Ovary pain, felt in the lower abdomen or pelvis, is a common symptom that can range from a mild, temporary ache to severe, acute discomfort. While often associated with the menstrual cycle, the pain can signal various underlying conditions. A change in body position, such as lying down, can sometimes amplify or trigger this pelvic discomfort. This positional factor suggests a mechanical element is influencing the internal organs and surrounding tissues.
The Positional Factor: Why Lying Down Increases Pain
The sensation of increased ovarian pain when lying down (supine position) is often due to changes in intra-abdominal pressure and the shifting of pelvic organs. When a person lies flat, the distribution of gravity changes, leading to a slight increase in pressure within the abdominal cavity.
This change in pressure can compress or stretch sensitive structures in the pelvis that are inflamed or under tension. For instance, an enlarged ovary due to a cyst or tissue scarred by endometriosis can be pushed against surrounding nerves or the pelvic wall. The broad ligaments, which hold the uterus and ovaries in place, may also experience increased strain as the organs settle backward.
The supine position can also affect the movement of gas or waste material in the intestines. Gastrointestinal pressure from trapped gas or constipation can become more pronounced when lying down, creating referred pain often felt in the ovarian region.
Primary Ovarian and Uterine Causes
Many gynecological conditions involve inflammation or structural changes susceptible to positional aggravation. Ovarian cysts, which are fluid-filled sacs on the ovary, are a frequent source of this type of positional pain. A cyst, especially if large or hemorrhagic, can cause a dull ache or pressure that is exacerbated by lying flat if it presses against the pelvic wall.
Endometriosis, where tissue similar to the uterine lining grows outside the uterus, creates adhesions and inflammation sensitive to movement. When the body shifts horizontally, these adhesions—which may tether the ovary to the bowel or pelvic wall—can be stretched or compressed, resulting in positional pain. This chronic inflammation can also irritate nearby nerves.
Pelvic Inflammatory Disease (PID), an infection of the reproductive organs, causes inflammation and scarring around the ovaries and fallopian tubes. The resulting scar tissue and swelling make the organs less mobile and more tender, and the increased intra-abdominal pressure from lying down can intensify the pain. Uterine fibroids can also press against the ovaries or other pelvic structures, with the pressure becoming more noticeable when the body is supine.
Mittelschmerz, or pain experienced during mid-cycle ovulation, is a transient cause. The minor irritation from the released fluid or blood can be felt more acutely when lying down due to the settling of this irritant fluid within the pelvic cavity.
Ovarian torsion, where the ovary twists around its supporting ligaments, cuts off its blood supply and requires immediate attention. This condition causes sudden, severe pain, often accompanied by vomiting and nausea. Any change in position, including lying down, will not alleviate and may worsen the discomfort. Torsion is often associated with a large ovarian mass or cyst that makes the ovary unstable.
Conditions That Mimic Ovarian Pain
Pain felt in the lower abdomen that seems to originate from the ovaries is often referred pain from other nearby systems. The close proximity of the digestive and urinary tracts to the reproductive organs means issues in these systems can be misinterpreted as ovarian discomfort, and the positional factor of lying down can aggravate several non-gynecological conditions.
Gastrointestinal issues, such as Irritable Bowel Syndrome (IBS) or chronic constipation, can cause discomfort mimicking ovarian pain. When lying flat, gas and stool within the colon shift, intensifying the pressure they exert on pelvic structures and nerves. This mechanical pressure is acute with conditions like diverticulitis, where inflamed pouches in the colon are highly sensitive to internal pressure changes.
Musculoskeletal sources are another common mimic, with issues in the lower back or hip joint projecting pain into the pelvic area. Strained hip flexor muscles or lower back conditions can irritate pelvic nerves. The change in spinal alignment and muscle tension from standing to lying down can either relieve or increase this nerve irritation. Pelvic floor muscle spasms can also cause intense, localized pain affected by the pressure of a supine position.
Urinary tract conditions, like a Urinary Tract Infection (UTI) or kidney stones, can also produce pain felt in the ovarian area. Bladder inflammation from a UTI can cause general pelvic tenderness that becomes more prominent when resting. A kidney stone moving through the ureter can cause flank pain that radiates forward, and the change in gravity when lying down may alter the stone’s position or the pressure around the ureter.
When to Seek Medical Help and What to Expect
Any new or persistent pain that disrupts daily life, including pain that increases when lying down, warrants a medical evaluation. Immediate medical attention is required for “red flag” symptoms, such as sudden, severe, or debilitating pain that does not resolve. Accompanying symptoms like fever, chills, fainting, or persistent vomiting should prompt an emergency visit, as these can signal acute conditions like ovarian torsion, a ruptured cyst, or appendicitis.
A medical evaluation for positional ovarian pain begins with a detailed history focusing on the timing, quality, and relationship to the menstrual cycle and body position. A healthcare provider will perform a pelvic exam to check for tenderness, masses, or signs of infection.
Diagnostic steps often include blood tests to check for infection or inflammation, a pregnancy test, and imaging studies. A transvaginal or pelvic ultrasound is essential for visualizing the ovaries and uterus to identify cysts, fibroids, or signs of torsion. Symptom management may involve over-the-counter pain relievers. Positional comfort, often achieved by placing a pillow under the knees or between the legs when side-lying, can sometimes reduce mechanical pressure on the pelvic organs.