aches to chronic, persistent pelvic pain.
Pain Originating from Retained Ovaries
Retained ovaries continue their normal function of producing hormones, which can lead to cyclical pain even without a menstrual period. As the ovaries progress through their monthly cycle of follicle development, a woman may experience premenstrual syndrome (PMS)-like symptoms, including bloating, mood changes, and cramping sensations. The ovaries also remain susceptible to functional ovarian cysts, which are common, fluid-filled sacs. These cysts typically resolve on their own, but they can cause sharp or dull pain if they grow large or rupture. Post-surgical inflammation or irritation in the surrounding tissues can also directly affect the ovaries, contributing to general pelvic discomfort.
Understanding Ovarian Remnant Syndrome
Ovarian Remnant Syndrome (ORS) is a rare complication that occurs after an attempted oophorectomy. ORS is defined by the inadvertent presence of a small piece of hormonally active ovarian tissue left behind in the pelvic cavity. This microscopic tissue can become functional, producing hormones and developing cysts or masses that cause chronic or recurring pain. The condition often results from a technically difficult initial surgery, especially when severe adhesions or scar tissue obscure the anatomical boundaries. The resulting pain is frequently severe and cyclical, mimicking menstrual pain or causing pain during intercourse. Diagnosing ORS is difficult, requiring advanced imaging like CT or MRI to locate the source of the persistent hormonal activity and pain.
Pelvic Pain Sources Unrelated to Ovaries
Many sources of post-hysterectomy pelvic pain are not related to the retained ovaries. One common non-ovarian cause is the formation of pelvic adhesions, which are bands of scar tissue that form between organs following abdominal surgery. These fibrous bands can tether the bowel, bladder, or remaining pelvic structures, causing a pulling sensation or chronic pain, especially with movement. Discomfort can also relate to nerve entrapment or damage near the surgical sites, leading to persistent, sharp, or burning pain. Other sources include conditions related to the urinary tract or bowels (such as interstitial cystitis or Irritable Bowel Syndrome) or pain originating from the vaginal cuff, which is the closed-off top of the vagina.
Diagnosis and Management of Post-Surgical Pain
A patient experiencing persistent or worsening pelvic pain after a hysterectomy, especially if accompanied by fever or severe acute onset, should seek medical attention. Diagnosis begins with a detailed medical history and a physical examination to localize the pain and assess for masses or tenderness. Imaging studies, such as a transvaginal ultrasound, are used to visualize the retained ovaries and check for cysts or structural abnormalities. If ovarian pain is suspected, blood tests measuring hormone levels (e.g., FSH and estradiol) confirm if the ovarian tissue is still hormonally active. Management strategies depend on the cause of the pain. Mild, cyclical discomfort may be treated with over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), while functional cysts often require observation. For chronic pain or confirmed Ovarian Remnant Syndrome, treatment involves hormonal suppression therapy or, in severe instances, a second surgical procedure to remove the painful remnant tissue or mass.