Ovulation might be one of the most critical parts of reproduction, but it's also known as a source of pain for many. While 50 percent of women will experience ovulation pain at least once in their lives, the Nordica Facility Center reports 20 percent of women get ovulation cramps every month.
Dr. Donnica Moore of the Sapphire Women's Health Group says ovulation pain is a very common sudden, sharp, dull or crampy pain that happens with the release of an egg approximately 14 days before the onset of a menstrual period. Commonly referred to by doctors as a "mittelschmerz," this type of pain usually lasts for a few minutes to an hour, or even one to two days.
While it might be scary for someone who has never experienced it before, ovulation pain is treatable with over-the-counter medication like acetaminophen or ibuprofen. However, occasionally that painful sensation in the lower abdomen can be a red flag to an underlying health issue that needs attention.
Why do women experience it?
As Moore reveals, ovulation pain occurs when there might be a minor leakage of blood from the ovary when the egg is released during ovulation, which irritates the abdominal wall and causes discomfort.
"The amount of discomfort may depend upon how much blood has leaked, a woman's pain threshold, and many other factors which vary from woman to woman and cycle to cycle," she says.
Moore adds that it's important for girls or women who take birth control pills to understand mittelschmerz should not occur if you are on birth control pills as they work by "preventing ovulation" entirely.
When should women worry about ovulation pain?
Moore reassures readers to never "worry" about ovulation pain, but instead pay attention to the severity of pain as you seek treatment from over-the-counter pain medication or in hopes to prevent pain altogether, the use of birth control pills. However, if pain does not resolve in 24 hours, becomes increasingly severe, does not respond to over-the-counter medicines or is associated with vomiting, women should seek medical attention immediately — especially if it's experienced in the right lower abdomen.
"In some women, the pain of mittelschmerz may mimic appendicitis or vice versa, which we would hate to overlook," she says.
Is it a sign of fertility problems?
"No!" Moore stresses. "[It] indicates normal ovulation. However, there are some women with conditions such as fibroids or polycystic ovary syndrome who may have painful ovulation as a result."
If you're concerned symptoms are more than mittelschmerz and might be a result of cysts or a bacterial infection, Moore recommends discussing the discomfort with your obstetrician-gynecologist, especially if you have hopes to become pregnant. There are a few possibilities to consider in determining the cause of your pain as you reach out to your doctor for guidance.
As a pregnancy that progresses outside of the womb and typically in one of the fallopian tubes, symptoms of this one-sided pelvic ache include vaginal bleeding, cramping and abdominal pain. Moore says if your doctor is concerned about an ectopic pregnancy, they will get a pregnancy test immediately and run other tests depending on the results and your symptoms.
Known as an inflammatory disorder that affects ovaries and fallopian tubes, this condition can cause headaches, dizziness and pain during intercourse. Moore says endometriosis pain is often the worst on the first day of your period, with mittelschmerz actually taking place 14 days prior to menstruation.
Cysts and scarring
"Pain as a result of adhesions from previous C-sections or other abdominal or pelvic surgeries is unlikely to occur just at the time of ovulation, but [it] might," Moore says. Moreover, she shares to rule out ovarian cysts, your doctor might recommend an ultrasound.
"[However], the only way to absolutely rule out endometriosis or adhesions would be with a minimally invasive procedure called a laparoscopy," she says. This method to diagnose is done with the insertion of a small fiber-optic camera through the abdominal wall to help view organs in the abdomen and provide clearance for surgery.
"Appendicitis doesn't come and go every month and has characteristic symptoms including pain on exam, vomiting and low fever," Moore says. "Since this is unreliable, your doctor might order a CT [scan] for further evaluation."
While these particular kinds of pain in women signal ovulation, not all women will experience mittelschmerz. However, Moore says of those who do, it might not be experienced every cycle.
Women may have bacteria in their pelvic cavity that causes inflammation and infection. Moore says you will notice this if you have a discharge or a fever.
"Chart your symptoms on a calendar, noting the days of your period — yes, there are apps for that but you can also use a regular calendar," she says.
When you see your OB-GYN to help you diagnose pain symptoms, Moore tells us they will take a thorough history and rule out certain concerns based on these results. In addition, your physical exam will give much more information with diagnostic tests formally suggested.