Pain near your right ovary, felt in the lower right abdomen, most commonly comes from ovulation, an ovarian cyst, or a reproductive infection. Less often, it signals something that needs urgent attention like ovarian torsion or an ectopic pregnancy. Because the right ovary sits close to the appendix, pain in this area sometimes turns out to be unrelated to the ovary entirely.
The cause usually depends on where you are in your menstrual cycle, how suddenly the pain started, and what other symptoms are present. Here’s what each possibility looks like.
Ovulation Pain
The most common and least concerning explanation is ovulation pain, sometimes called mittelschmerz. This happens about two weeks before your period, around day 14 of a 28-day cycle, when one of your ovaries releases an egg. If your right ovary released the egg that month, you’ll feel it on the right side. The pain can be a dull ache or a sharper twinge, and it typically lasts a few hours but can stick around for up to 48 hours.
Ovulation pain is one-sided and tends to alternate sides from month to month, though not always in a predictable pattern. If you notice the pain keeps showing up at the same point in your cycle and resolves on its own, ovulation is the most likely explanation. It doesn’t require treatment, though an over-the-counter pain reliever can help if it’s bothersome.
Ovarian Cysts
Ovarian cysts are fluid-filled sacs that form on or inside an ovary. The most common type, called a functional cyst, develops as part of your normal menstrual cycle. These are usually harmless, rarely cause pain, and disappear on their own within two to three menstrual cycles. You may never know one was there.
Pain becomes more likely when a cyst grows large, bleeds internally (a hemorrhagic cyst), or ruptures. A ruptured cyst can cause severe, sharp pain in the pelvis along with nausea, vomiting, dizziness, and rapid breathing. The pain often starts out dull and intermittent, then becomes sharp once the cyst bursts. Other types of cysts, like dermoid cysts, can grow large enough to shift the ovary out of position, which raises the risk of a painful complication called ovarian torsion.
Ovarian Torsion
Torsion happens when the ovary twists around the ligament that holds it in place, cutting off its blood supply. This is a medical emergency. The hallmark is sudden, severe lower abdominal pain that comes on without warning, usually accompanied by nausea and vomiting. You may also be able to feel a mass in your lower abdomen, or a doctor might find one during an exam.
Torsion is more likely if you already have a cyst or mass on the ovary that makes it heavy enough to rotate. Diagnosis typically involves an ultrasound that shows an enlarged ovary with reduced or absent blood flow. If the blood supply isn’t restored quickly through surgery, the ovary can be permanently damaged.
Endometriosis
Endometriosis occurs when tissue similar to the uterine lining grows outside the uterus. When it involves the ovaries, it can form cysts called endometriomas, sometimes referred to as “chocolate cysts” because of the dark blood they contain. The tissue responds to your hormonal cycle the same way your uterine lining does: it thickens, breaks down, and bleeds. But because it has no way to leave the body, the surrounding tissue becomes irritated and forms scar tissue and adhesions that can bind pelvic organs together.
The main symptom is pelvic pain that goes beyond normal menstrual cramping. This pain may start before your period and last for days into it, and it often comes with lower back pain, pain during sex, and pain with bowel movements or urination. If endometriosis is concentrated on or near your right ovary, the pain can feel localized to that side. Unlike ovulation pain, it tends to worsen over time and persist across multiple cycles.
Pelvic Inflammatory Disease
Pelvic inflammatory disease (PID) is an infection of the reproductive organs, usually caused by sexually transmitted bacteria that travel upward from the cervix. It can affect the ovaries, fallopian tubes, and uterus. What makes PID tricky is that the symptoms are often subtle or easy to dismiss: mild pelvic pain, unusual vaginal discharge, abnormal bleeding, or discomfort during sex. Many episodes go unrecognized entirely.
If the infection is more concentrated on the right side, it can feel like right ovarian pain. Left untreated, PID can cause lasting damage to the fallopian tubes, increasing the risk of infertility and ectopic pregnancy. A fever over 101°F alongside pelvic pain and discharge makes PID more likely and worth getting evaluated promptly.
Ectopic Pregnancy
If there’s any chance you could be pregnant, right-sided pelvic pain should raise a red flag for ectopic pregnancy. This happens when a fertilized egg implants outside the uterus, most often in a fallopian tube. If it implants in the right tube, you’ll feel pain on the right side.
Early signs include light vaginal bleeding and pelvic pain. As the pregnancy grows, it can rupture the tube, causing heavy internal bleeding, extreme lightheadedness, fainting, and shock. Shoulder pain or a sudden urge to have a bowel movement can also signal internal bleeding irritating nearby nerves. Your risk is higher if you’ve had a previous ectopic pregnancy, pelvic infections, tubal surgery, or if you smoke. Getting pregnant with an IUD in place, while rare, also increases the chance of ectopic implantation.
This is always a medical emergency. A pregnancy test and ultrasound can confirm or rule it out quickly.
Appendicitis Can Mimic Ovarian Pain
The appendix sits in the lower right abdomen, very close to the right ovary. Appendicitis pain often starts near the navel, then migrates to the lower right side where it becomes intense. It’s usually accompanied by loss of appetite, nausea or vomiting, fever, and abdominal swelling. Some people also experience constipation or diarrhea.
One key difference: appendicitis pain tends to get steadily worse over hours and intensifies when you move, cough, or press on the area and then release. Ovarian pain, by contrast, is more likely to come and go with your cycle or stay localized without that characteristic worsening pattern. But the overlap is significant enough that doctors frequently need imaging to tell the two apart in women of reproductive age.
When Right Ovary Pain Needs Urgent Care
Most right-sided ovarian pain is benign and resolves on its own or with straightforward treatment. But certain combinations of symptoms point to something more serious. Seek emergency care if your pain is sudden and severe, especially if it comes with any of the following:
- Heavy vaginal bleeding
- Fever
- Nausea or vomiting
- Fainting, extreme lightheadedness, or signs of shock
- Shoulder pain (which can indicate internal bleeding)
How the Cause Gets Identified
When you see a provider for right ovary pain, the first step is usually a detailed history of your symptoms: when the pain started, where exactly it is, whether it tracks with your cycle, and whether you could be pregnant. A pelvic exam can identify tenderness, masses, or signs of infection.
The most useful imaging tool is a transvaginal ultrasound, which can detect ovarian cysts, enlarged ovaries, signs of torsion, and ectopic pregnancies. Blood work, including a pregnancy test and markers for infection, helps narrow the possibilities further. For conditions like endometriosis, diagnosis often takes longer because the tissue doesn’t always show up clearly on imaging, and a definitive answer sometimes requires a minor surgical procedure to look directly at the pelvic organs.
Tracking your symptoms relative to your menstrual cycle gives your provider one of the most useful pieces of information. If the pain reliably appears mid-cycle and resolves within a day or two, ovulation is the likely cause. If it’s constant, worsening, or paired with other symptoms, that points toward something that needs closer investigation.