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How Can Endometriosis Affect the Ovaries?

Posted on February 14, 2022
Medically reviewed by
Dan Martin, M.D.
Article written by
Elizabeth Wartella, M.P.H.

Endometriosis is a condition in which tissue similar to what lines the uterus — called the endometrium — grows outside of the uterus. Endometriosis commonly affects the ovaries. It can also grow in the fallopian tubes, bladder, bowels, and in severe cases, areas outside of the pelvic area.

Endometriosis in the ovaries can cause chronic pelvic pain, one of the main symptoms of endometriosis. “I’ve been in bed most of the day. I started cramping two days ago. The pressure on my ovaries is unbearable,” wrote one member of MyEndometriosisTeam.

Endometriosis can also cause deep ovarian cysts, inflame and irritate surrounding tissue, and increase the risk of ovarian cancer.

Read on to find out how endometriosis can affect the ovaries, as well as what your treatment options may include.

Lesions and Implants

The most common way that endometriosis affects the ovaries is through lesions and implants. “Lesions” and “implants” are the terms used to describe the areas of growth of endometrium-like tissue outside the uterus. These growths are usually observed using a device called a laparoscope. A surgeon makes several small incisions near the belly button and uses the laparoscope to examine the abdomen and pelvic areas.

Surgeons observe lesion color, size, and location in determining a diagnosis of endometriosis. Lesions vary in color, including black, dark brown, red, and clear. Lesions found in the ovaries commonly predict endometriosis.

The extent of lesions and implants on the ovaries also helps to define the stage of endometriosis:

  • Stage 1 (minimal) — There may be inflammation in the pelvic cavity and small lesions on the organs. There are no adhesions.
  • Stage 2 (mild) — Lesions in the form of shallow implants are common on the ovaries.
  • Stage 3 (moderate) — There are deeper implants on the ovaries.
  • Stage 4 (severe) — This stage is characterized by deep implants and possibly endometriomas (blood-filled cysts) in the ovaries.

The size and severity of lesions on the ovaries or other areas don’t correlate directly with the amount of pain they cause. Some people with large lesions have mild symptoms, and people with smaller, fewer lesions may experience more severe pain. In other words, you may experience pain in the ovarian area regardless of the amount and severity of lesions and implants on the ovaries.

Scarring and Adhesions

Scarring occurs when endometrium-like tissue on the ovaries or other areas outside of the uterus causes a chronic inflammatory reaction that can irritate and damage other surrounding tissue.

Adhesions are bands of scar tissue that can cause other tissue and organs in the pelvic cavity to stick together. They can form on and around the ovaries, and they can bind an ovary to, for example, the side of the pelvic wall. An adhesion can increase the severity of pelvic pain, which may feel like stabbing pain and lead to nausea.

A member of MyEndometriosisTeam commented about their experience with adhesions, saying, “My endometriosis may not be active, but the adhesions cause as much grief, just in a different way.” Another member shared, “I wish there was a safe way to get the adhesions removed. Adhesion pain is terrible … like something is pulling you from the inside out.”

Adhesions generally indicate a more advanced stage of endometriosis. Adhesions on the ovaries may play a role in reducing fertility and are difficult to prevent and treat.

Endometriomas

Endometriomas are deep ovarian blood-filled cysts, sometimes called “chocolate cysts” due to their dark color. These cysts indicate a more severe stage of endometriosis and can have harmful effects on the ovaries, including:

  • Severe pelvic pain
  • Infertility
  • Increased risk of ovarian cancer
  • Decreased functioning of the ovary or ovaries

Endometriomas are different from functional ovarian cysts, which are fairly common and harmless cysts that develop on the ovaries as part of the menstrual cycle. Functional ovarian cysts usually go away on their own after menstruation and do not always signify endometriosis.

There are different ways to treat endometriomas, depending on their severity and your age. If you have an endometrioma, your doctors may suggest you meet with a fertility specialist. They may also suggest that you:

  • Undergo symptom observation
  • Have an ultrasound, a type of imaging scan that produces pictures of organs and tissues
  • Try a medication
  • Undergo a surgical treatment

Managing Pain From Endometriosis on the Ovaries

Pain from lesions, implants, scarring, adhesions, and cysts on the ovaries is common. Endometriosis pain can be severe and can have an impact on quality of life. Members of MyEndometriosisTeam report feeling varying levels of pain in and around their ovaries. “My right ovary feels like it’s always swollen and inflamed,” wrote one member. Another commented, “My ovaries are killing me and I’m so nauseous.”

There are several approaches for managing endometriosis pain caused by endometriosis on the ovaries.

Pain Relief Medications

Doctors and gynecologists often recommend over-the-counter pain relievers such as nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, for endometriosis pain.

Hormone Therapy

If you’re not trying to get pregnant, hormone therapy may help with pain management. Hormone therapy aims to regulate the menstrual cycle, or the monthly fluctuation in hormones a person experiences in preparation for pregnancy. Hormone therapy or supplementation sometimes helps to slow the growth of endometrial-like tissue and may help manage pain.

Hormonal therapies and medications include contraceptives like birth control pills, gonadotropin-releasing hormone agonists and antagonists, progestin therapy, and aromatase inhibitors.

Surgical Procedures

Surgery to remove endometriosis lesions or adhesions from the ovaries sometimes helps reduce pain and other symptoms. However, the success of surgery depends on many factors including the severity of the disease. Lesions, adhesions, and pain due to these growths may return after surgery.

In severe cases, doctors may advise a hysterectomy (a procedure to remove the uterus).

Oophorectomy — surgery to remove the ovaries — may help symptoms due to endometriosis in the ovaries. Removal of both ovaries will cause a person to enter menopause because the body will no longer produce reproductive hormones. Oophorectomy may also cause infertility. The surgery is not advised in women of reproductive age (around 12 to 51).

According to the Mayo Clinic, doctors are moving away from the practice of hysterectomies and oophorectomies for endometriosis, opting to remove the abnormal endometrial tissue instead.

Read more about endometriosis treatment options.

Talk to Others Who Understand

MyEndometriosisTeam is the social network for people with endometriosis. More than 123,000 members come together to ask questions, give advice, and share their stories with others who understand life with endometriosis.

Do you have endometriosis that affects your ovaries? Share your experience in the comments below, or start a conversation by posting on your Activities page.

All updates must be accompanied by text or a picture.
Dan Martin, M.D. is the scientific and medical director of the Endometriosis Foundation of America. Learn more about him here.
Elizabeth Wartella, M.P.H. is an Associate Editor at MyHealthTeam. She holds a Master's in Public Health from Columbia University and is passionate about spreading accurate, evidence-based health information. Learn more about her here.

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