Ovulation pain – Better Health Channel

Summary

Read the full fact sheet

• About one in five women experience pain during ovulation that can last from a few minutes to 48 hours.
• Ovulation pain is usually harmless, but can sometimes indicate various medical conditions such as endometriosis.
• See your GP (doctor) if your ovulation pain lasts longer than three days or is associated with other unusual menstrual symptoms, such as heavy bleeding.

Up to 40% of women experience pain during ovulation. Ovulation pain is usually harmless, but severe pain may indicate other health conditions. It’s good to know there are many practical ways to manage ovulation pain.

What is ovulation?

Ovulation is part of the female menstrual cycle. An egg is released from an ovary and moves along a fallopian tube towards your uterus.

When does ovulation happen?

Ovulation usually happens once each month, around two weeks before your next period.

Ovulation does not happen if you are:

• on the contraception pill
• pregnant
• postmenopausal.

Some women do not ovulate regularly. This is common when you first start getting your periods. It can also happen during perimenopause (the lead-up to menopause). Hormone conditions can also affect ovulation (e.g. polycystic ovary syndrome (PCOS)).

Symptoms of ovulation pain

Up to 40% of women experience pain and discomfort during ovulation. The pain can last from a few minutes to 48 hours.

Women may experience different symptoms of ovulation pain, including uncomfortable pressure, twinges, sharp pains, cramps or strong pain in the lower abdomen.

What causes ovulation pain?

We don’t know exactly what causes ovulation pain, but it may be caused by:

• the surface of the ovary swelling before the egg is released
• the egg being released from a mature follicle (the sac containing an egg).

Getting a diagnosis

In most cases, ovulation pain is harmless. But severe pain in the lower abdomen might mean you have other health conditions (e.g. endometriosis, appendicitis or pelvic inflammatory disease).

Your GP (doctor) may ask about your medical history and do a physical examination to find the cause of your pain. They might also do some tests. For example:

• blood tests
• swabs from the cervix for sexually transmitted infections (STIs) and other bacteria
• an abdominal ultrasound
• a vaginal ultrasound (preferably at the time the pain is occurring)
• exploratory surgery (a laparoscopy or ‘keyhole’ surgery).

Managing ovulation pain

There are many practical ways to manage ovulation pain.

For example, you can:

• relax by having a warm bath, or rest in bed with a heat pack or hot water bottle
• use pain relief or period pain medication (e.g. anti-inflammatories) – ask your GP (doctor) or pharmacist for recommendations
• take the contraceptive pill or other forms of hormonal contraception, as they stop ovulation.

When to see your doctor

See your GP (doctor) if your ovulation pain lasts longer than three days or if it is associated with symptoms such as heavy bleeding or vaginal discharge.

For more detailed information, related resources, articles and podcasts, visit Jean Hailes for Women’s HealthExternal Link.

Where to get help

• Your GPExternal Link
• Gynaecologist
• Jean Hailes for Women’s HealthExternal Link
• Women’s health clinic
• Sexual Health VictoriaExternal Link Tel. (03) 9257 0100

• T. Cornforth, T 2017, Mittelschmerz pain between periodsExternal Link, verywellhealth, USA.
• C O’Herlihy, HP Robinson, L De Crespigny. Mittelschmerz is a preovulatory symptom. Br Med J. 1980 Apr 5;280(6219):986.
• eMedicine Consumer HealthExternal Link.

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Why It Shouldn’t Be Ignored and When to Get Help

Some people may feel pain during ovulation. But other health conditions, such as cysts or endometriosis, can also cause pain during ovulation and may require medical attention.

Ovulation is a critical part of reproduction. Not every person who menstruates will feel ovulation when it occurs, but it can be very painful for others.

Though the sensation isn’t necessarily a cause for alarm, you shouldn’t ignore ovulation pain — it can be a sign of something more serious.

Here’s what you need to know:

In most cases, ovulation discomfort is brief and harmless. You may notice one-sided pain for a few minutes or even a couple hours on your day of suspected ovulation.

Ovulation involves a follicular cyst swelling and then rupturing to release the egg after a surge in luteinizing hormone (LH) goes through your body.

After the egg is released, the fallopian tube contracts to help it reach awaiting sperm for fertilization. Blood and other fluid from the ruptured follicle may also enter the abdominal cavity and pelvis during this process and cause irritation.

The sensation can range from a dull ache to sharp twinges. It may be accompanied by spotting or other discharge. If your pain becomes severe or happens at other points in your cycle, check in with your doctor.

There are several other reasons why you might be experiencing pain during your cycle.

Try keeping track of when and where you feel the discomfort, how long it lasts, and any other associated symptoms. Keeping a record can help you and your doctor figure out the underlying cause.

If your midcycle pain persists, your doctor can perform different tests to identify the source and offer treatment to help.

Cysts

An ovarian cyst can cause a number of symptoms, from cramping and nausea, to bloating. Some cysts may cause no symptoms at all.

Dermoid cysts, cystadenomas, and endometriomas are other, less common types of cysts that might cause pain.

Another condition called polycystic ovary syndrome (PCOS) is marked by many small cysts on the ovaries. Untreated PCOS can cause infertility.

Your doctor may order a CT scan, MRI, or ultrasound to help determine if you have a cyst and what type it is. Many cysts resolve on their own without medical intervention.

If they grow or are abnormal, though, cysts can lead to complications and may need to be removed.

Endometriosis or adhesions

Endometriosis is a painful condition where tissue similar to the inner lining of the uterus grows outside the uterine cavity.

Areas affected become irritated when the lining tissue responds to hormones during your cycle, causing bleeding and inflammation outside of the uterus. You may develop scar tissue or endometriosis adhesions that are particularly painful during your period.

Likewise, intrauterine adhesions, also known as Asherman syndrome, can develop if you’ve had previous surgery. This includes a dilation and curettage (D & C) or cesarean delivery.

A prior infection in the uterus can also cause these adhesions. You can also develop Asherman syndrome with no known cause.

Since doctors can’t see these conditions during a routine ultrasound, your doctor may order a hysteroscopy or laparoscopy. These are surgical procedures that let doctors see directly inside your uterus or pelvis.

Infection or sexually transmitted infections (STIs)

Is your pain accompanied by unusual or foul-smelling discharge? Do you have a fever? Do you feel burning when you urinate?

These symptoms might indicate a bacterial infection or a sexually transmitted infections (STI) that needs urgent medical attention.

Medical procedures — or even childbirth — can cause infections. Sometimes a urinary tract infection (UTI) might even cause general pelvic pain.

STIs like chlamydia, gonorrhea, and human papillomavirus (HPV) are contracted from condomless sex.

Ectopic pregnancy

One-sided pelvic pain could be a sign of an ectopic pregnancy.

This occurs when an embryo implants in the fallopian tubes or other location outside of the uterus. An ectopic pregnancy is potentially life-threatening and is usually discovered by the eighth week.

If you think you might be pregnant, see your doctor immediately. If you have an ectopic pregnancy, you’ll require immediate treatment with medication or surgery to prevent your fallopian tube from rupturing.

If you’ve visited your doctor and ruled out any issues, you’re likely experiencing normal ovulation discomfort. Continue to pay attention to any changes in your symptoms.

Here are some things you can do to ease the discomfort of midcycle pain:

• Try over-the-counter (OTC) pain relievers, such as ibuprofen (Advil, Motrin, Midol) and naproxen (Aleve, Naprosyn).
• Ask your doctor about birth control pills to prevent ovulation.
• Apply a heating pad to the affected area, or take a hot bath.

The American College of Obstetricians and Gynecologists (ACOG) recommends women from ages 21 to 29 have a Pap smear to screen for cervical cancer every 3 years.

ACOG also recommends women ages 30 to 65 have either a Pap smear every 3 years, or a Pap smear with an HPV test every 5 years.

Women over 65, according to ACOG, don’t need to have cervical screening unless they have a history of:

• abnormal cervical cells
• a number of abnormal Pap test results in the past
• cervical cancer

All people who menstruate should also have a yearly wellness visit with their gynecologist for a full pelvic exam and to discuss any other concerns about their gynecological health.

Yearly exams are recommended, even though you might not need a Pap smear each time. If you’re overdue for your visit or are having pain and other symptoms, call your doctor today.

For many people who menstruate, midcycle pain is simply a sign of ovulation. There are several other conditions that can cause pelvic pain, some of which are serious if left untreated.

It’s always a good idea to pay attention to your body and report anything new or different to your healthcare provider.

Read this article in Spanish.

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 to 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. Valuable information in this case is provided by ultrasound of the pelvic organs, 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 for periodic or systematic pain 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 adhesive process in the small 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 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.

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Causes of pain

ovulation

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.

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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 a stomachache 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.