Pelvic discomfort after menopause (the cessation of menstrual periods for 12 consecutive months) can be concerning. While the term “ovary pain” suggests the ovaries are the source, most post-menopausal pelvic pain originates from other structures. However, any new or persistent pain in the lower abdomen warrants a thorough medical evaluation. Although rare, some ovarian conditions can still occur, making it important to understand both ovarian changes and common non-ovarian sources of pain.
The Post-Menopausal Ovary
After menopause, the ovaries undergo significant physiological transformation due to declining hormone production. They cease ovulation and the release of reproductive hormones like estrogen and progesterone, becoming functionally inactive and shrinking noticeably (atrophy). This reduced size means the ovaries are structurally less likely to generate pain associated with ovulation or functional cysts seen in younger women. A healthcare provider should not be able to feel the ovaries during a routine pelvic examination after menopause; a palpable ovary is considered an abnormal finding requiring immediate investigation.
Common Sources of Pain That Mimic Ovarian Discomfort
The pelvic region contains numerous organs, and pain from non-gynecological sources frequently mimics ovarian discomfort. Gastrointestinal (GI) issues are common culprits, as the intestines occupy much of the lower abdominal space. Conditions like Irritable Bowel Syndrome (IBS), chronic constipation, or diverticulitis can cause cramping, bloating, and localized pressure perceived as ovarian pain. Referred pain from the bowel, which shares nerve pathways with reproductive organs, can feel like it is emanating directly from the ovary.
Urinary tract issues also often present as lower abdominal or pelvic pain. Low estrogen levels after menopause can lead to changes in genitourinary tissue, known as genitourinary syndrome of menopause (GSM). This can cause atrophic cystitis, making the bladder susceptible to irritation and infection, or contribute to interstitial cystitis, characterized by chronic bladder pain and pressure.
Musculoskeletal sources, including the pelvic floor muscles and various ligaments, are another frequent origin of pain. Estrogen loss can affect muscle tone and elasticity, leading to pelvic floor tension or dysfunction. This can create chronic aching or pressure, especially when combined with scar tissue or adhesions from previous surgeries that pull on surrounding structures.
Rare Ovarian Causes of Pain
Despite the general inactivity of the ovaries, they can still be a source of pain. While functional cysts related to the menstrual cycle cease, non-functional ovarian cysts (such as serous or mucinous cystadenomas) can still develop. These cysts may cause a dull ache, or lead to acute, severe pain if they rupture or cause ovarian torsion (twisting upon the blood supply). Ovarian torsion is a surgical emergency causing sudden, intense pain, often with nausea and vomiting, and is frequently associated with an underlying ovarian mass.
The most concerning cause of new or persistent pelvic pain is ovarian cancer, which is more prevalent in older women. Symptoms like persistent bloating, feeling full quickly, changes in urinary or bowel habits, and pelvic pain require immediate investigation. Any enlargement of the ovary in a post-menopausal woman is treated with suspicion and necessitates a full malignancy evaluation.
When to Seek Immediate Medical Attention
Persistent or worsening pelvic pain after menopause should always be evaluated by a healthcare provider to rule out serious causes. Urgent medical attention is needed for “red flag” symptoms, such as pain accompanied by a fever or sudden, severe pain. Other concerning symptoms include unexplained weight loss, new onset of persistent constipation or bloating, or any new instance of vaginal bleeding more than a year after the last menstrual period.
A medical professional will begin with a comprehensive pelvic examination and history review to assess the pain. Diagnostic tools include a transvaginal ultrasound to visualize pelvic organs and check for masses. Blood tests, such as the CA-125 marker, may be used as part of the overall assessment. Prompt evaluation is necessary for any new or persistent pelvic discomfort.