In a fertile female, either the right or left ovary produces a mature egg for fertilization every month during ovulation. Typically, a single egg is released at a time, but in some cases, more than one egg can be released, sometimes resulting in the conception of multiples (such as twins or triplets).
Ovarian Follicles
At birth, a female baby has about 1 million ovarian follicles. Each ovarian follicle contains a hollow ball of cells with an immature egg in the center.
During childhood, approximately half of the ovarian follicles are absorbed by the body. By the time of puberty and the beginning of an individual’s menstrual cycle, only about 400,000 ovarian follicles are left to develop into mature eggs.
Although only one egg usually fully matures during each ovulation, between 10 and 20 follicles begin the process of maturation monthly. The excess ovarian follicles are reabsorbed before ovulation occurs.
Ovulation
Around the middle of the menstrual cycle (typically day 14 of a 28-day cycle, though this timing may vary), the process of ovulation is initiated.
The steps of ovulation are:
A decrease in estrogen (mostly estradiol) and secretion of gonadotropin-releasing hormone (GnRH) sends a message to the pituitary gland to increase its secretion of follicle-stimulating hormone (FSH). The increase in FSH causes the growth of 10–20 ovarian follicles (immature eggs). Estrogen is secreted by some of the cells in the follicle and progesterone is produced by the cells in the ovarian follicles shortly before ovulation occurs. Just before ovulation occurs, the follicle that contains the maturing egg eases toward the surface of the ovary. Once the matured egg reaches the ovarian surface, ovulation occurs, when the follicle and the ovarian surface open, allowing the egg to drift out of the ovary. After the egg is released from the ovary, it travels to the oviducts (the funnel-shaped ends of the fallopian tubes), where it begins its long journey of several days into the uterus. The mature egg is moved along on its journey by wavelike muscle contractions in the fallopian tube. The inner lining of each fallopian tube contains cilia, which are constantly beating microscopic hairs. These cilia are what help move the sperm toward the egg if a person has had unprotected sexual intercourse.
Conception (the fertilization of an egg with sperm) most often occurs in the part of the fallopian tube that is nearest the ovary. Five to six days are required for the fertilized egg to reach the uterus.
After ovulation, if pregnancy has not occurred, the empty follicle, called the corpus luteum, is reabsorbed into the body. If pregnancy does occur, the corpus luteum produces hormones that help to maintain the pregnancy.
Why Do My Ovaries Hurt?
You might experience a twinge, a cramp, or some discomfort in your lower back or abdomen when ovulation occurs. Some people notice a small amount of vaginal discharge, sometimes containing a small amount of blood, during ovulation.
Symptoms during ovulation are called “mittelschmerz,” or midcycle pain. For some people, these symptoms are severe enough to be mistaken for an ectopic pregnancy (when a fertilized egg implants outside the uterus) or appendicitis (inflammation of the appendix, on the lower right side of the abdomen). Others experience headaches, gastric pain, or general malaise (overall feeling of not being well), while still others actually feel much better during ovulation.
Ovarian Torsion
Rarely, an ovary can twist around the ligament that’s holding it in place. This condition is known as ovarian torsion and can result in severe pain. Ovarian torsion is considered a medical emergency because the twisting (torsion) can cut off blood supply to the ovary and fallopian tube.
The initial symptoms are severe pelvic pain, typically on one side, along with nausea and vomiting. Immediate surgery is usually required to restore the blood supply and preserve the ovary. Ovarian torsion may account for up to 3% of all gynecological emergencies.
Ovarian Cysts
Ovarian cysts are fluid-filled sacs similar to blisters that can form on the ovaries. Ovarian cysts are common during the reproductive years. Most types of ovarian cysts are harmless and go away without any treatment.
Polycystic Ovary Syndrome
Polycystic ovary syndrome (PCOS) is a hormonal disorder that affects an estimated 7% of all females. It is the most common hormonal disorder among females. According to experts, the actual number of people affected by PCOS may be as high as 1 out of 10.
Many cases of PCOS are undiagnosed because the symptoms can vary from person to person. It also is often difficult to accurately diagnose. Because polycystic ovary syndrome can cause significant long-term health consequences, getting an accurate diagnosis, followed by proper treatment, is important.
Ovarian Cancer
Ovarian cancer is often called the “silent killer” because it usually doesn’t cause symptoms until the disease has progressed to an advanced stage. In the United States, ovarian cancer ranks fifth in cancer deaths among women, making it the deadliest gynecological cancer.
Fallopian Tube Damage
Fallopian tubes that have been damaged by diseases, infections, or other conditions may be scarred or damaged, which increases the risk of an ectopic (tubal) pregnancy.
Some of the causes of fallopian tube damage are pelvic inflammatory disease (PID, an infection in the upper reproductive system) or endometriosis (tissue that normally grows inside the uterus develops outside this organ), as well as some sexually transmitted infections (STIs) or other pelvic infections.
