Let's Talk About Ovulation Pain

When I was 16, I went to the ER because of a sharp pain in my lower right side. I thought my appendix was bursting. And so did the nurse. Except she was confused about why I didn't have other telltale signs of appendicitis. I had no fever and I wasn't throwing up. Though, I did feel nauseated.

I didn't know about endo back then. But I told her about my terrible menstrual cycles. In fact, she brought it up. It couldn't be period pain, I assured her, because my bleeding wasn't due for another two weeks. That's when she told me my symptoms sounded more like ovulation.

She shot some kind of painkiller into my butt and told me to keep an eye on my temperature. If I got a fever, I should come back. But I felt better in a day or so, thankfully.

Since I know it's coming, I don't get freaked out about my mid-month agony anymore. But that cyclical pain, which is called Mittelschmerz — German for "middle pain" — has persisted for more than 20 years. Here's what I've learned about it so far.

What does ovulation pain feel like?

It doesn't happen every month. But when it does, it's a multi-day process that ends with what feels like a final hot poker to my pelvis.

Research shows Mittelschmerz happens when your luteinizing hormone (LH) rises and peaks. LH stimulates your follicle. That's the fluid-filled sac where your egg grows. As my follicle matures, I get dull aches in my pelvis. This happens about 9 or 10 days after my period starts. It gets worse the closer I get to ovulation.

Then somewhere around day 12, my egg goes searching for sperm it never finds. (My husband has a vasectomy.) That's when I can get:

• A sharp, blinding pain on my lower right side
• Pain that radiates around my tail bone (especially when I poop)
• Nausea
• Back or rib pain one side
• Diarrhea
• No urge to eat

The worst pain can last for a few hours or a full day.

Research backs up my experience. Studies show it may or may not happen every month. Even though the pain can happen from whichever side you're ovulating from, it's most often concentrated on the lower right side.¹

What causes the pain?

Experts don't exactly know why ovulation hurts some people. They think it has something to do with your LH surge and the fluid and blood that spill out after your egg breaks free.² For people with endometriosis, those hormone changes may bother pelvic tissue or impair the sympathetic nervous system.³

Does it happen more often if you have endo?

About 40% of people with periods get ovulation pain.¹ So that makes it pretty common in the general population. But it's often a symptom reported by people who have endo.

I'd wager that, like other kinds of pelvic problems, ovulation pain is more severe if you have endometriosis.

Is there a way to treat it?

Hormonal birth control (HBC) may help.¹ That's because it's designed to stop you from ovulating. For the most part, my Mittelschmerz went away the few years I used the Nuvaring. But HBC gave me so many other terrible symptoms, that I had to quit.

Is there any benefit to ovulation pain?

Not for me. But if you want children, it might help you figure out when you're fertile. So if you're someone who gets Mittelschmerz, you may already know — albeit, uncomfortably — the best days of your cycle to get pregnant.¹

How I manage

Muscle relaxers don't work for me. And most prescription painkillers aren't a good long-term option. Since my ovulation pain only lasts a day or two, I usually take ibuprofen. Sometimes it helps. Sometimes it doesn't. Mostly, I just wait it out.

But if it causes you distress, bring it up with your doctor. They may have options that can help. And mention your ovulation pain if you're ever in the ER. That way you don't lose a perfectly good appendix.