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Cramping during fertile window: Cramping when Ovulating – Signs, Treatment

Cramping when Ovulating – Signs, Treatment

Many women experience some cramping when they ovulate — there’s even a term for the pain: mittelschmerz.

By Jan SheehanMedically Reviewed by Lindsey Marcellin, MD, MPH


Medically Reviewed

If you have abdominal pain or cramping in the middle of your menstrual cycle, when you’re ovulating, you may be experiencing mittelschmerz, a word derived from the German for “middle” and “pain.”

Mittelschmerz occurs when the follicle — a tiny sac in the ovary that contains an egg — ruptures and releases the egg. This mid-cycle pain and discomfort can range from a minor pinch or twinge that’s over in minutes to more severe cramping that lasts for hours.

“You’ll feel it only on one side of your lower abdomen, depending on which ovary is releasing an egg,” says Amy Autry, MD, clinical professor of obstetrics-gynecology and reproductive sciences at the University of California at San Francisco.

Some women don’t feel anything when the egg is released from the ovary; others feel cramping a couple of weeks before their menstrual period. Overall, about 20 percent of women experience some type of ovulation pain, according to Dr. Autry.

While it’s unknown exactly why women experience cramping or ovulation pain, several theories exist. Before the egg is released, the follicle grows. This may stretch the surface of the ovary, causing pain. It’s also believed that blood and other fluid is released when the follicle ruptures, causing irritation that disappears as the fluid is reabsorbed. Because the ovaries have no openings, there may be some pain when the egg breaks through the ovary wall.

Six Signs of Ovulation Pain

Ovulation pain differs from menstrual cramps that come on just before or during a woman’s menstrual period. “It’s easy to recognize ovulation pain because it has a number of symptoms that are different from menstrual cramps,” says Autry.

The six signs of ovulation pain are:

  • It’s one-sided.
  • It comes on suddenly and without warning.
  • It’s a sharp pain, twinge, or cramping rather than a dull ache.
  • It often lasts only minutes, but may last a few hours or even up 24 hours.
  • It may switch sides from month to month.
  • It occurs about two weeks before your menstrual period starts.

Mild bleeding (spotting) or vaginal discharge may occur during this time. Some women may also experience nausea, especially if the cramping is severe. Mid-cycle pain is most common in adolescents and women in their twenties, but it can occur all the way up to age 45.

Understanding Your Body’s Signals

Women who experience ovulation pain may actually be at an advantage if they’re trying to get pregnant. Cramping in the weeks before your menstrual period is a sign that you’re ovulating and probably fertile. “You’re most likely to conceive if you have intercourse right before ovulation, on the day of ovulation, or immediately after ovulation,” says Autry.

On the other hand, mid-cycle pain may also help women who would rather not get pregnant. But while avoiding intercourse during times when you feel ovulation pain can be an effective back-up to your regular birth control method, don’t rely on it as your sole method of preventing pregnancy. “Sperm can live up to five days in a woman’s body,” cautions Autry. So you could get pregnant from unprotected sex on the days before you feel mittleschmerz pain.

Preventing and Treating Mid-Cycle Pain

For minor or brief ovulation pain, treatment is usually not necessary. For cramping that lasts more than a few minutes, over-the-counter pain relievers, such as ibuprofen (Motrin, Advil, and others) or naproxen (Aleve and others) will usually relieve the discomfort. Applying a heating pad to the site of the abdominal pain or taking a warm bath can also help. Heat increases blood flow, which relaxes tense muscles and eases cramping.

If your mid-cycle abdominal pain happens every month and is particularly bothersome, hormonal contraception (birth control pills, patches, or the vaginal ring) is an option because it prevents ovulation. And without ovulation, you can’t have ovulation pain.

Mid-cycle abdominal pain that is extreme or lasts longer than a day should be evaluated by a doctor. Appendicitis, ovarian cysts, and ectopic (tubal) pregnancy can sometimes mimic ovulation pain, although pain from these conditions is typically much more severe.

A medical exam and diagnostic tests can rule out other causes for abdominal pain. “But in the vast majority of cases, abdominal pain or cramping in the middle of the menstrual cycle simply means that you’re ovulating and the pain will disappear soon,” says Autry.

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Symptoms and what they mean for fertility

Cramps that occur outside of a menstrual period might be a sign that a person is ovulating. Ovulation cramps occur when one of the ovaries releases an egg, which typically happens halfway through a person’s cycle.

Being aware of the symptoms of ovulation may help a person identify when they are most fertile.

In this article, we explore what ovulation cramps feel like and what they mean for fertility. We also look at other symptoms of ovulation and other causes of mid-cycle cramps.

Share on PinterestOvulation cramping begins about halfway through a person’s cycle, rather than right before or during menstruation.

An ovary typically releases an egg about midway through a person’s menstrual cycle. This is ovulation.

For some people, ovulation creates a sensation of cramping or pain once a month on one side of the abdomen. If a person has these cramps every month, the sensation may switch sides from month to month, depending on which ovary releases the egg.

Ovulation cramping may happen before, during, or shortly after the release of an egg.

Not everyone who menstruates has ovulation cramps. According to the University of Florida, about 1 in 5 people who menstruate have cramping around the time of ovulation.

Some people do not experience the cramping every month or do not have the same amount of discomfort every month.

Ovulation cramping may occur if:

  • the follicle where the egg develops stretches the ovary
  • the release of blood and other fluid from the ovary irritates surrounding tissue

The sensation of ovulation cramping can range from mild discomfort to intense pain. It may be difficult to identify the cause of the pain, especially if ovulation cramps do not occur every month.

The primary symptom of ovulation cramping is pain on one side of the abdomen, and this typically lasts 3–12 hours. However, a person who has had ovarian surgery may experience the pain until menstruation.

Below are characteristics of ovulation cramping:

  • pain or cramping on one side of the abdomen
  • pain or cramping that starts midway through the menstrual cycle
  • pain or cramping that switches sides, month by month
  • pain that is sharp and may be severe

Ovulation pain occurs right before, during, or right after the release of an egg, which is also when a female is most likely to become pregnant. As a result, the sensation may help with recognizing fertility.

However, people who do not want to conceive should not use ovulation cramps to determine when it is safe to have unprotected sex — this method is not accurate, the University of California note, and could result in unintended pregnancy.

Some people who menstruate do not experience any discomfort during ovulation.

A person might also recognize that they are ovulating by the following signs:

  • increased cervical mucus
  • breast tenderness
  • spotting or light bleeding
  • increased libido
  • increased basal body temperature

Ovulation cramps occur when one ovary releases an egg. If sperm do not fertilize the egg, the menstrual cycle continues: the egg breaks and the uterus sheds its lining.

If sperm do fertilize the egg, the fertilized egg attaches to the lining of the uterus. This attaching is called “implantation.”

Implantation can cause cramping. It can also cause a small amount of bleeding or spotting, which can occur 3–14 days after fertilization. Implantation bleeding is typically brownish and the flow is light.

Beyond implantation bleeding and cramping, early pregnancy can cause:

  • nausea
  • a frequent urge to urinate
  • fatigue
  • vomiting

Various health conditions cause abdominal cramps, which may happen to occur in the middle of the menstrual cycle and resemble ovarian cramping.

Some other causes of abdominal cramping or pain include:

  • acute appendicitis, which can present with similar symptoms to ovulation cramps
  • endometriosis, which involves tissue similar to uterine lining tissue growing outside the uterus and affects at least 11% of females in the United States ages 15–44
  • uterine fibroids, which are noncancerous growths in the walls of the uterus and can cause pain, bleeding, and a feeling of fullness in the abdomen

Ovulation cramps typically go away on their own. To relieve the pain, the following can often help:

  • over-the-counter pain medications, such as ibuprofen (Advil)
  • a warm compress or bath
  • hormonal contraceptives that prevent ovulation

If ovulation cramps go away within a few hours, a person usually does not need medical attention.

A person should contact a healthcare provider if they have cramping and:

  • pain that lasts longer than 24 hours
  • unusual vaginal bleeding
  • painful urination
  • vomiting
  • have missed a period

Ovulation cramping is often mild and goes away after a few hours. It can let people who want to conceive know that the time might be right.

However, people who do not want to conceive should not rely on ovulation cramps to indicate fertility. This is not an effective way to time unprotected sex.

If the cramping or pain is intense, a warm bath and over-the-counter pain medication may help. Anyone who experiences severe pain or cramps accompanied by vomiting or unusual bleeding should contact a doctor.

Painful ovulation – normal or disease

Pain in the middle of the cycle, ovulatory syndrome – occurs in every fifth woman.

Mittelschmerz (pain in the middle of the cycle) was described in medical periodicals as early as 1940.

How can ovulatory syndrome manifest itself?

During ovulation, a woman may experience a dull, sudden sharp or cramping pain in the lower abdomen. In this case, pain can be localized on the right or left, depending on which ovary ovulation occurs.

Pain may radiate to the lumbar region, sacrum, or groin and may be aggravated by strenuous exercise, sudden changes in body position, and sexual intercourse. These days, pain may be accompanied (or appear independently) by mild bloody discharge from the genital tract.

In addition, some women experience weakness, rarely nausea and even vomiting.

For some women, pain may accompany every ovulation, for others it may occur occasionally.

The duration of pain can vary from a few minutes to 24 hours, but no more. This is one of the features that distinguishes “ovulatory syndrome is not a disease” from gynecological diseases (endometriosis, inflammatory diseases of the pelvic organs), manifested by pain.

What causes pain and spotting in the middle of the cycle?

The causes of pain during ovulation are:

  • damage to the ovary wall at the time of ovulation
  • irritation of the inner lining of the abdomen, resulting from the reflux of a small amount of blood from a burst follicle into the pelvic cavity.
  • low pain threshold. Most women are able to easily tolerate unpleasant symptoms, but sometimes hypersensitivity can provoke subjective pain.

Minor spotting is caused by the sudden change in sex hormone levels that accompanies ovulation.

Illness or not and what to do about it?

A natural question arises: “If ovulation is a physiological process, why is it accompanied by pain?”

According to an incomprehensible idea of ​​nature in women, pain often accompanies many physiological (menstruation, childbirth) processes. Pain is associated with participation in events such as menstruation and ovulation of inflammatory substances (cytokines) and spasm of small vessels. The peculiarities of the exchange of pro-inflammatory cytokines, as well as individual sensitivity to pain, explain the fact that some women do not feel ovulation at all, while others experience significant discomfort during a certain period of their life.

In the case of ovulatory syndrome, the line between the norm and the disease is very thin.

To answer the question of whether pain in the middle of the cycle is a problem requiring treatment, it is necessary to conduct an examination. In this case, ultrasound of the pelvic organs provides valuable information, which allows an experienced specialist to determine with high accuracy the presence or absence of such probable causes of pain as endometriosis, inflammatory tumors of the small pelvis, adhesive disease of the pelvic organs, functional ovarian cysts, tumors, anomalies in the development of the genital organs and other.

According to individual indications, the gynecologist can prescribe microbiological and hormonal tests.

So, if gynecological diseases are excluded, this is ovulatory syndrome.

If the pain associated with ovulation is mild, there is usually no need for treatment.

If the pain associated with ovulation is limiting your activities, your gynecologist will help you find the treatment that is best for you at that time in your life (pain medications and other options).

So, is it necessary to go to the gynecologist in case of periodic or systematic pains in the middle of the cycle? – Definitely YES!

As already mentioned, ovulatory syndrome is a diagnosis of exclusion: you need to conduct an examination to make sure that the cause of pain is not a gynecological pathology.

The experience of our specialists shows, especially in severe pain syndrome, a thorough examination using modern ultrasound devices, less often hysteroscopy allows us to identify previously undiagnosed problems: endometriosis, associated or unrelated adhesions in the pelvis, rare anomalies in the development of the genital organs.

Moreover, our experience with women with ovulatory syndrome shows that in the absence of endometriosis, adhesions and other morphological problems, hormonal imbalance is a common cause of pain, the correction of which led to a significant improvement in the quality of life of patients.

Does ovulatory syndrome affect the possibility of getting pregnant?

No evidence that mid-cycle pain impairs fertility or adversely affects pregnancy .

Can ovulation pain be used to determine fertile days?

Only in combination with other signs (changes in cervical mucus, safe days method, basal temperature) and only with a regular menstrual cycle.

If there is no more pain, does this mean that ovulation has stopped?

Not at all if the regular cycle is maintained. Most likely, due to some changes in the body, the pain stopped.

why it occurs, causes, what to do and how to treat

Discomfort in the lower abdomen can haunt a woman not only during menstruation. One in five people experience ovulatory syndrome. This is when discomfort occurs in the middle of the cycle and can be sudden, acute or marked in the form of spasms. Read about why pain occurs during ovulation, how to deal with it, and when to see a doctor.



Women Health


Causes of pain


To understand the symptoms and causes of their occurrence, it is worthwhile to understand whether the pain during ovulation is typical and what happens to the female body during this period.

Do not self-medicate! In our articles, we collect the latest scientific data and the opinions of authoritative health experts. But remember: only a doctor can diagnose and prescribe treatment.

How does the process of ovulation occur and can the stomach hurt at the same time?

Ovulation is the release of a developed egg from the ovary into the fallopian tube. It does not pass in every menstrual cycle and pain on the days of ovulation is a fairly common occurrence. Attachment of the fetal egg occurs 6-12 days after ovulation. As a rule, only one egg is released from the ovary during one ovulation.

Ovulation can be determined in several ways:

  • using a calendar;
  • using basal temperature charts;
  • a special test from a pharmacy;
  • Ultrasound.

Many women additionally focus on their well-being: during ovulation, many have pain in the lower abdomen. Of course, this sign cannot be considered the main one, it only supplements the data of the calendar, test or ultrasound. Determining the date of ovulation helps to plan the conception of a child, or to prevent unwanted pregnancy.

If fertilization does not occur during ovulation, the egg is absorbed by the lining of the uterus and is later expelled from the body during menstruation. After that, a new egg begins to mature in the ovary.

If the menstrual cycle is stable and lasts 28 days, ovulation will begin on days 10-12. The occurrence of ovulation may be accompanied by mild, less often strong, aching, pulling or dull pains in the lower abdomen. This is not such a rare problem: on women’s forums, questions about unpleasant discomfort arise with frightening regularity. Someone shares that after ovulation, the stomach didn’t hurt at all, and someone has to stock up on analgesics in anticipation of the middle of the cycle.


Pain during ovulation and other symptoms

During ovulation, the lower abdomen often hurts, depending on the activity of the ovaries: on the left or right side. Sometimes there are sharp mood swings that accompany tearfulness, irritability and irritability. Thus, the body signals that it is ready for conception.

Another typical symptom is discharge from the vulva, which is stretchy and slippery. They have the appearance of raw egg white, usually odorless, do not cause itching and irritation. Their color may change. In medicine, this is called cervical mucus. Discharge does not depend on whether the stomach hurts during ovulation or not.

Attention! If the discharge is accompanied by a pungent odor, burning, pain in the lower abdomen. At the same time, they acquire dark red, green or yellow hues. You need to see a doctor immediately. Such discharges are not normal and may indicate the development of a disease or an inflammatory process. The doctor will determine the cause of their occurrence and prescribe adequate treatment.

A relatively rare symptom is if the chest hurts after ovulation. But it still happens that during this period there are unpleasant sensations in the area of ​​​​the mammary glands, the shade of the nipples changes. This is due to the swelling of the mammary glands. You should not be afraid of this symptom, such an indisposition is acceptable.

How common are ovulation pains and how dangerous are they

Slight pain before and during ovulation is not a dangerous symptom and in most cases does not pose any threat to the body. However, if you have not noticed such a condition before or the discomfort has become much more intense, you should contact a specialist. In these cases, the body may signal the onset of a serious illness. Below we have listed the symptoms that you should definitely pay attention to.

Not all women have pain in the lower abdomen after ovulation. In some cases, pain may radiate to the lower back. And sometimes the release of an egg from the ovary is extremely unpleasant and deprives women of working capacity, sometimes even leads to loss of consciousness.

Why does the stomach hurt before ovulation

The discomfort before the process begins is explained as follows. Pain before ovulation can occur when the vessels at the base of the follicle rupture when the egg is released. A hemorrhage occurs, the uterus begins to contract when fluid from the follicle enters it, which causes pain just below the navel. This is the most common cause for discomfort.

But its appearance can also be an indicator of the development of various diseases. It is better not to self-medicate and you should not delay a visit to the doctor. If you are worried about pain during ovulation in the lower abdomen, you should discuss this issue with a gynecologist.

1. “Middle” pain

Most often, during ovulation, the lower abdomen hurts, and discomfort occurs only on one side, and this side can change in different cycles. Unpleasant sensations last from a few minutes to half an hour, may be accompanied by bloating and mild nausea. In medicine, it is called the German term Mittelschmerz (“middle” pain).

How to get rid of: if the sensations pass and the pain is not too severe, a warm bath and painkiller tablets are sufficient. If your health leaves much to be desired and literally folds you in half, it is better to meet with a doctor and discuss why pain occurs during ovulation. It may be worth discussing the use of low-dose hormonal contraceptives.

2. Polycystic ovaries

In cases where the critical days are long and irregular, and there is a lot of hair on the body, the fact that you have stomach pain after ovulation may signal polycystic ovaries. Complications can be serious, from infertility to cancer, so you should see a doctor.

How to get rid of: after diagnosis, treatment varies, but usually includes a special diet and hormonal medication. If the treatment is chosen correctly, the stomach will no longer hurt after ovulation.

3. Inflammatory diseases of the pelvis

Often pain in the lower abdomen after ovulation is the result of an infection such as chlamydia or gonorrhea. Before or during the process, discomfort in the pelvis is noted, which can even lead to hospitalization.

How to get rid of: most often the doctor prescribes antibiotics, and the infection goes away with pain.

4. Pain after caesarean section

It leaves a scar in any case, and pain can occur in that area during ovulation for a year after childbirth. In this case, the problem is not in the ovary, but in the scar itself, so the nature of the discomfort is different.