Ovulation Pain: Symptoms and Treatment

Unfortunately, for those living with endometriosis, pelvic pain during periods is very familiar. However, there are other times in the menstrual cycle when you may experience pelvic pain.

Ovulation pain, also called "mittelschmerz," is a phenomenon that people with and without endometriosis may experience. Over 40 percent of women may experience mittelschmerz at some time in their life. Mittelschmerz is not dangerous. It can be a normal part of your menstrual cycle.1,2

What is mittelschmerz?

The word mittelschmerz comes from the German words for "middle" and "pain." Ovulation is the time each month when an ovary releases an egg. This occurs about halfway through your menstrual cycle or around 2 weeks after the start of your last period. Many people experience mittelschmerz every month, but some only feel it occasionally.1-3

Usually, mittelschmerz is felt on 1 side of your lower abdomen. This pain may change sides depending on which ovary is releasing an egg. The pain can feel dull, sharp, or crampy. It can last anywhere from a few minutes to 48 hours. You may also notice a small amount of clear vaginal discharge or spotting.3,4

Why is mittelschmerz painful?

There are a few reasons why ovulation pain might occur. Before ovulation occurs, 1 egg must grow. Each egg grows in a fluid-filled sac in the ovary called the follicle. The fluid in the follicle is usually water mixed with hormones and enzymes. Sometimes, the fluid contains blood.2,3

As the follicle grows, it can stretch the lining of the ovary, causing pain. When the egg is released, the follicle is broken and the fluid is released. This is a normal process, but it can irritate the lining of the abdomen.3

How is mittelschmerz diagnosed?

It may be helpful to track your periods on a calendar or using an app. This can help you see if there is a pattern to when you feel this pain. If the pain happens about halfway between your periods, is on 1 side, and goes away on its own (or with over-the-counter pain medicines), it is most likely mittelschmerz.4

You can also discuss your symptoms with your doctor. They will likely ask you about when you feel the pain and what it feels like.2

Mittelschmerz can usually be diagnosed just by discussing your symptoms. However, if your doctor is worried that your symptoms may be something else, they may order other tests. These can include:2

  • A pelvic exam
  • An abdominal or vaginal ultrasound
  • Swabs of your discharge

Mittelschmerz treatment

Mittelschmerz may be annoying or painful, but it is generally harmless. It often will go away on its own. Heating pads may help. It can also be treated by over-the-counter medications like Advil or Tylenol. But if mittelschmerz is affecting your quality of life, speak to your doctor or gynecologist. They may recommend certain birth control methods that can stop ovulation to prevent this pain.5

When should I talk to my doctor?

Because there are so many organs in the abdomen, it can be easy to confuse 1 pain with another. Mittelschmerz can be mistaken for:2

  • Scar tissue pain
  • A sexually transmitted infection
  • Ovarian cysts
  • Ectopic pregnancy
  • Appendicitis
  • Diverticulitis

Reach out to your doctor if you are concerned about what you are feeling. It is particularly important to call your doctor if the pain becomes severe or if you develop symptoms such as nausea, fever, or pain while urinating. These could be the sign of a more serious condition.4

If you believe you may be experiencing mittelschmerz or have more questions, speak to your doctor.

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