when the oocyte is released during ovulation, pain can develop due to rupture of the follicle and subsequent release of a small amount of blood and fluid that irritates the peritoneum.

Sudden left lower quadrant pain and an enlarged left adnexa; in reproductive-aged women with these findings, initial evaluation includes a pregnancy test and transvaginal ultrasound to rule out gynecologic emergencies (eg, ectopic pregnancy, ovarian torsion).

negative pregnancy test and an ultrasound that shows a simple ovarian cyst with a small amount of free fluid in the pelvis suggest a benign etiology.  With the timing of the patient's last menstrual period 2 weeks ago (eg, late follicular phase of menses), the most likely cause of her symptoms is ovulation

Most patients can be managed with reassurance and pain management (eg, nonsteroidal anti-inflammatory medications).