Painful Ovulation (Mittelschmerz) – Symptoms and Treatment of Ovulation Pain

Ovulation pain, also known as ovulalgia or mittelschmerz, is a short-lived, sharp or cramping pain that occurs during ovulation. Around 40% of women experience painful ovulation at some point during their reproductive years – either occasionally or even every month.

There are many ways to ease the symptoms of ovulalgia, and generally speaking, painful ovulation is no cause for concern. Even so, it's worth speaking to your doctor if the pain is severe or persists despite treatment.

What is ovulation

Ovulation is one of the four phases of the menstrual cycle – the point at which an egg is released from an ovary. During each cycle, the egg develops and matures within an ovarian follicle. At ovulation, this follicle stretches and opens to release the egg – processes that can cause discomfort.

After ovulation, the egg survives for 12 to 24 hours in a woman's body. During this window it can be fertilised by a sperm cell and lead to pregnancy. This process repeats month after month roughly in the middle of the menstrual cycle, so around day 14 of a 28-day cycle.

This is precisely why ovulation forms the basis of the calendar method, which allows women to track their menstrual cycle and their fertile days. The ovulation phase (comprising the day of ovulation itself, the days leading up to it and the following 24 hours) represents a woman's fertile window – in other words, the days when the chances of conceiving are at their highest.

What causes ovulation pain?

The cause of painful ovulation is the process of ovulation itself. Both the stretching of the ovarian follicle and the release of the egg can cause pain. As long as the discomfort isn't severe, this is perfectly normal.

The pain may feel like a sharp stabbing sensation or a cramp – either occasionally or with every ovulation, and usually only on one side of the lower abdomen (depending on which ovary released the egg).

However, other conditions can also produce pain similar to ovulation pain, including:

• Endometriosis, ovarian cysts, ovarian torsion or other conditions affecting the ovaries or the uterus
• Chlamydia and other sexually transmitted infections
• Pelvic inflammatory disease
• An ectopic pregnancy
• Post-operative adhesions following a caesarean section or other surgical procedures on the ovaries

• Appendicitis

  

Mittelschmerz syndrome 

Mittelschmerz is another term for pain during ovulation. The word comes from German and combines "Mittel" (middle) and "Schmerz" (pain) – referring to the pain that occurs in the middle of the menstrual cycle, during the ovulation phase.

As a rule, mittelschmerz is not a serious condition and requires no medical treatment. However, there are numerous other possible causes of ovarian pain, which is why a visit to the doctor is recommended for further investigation if you experience such symptoms.

Symptoms of painful ovulation

Abdominal pain around day 14 of the menstrual cycle is the main symptom of painful ovulation. Generally, ovulalgia presents as a sharp stabbing sensation or a cramp, affects alternately either the left or the right side only (depending on which ovary released an egg that month) and can last anywhere from a few minutes to a whole day or even 2 days.

In addition, painful ovulation may be accompanied by other symptoms:

• Light vaginal bleeding (use period products made from 100% organic cotton to protect against staining and keep your intimate area dry during this time)
• Clear, stretchy vaginal discharge (similar to egg white)
• Migraine, if the pain is severe
• Lower back pain

How to recognise ovulalgia (painful ovulation) 

Painful ovulation is fairly easy to identify based on when the discomfort occurs. To work out whether there's a link between your symptoms and ovulation, keep track of your menstrual cycle. Note down the first day of each period and the days on which the pain occurs, to see whether they fall within the ovulation phase.

If you notice that pain in the lower abdomen appears about two weeks after the first day of your period, is stronger on one side and lasts no more than 2 days, you can assume the pain is linked to ovulation.

Although ovulalgia is nothing to worry about, a visit to a specialist is advisable. Pain in the area of the ovaries can have various causes, and a gynaecological examination can help rule out other conditions.

Treatment of ovulation pain 

There are many ways to relieve ovulation pain – from natural methods for mild discomfort through to medication for severe pain. Since the pain usually passes within a few minutes or 1 to 2 days, no treatment at all is needed in most cases.

If the pain is intense, rest, staying in bed and avoiding physical activity are recommended. Warm baths, warm compresses or heat patches with natural ingredients can also help ease the cramping.

If the pain persists, treatment with anti-inflammatories can be tried. For severe pain, your doctor may recommend treatment with contraceptives that prevent ovulation. Without ovulation, the typical pain doesn't occur either. However, bear in mind that you cannot become pregnant while taking contraceptives.

Frequently asked questions about painful ovulation 

If you have further questions about painful ovulation, take a look at this section. Here we've gathered answers to the most common questions about this pain – including how it affects fertility and when you should see a doctor.

When should we see a doctor?

The symptoms of painful ovulation should subside within 1 to 2 days at most. If the pain lasts longer than 3 days, doesn't improve with rest or any other treatment, or is accompanied by other worrying symptoms such as vaginal bleeding, fever, nausea and vomiting, you should seek medical advice.

A visit to the doctor is also recommended if the pain recurs repeatedly or if you suspect you may be pregnant.

Does painful ovulation affect fertility? 

Painful ovulation is not a sign of infertility and doesn't affect your ability to conceive. It's simply a symptom of the process by which the egg is released from the ovary. On the contrary: this pain can help you identify more easily when you're ovulating – which is particularly useful if you're using the calendar method.

Which conditions can cause pain during ovulation?

Ovulation is the main cause of lower abdominal pain during the ovulation phase. However, this pain can easily be confused with the symptoms of other conditions, including:

• Endometriosis, a painful condition in which tissue similar to the endometrium (the lining of the uterine cavity) grows outside the uterus.
• Sexually transmitted infections, which cause inflammation and lead to painful ovulation.
• Pelvic inflammatory disease, an infection affecting the reproductive system.
• Ovarian cysts, fluid-filled sacs that form on the ovaries.
• Ovarian torsion, when the ovary twists around the ligaments that hold it in place.
• Appendicitis, inflammation of the appendix.
• Ectopic pregnancy

• Adhesions following surgery on the ovaries

  

Can pain during ovulation be prevented?

The only way to prevent pain during ovulation is to suppress ovulation itself. This is possible with hormonal contraceptives – and only on a doctor's recommendation.

Is it normal for me to have ovulation pain every month? 

Ovulation pain is normal and poses no risk to your health. It's simply a sign that ovulation is taking place.

However, if the pain is severe, doesn't respond to treatment, lasts longer than 3 days or is accompanied by other worrying symptoms, it's worth seeing a doctor to check whether other causes lie behind these symptoms.

Sources

For this article, we reviewed and drew on information from the following sources:

1. Cleveland Clinic, "Ovulation Pain": https://my.clevelandclinic.org/health/diseases/9134-ovulation-pain-mittelschmerz

2. NHS, "Ovulation pain": https://my.clevelandclinic.org/health/diseases/9134-ovulation-pain-mittelschmerz

3. Better Health Channel, "Ovulation pain": https://my.clevelandclinic.org/health/diseases/9134-ovulation-pain-mittelschmerz

4. Mayo Clinic, "Mittelschmerz": https://www.mayoclinic.org/diseases-conditions/mittelschmerz/symptoms-causes/syc-20375122

5. Verywell Health, "Ovulation Pain and Relief Options": https://www.verywellhealth.com/ovulation-pain-8628062

6. Healthline, "Why Ovulation Pain Shouldn't Be Ignored": https://www.healthline.com/health/pregnancy/ovulation-pain

7. NIH, "Mittelschmerz": https://www.ncbi.nlm.nih.gov/books/NBK549822/

8. WebMD, "Painful Ovulation (Mittelschmerz)": https://www.webmd.com/women/mittelschmerz-pain

9. MedlinePlus, "Mittelschmerz": https://medlineplus.gov/ency/article/001503.htm

10. University of Florida Health, "Mittelschmerz": https://ufhealth.org/conditions-and-treatments/mittelschmerz

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