If you’re having ovulation pain, you’re not alone. Painful ovulation is a very common phenomenon and it’s usually not a sign of anything worrisome. In this guide to pain during ovulation, we’ll discuss what causes pelvic pain during ovulation, when you should be concerned about it, how to treat it, and some other signs of ovulation you might want to know about if you’re trying to predict when you’re most fertile!
What Is Ovulation Pain?
You’re probably familiar with the concept of pain during your period. But did you know you can also experience pain during ovulation?
Ovulation pain is discomfort in the abdomen or pelvis caused by the monthly release of the egg from the ovary during the menstrual cycle. About 20% of women experience pain when ovulating, so it’s quite common. Painful ovulation is also known as mittelschmerz, German for “middle pain.”
We’ll answer your common questions on painful ovulation here:
What does ovulation pain feel like? Can ovulation cause back pain? It’s hard to generalize what pain during ovulation feels like, because it’s not the same for everyone. You might feel ovulation pain in your lower abdomen or lower back. It might feel similar to your period cramps. It might be a sharp, localized pain, or a generalized, dull ache. Sometimes the pain is on one side of the abdomen or lower back. Your ovulation pain might switch sides every month, or stay on the same side for multiple months.
How long does ovulation pain last? You may only feel ovulation pains for just several minutes or for up to two days.
How do I know I’m having ovulation pain? When does ovulation pain occur? The main way you’ll know that you’re having pain with ovulation is that the pain will consistently happen about fourteen days before your period starts, and it will resolve on its own. You may want to keep a calendar of when the pain happens and when your period starts and ends to get a sense of any patterns and help pin down if you are experiencing mittelschmerz.
What Causes Painful Ovulation?
Scientists actually don’t fully understand what causes ovulation pain. But there are two main theories:
Every month, an egg (or ovum) matures inside of a collection of specialized cells called the follicle. As the ovum matures, the follicle surrounding that egg grows. One theory is that the growth of the maturing follicle stretches the ovary wall, which may cause discomfort just before ovulation.
When the egg is fully mature, the follicle ruptures, releasing the egg into the fallopian tubes. When the follicle ruptures with ovulation, some fluid (and blood) is also released. This fluid and blood may irritate the abdominal cavity, causing abdominal and ovary pain after ovulation.
Additionally, if you have scar tissue around one or more of your ovaries from a C-section or other abdominal surgery, the scar tissue may create tightness or restriction around the ovary. This can cause or worsen painful ovulation.
When Should You Be Worried About Ovulation Pain?
For the most part, ovulation pain is not anything to be worried about. It has no long-term health consequences. However, there are situations where underlying issues may make worsen painful ovulation. Here are two underlying medical conditions that can make your ovulation pain worse:
- Untreated STIs: An untreated STI like gonorrhea or chlamydia can cause inflammation, irritation, and scarring around the fallopian tubes. This can cause ovulation pain.
- Endometriosis: Endometriosis is a condition in which part of the uterine lining (endometrial tissue) grows outside of the walls of the uterus. The monthly growth and shedding of this mis-located tissue can cause lots of discomfort. If you have endometriosis, the release of the egg from the follicle may irritate endometrial tissue located around the ovaries and/or the fallopian tubes, causing discomfort.
Is It Really Ovulation Pain?
Another thing to be aware of is that sometimes people confuse pain from another condition for painful ovulation. The following conditions may seem like ovulation pain at first, but they are serious medical conditions needing a clinician’s attention:
- Appendicitis: Appendicitis is the inflammation of the appendix, a small vestigial organ in the lower right abdomen. Because pain in this area is one of the first symptoms, people often confuse appendicitis for mittelschmerz at first. If your inflamed appendix ruptures, it can cause infection throughout the abdominal cavity. So doctors usually remove an inflamed appendix.
- Ectopic pregnancy: An ectopic pregnancy is a pregnancy that develops somewhere other than your uterus, like in your fallopian tube or ovary. The growth of the pregnancy tissue could cause the fallopian tube to rupture, causing serious internal bleeding. If this happens, you may need surgery.
- Ovarian cyst: Ovarian cysts are very common (you may make one every month) and usually asymptomatic. They typically go away on their own. However, if they grow too large, they can cause intense abdominal pain. They can even cause the ovary to twist, which is a medical emergency requiring immediate medical attention (usually surgery to remove the cyst). Cysts can also rupture, causing dangerous internal bleeding.
- Pelvic Inflammatory Disease: Pelvic inflammatory disease, or PID, is an infection typically caused by an untreated STI. PID can cause inflammation and swelling in one or more of your reproductive organs, like the cervix, uterus, fallopian tubes, and ovaries. This leads to abdominal pain. If untreated, PID can cause scarring and impact your future fertility. You can treat PID with antibiotics. However, this won’t eliminate any existing scarring.
When to See a Doctor for Ovulation Pain
So when should you see a doctor for your painful ovulation? If you are experiencing the following symptoms with your ovulation pains, you may actually have an unresolved infection or other health issue. So see a doctor as soon as possible if you are experiencing any of the following:
- Your ovulation pain changes; it becomes more severe, longer, or otherwise feels different
- Pain with urination or intercourse
- Pain that does not resolve after an entire day has passed
- Unusual discharge or heavy vaginal bleeding that is not your period
- Abdominal swelling
- A fever above 100.4 degrees
- Nausea and/or vomiting
- Dizziness, fatigue, or weakness
How to Treat Pain During Ovulation
You have two main options for treating pain during ovulation: at-home treatment or treatment by a doctor or other medical professional. We’ll discuss both options here.
If your painful ovulation is not too severe or bothersome, you can just address the symptoms of your monthly ovulation pain at home. This means taking over-the-counter painkillers like ibuprofen, acetaminophen, or naproxen. You might also find some relief by applying a heating pad or taking a hot bath or shower.
Treatment by a Doctor
If you find yourself experiencing debilitating pain every month, you may want to go to a doctor to address your painful ovulation. They will probably ask you questions about your pain. They will also probably perform a pelvic exam and possibly an ultrasound to be sure that your pain is not caused by another, more serious condition. If your pain is very severe, they may order other diagnostic imaging tests like X-rays or CT scans, and they might also order some blood tests.
If they find that your pain is caused by ovulation, they will likely recommend that you get on some kind of hormonal birth control method. Hormonal birth control stops you from ovulating. And if there’s no ovulation, there’s no ovulation pain!
How to Prevent Pain During Ovulation
For many women, ovulation pains cannot be prevented, except through halting ovulation with hormonal birth control. It’s just a normal part of the menstrual cycle.
However, as we mentioned above, certain conditions can potentially make ovulation pain worse. While you can’t do anything to prevent endometriosis or scar tissue from necessary surgery, there are steps you can take to avoid developing untreated STIs that will worsen ovulation pain:
- Practice safer sex. Use barrier methods (like condoms and dental dams) with all partners unless you are in a monogamous relationship where you have both been recently tested for STDs.
- Get regular STD tests. The CDC recommends that all women under 25 receive annual tests for chlamydia and gonorrhea. Women over 25 should be tested when they have new sex partners, multiple sex partners, or a partner who is diagnosed with an STI. Following these recommendations will help prevent you from developing an infection in your fallopian tubes or ovaries, which might cause pain with ovulation or other complications like PID. It’s important to get STD tests even if you are currently in a monogamous relationship. This is because some STIs (like herpes) may be asymptomatic for years after you get infected.
Other Signs of Ovulation
If you’re trying to get pregnant (or trying not to get pregnant!) you may want to know when you are ovulating. The best time to try to conceive is in the 4-5 days leading up to (and during) ovulation. Sperm can live 3-5 days in the uterus. But once the egg is released, it only has about a day to encounter a sperm before it starts to disintegrate.
While mittelschmerz can be a sign of ovulation, it’s not the most reliable one (it’s considered a secondary sign of ovulation—see below).
There are three primary signs of ovulation to help you figure out when you are fertile:
- Basal body temperature: Your basal body temperature (or BBT) is your body temperature immediately after you wake up, before you do anything else—even sit up or speak. Hormones cause your BBT to fluctuate slightly throughout the month. Your temperature will typically spike about .5 degrees right after ovulation. So by tracking your temperature with a special BBT thermometer for multiple months, you can eventually learn when in the month you are ovulating.
- Cervical mucus: The mucus your cervix produces changes throughout your menstrual cycle. You can check your cervical mucus every day (with a clean finger!) to get a clue as to when you might be ovulating. After your period, you will probably have a few days without much mucus. Then, you’ll start to produce more mucus, which may be thicker and cloudier. During ovulation, your mucus will be wet, thin, clear, and sticky, with an “egg white” consistency.
- Cervix position: You can also use a finger to feel your cervix for signs of ovulation. Leading up to and during ovulation, your cervix will feel high (further away from your vaginal opening), soft, wet, and open. After ovulation, the cervix will feel low, hard, drier, and more closed. You may need to feel your cervix through several menstrual cycles to get a sense of the difference.
In addition to primary signs, there are also secondary signs of ovulation. These are symptoms that you may notice around the time that you ovulate. But they don’t happen consistently for everyone.
- Ovulation pain: Mittelschmerz is a secondary sign of ovulation.
- Breast tenderness: You might also experience breast pain during ovulation. Ovulation breast pain is not the most reliable sign of ovulation because breasts can be tender at several points in the cycle due to hormonal shifts.
- Light spotting: Some people bleed when they ovulate, so you may notice some light spotting. (See a doctor if you are bleeding heavily).
- Abdominal bloating: You may experience fullness, bloating, or a gassy sensation in your abdomen.
- Heightened senses: You may experience a heightened sense of smell, vision, or taste.
- Increased libido: Some women report experiencing a bump in libido during ovulation.
Ovulation Pain: The Bottom Line
Ovulation is the release of the mature egg from your ovaries during your menstrual cycle.
Can ovulation be painful? Yes, some women experience pain during this process. While doctors do not fully understand what causes painful ovulation, it is typically not serious.
However, certain reproductive health conditions can make ovulation pain worse. Additionally, people sometimes confuse pain from other more serious conditions for ovulation pain. So if you are experiencing any of the following symptoms, see a doctor:
- Fever above 100.4
- Changes in ovulation pain; painful urination or painful sex during ovulation; pain that does not resolve
- Unusual bleeding or discharge
- Abdominal swelling
The only way to stop painful ovulation is to stop ovulation itself, through hormonal birth control. Otherwise, you’ll need to manage your symptoms with painkillers and heat therapy.
There’s not much you can do to prevent painful ovulation, but practicing safer sex and getting regular STI tests can prevent you from developing an untreated STI, which can cause scarring and inflammation and make pain with ovulation worse.
If you want to know what pain during ovulation means because you are interested in your own fertility status, there are more reliable ways to track your own ovulation status, including through your BBT, cervical mucus, and cervix position and feeling.
Worried about other reproductive health symptoms? We can help you interpret brown vaginal discharge and white vaginal discharge. But you don’t have to be concerned about blue waffles disease, a hoax STD!