When some women ovulate, they experience a sensation commonly referred to as ovulation pain, which is also known as mittelschmerz.
The sensation is usually a sudden twang, pop or twinge in the lower abdomen, which coincides with the ovulatory stage of their menstrual cycle.
But some women would describe ovulation as being painful.
Because ovulation pain is common these days, it might come as a shock to hear that ovulation pain is actually not normal.
Yes, many women feel ovulation and it isn’t a big deal. But acute, severe, stabbing or debilitating pain is not normal.
Ovulation pain is a red flag that you have an underlying health issue that should be addressed. In fact, some of the underlying causes can result in fertility problems that can prevent you from getting pregnant.
Doctor Andrew Orr is a specialist in reproductive medicine and women's health, with Masters degrees in both fields. He warns ovulation pain could be the result of any number of problems — all of which should be investigated by a professional.
The Most Common Causes Of Ovulation Pain
According to Doctor Orr, the most common causes of ovulation pain are:
#1: Cysts On The Ovaries
Ovulation pain is often the sign of cysts on the ovaries. Cysts can form, or can burst, during the ovulation period.
Women with PCOS (polycystic ovarian syndrome) often experience ovulation pain due to multiple ovarian cysts.
Cystic ovaries are the result of a hormonal imbalance, usually related to insulin resistance. Cutting out sugar and grains (which not only cause spikes in blood sugar levels, but also cause inflammation in the body) can be highly beneficial.
Doctor Orr recommends following a low GI or paleo/primal style of eating to get everything back under control — and it will keep it that way.
Endometriosis is an inflammatory disease which affects the ovaries and fallopian tubes. It can also cause pain during the ovulatory period.
Other symptoms include: pain during intercourse, migraines, constipation, headaches, dizziness and more.
#3: Adhesions From Prior Surgery
If you’ve had surgery — for example, a c-section or having your appendix out — adhesions and scar tissue can cause ovulation pain, by restricting the ovaries and surrounding structures.
Ovaries can adhere to the bowel and other organs, causing you pain when you ovulate. This is something I've personally experienced, and having a laparoscopy during day surgery helped to mobilise my ovary. Unfortunately, the procedure was done only after much insistence and delay, hence the pain. The obstetrician/gynaecologist was pushing for me to go on the pill to prevent ovulation. This wouldn’t have fixed the problem, and who knows what might have happened if it had become worse.
#4: Bacteria From Medical Procedures
Bacteria can be introduced into the pelvic cavity through catheters, surgery and even childbirth. This can cause inflammation and infection, resulting in ovulation pain.
#5: Sexually Transmitted Infections
Another reason for ovulation pain is sexually transmitted infections (STI’s). One example is chlamydia, which can cause inflammation in the tubes, scarring and pelvic inflammatory disease. Chlamydia can also cause a condition known as a hydrosalpinx, where the fallopian tubes are blocked with pus. This causes inflammation and pain.
But I've Had Children, So It Shouldn’t Be A Problem
Even if you have had children, there are still issues that you might not be fully aware of. If it’s a condition that might eventually lead to infertility, are you comfortable gambling with that?
But My GP/Doctor/Friend/Other Said That Ovulation Pain Is Normal
Doctor Orr says that you should not let anyone tell you that pain during ovulation is normal. “Many GPs don’t know that much about gynaecology… remember that it’s not their field of expertise, they are general practitioners. Always get a referral to see a specialist”.
But I Have Had A Scan And It Came Up Fine
Unfortunately scans don’t pick up everything – especially scar tissue, adhesions and endometriosis.
Doctor Orr says, “I need to point out that scans do not always pick up pelvic pathology. They will not pick up endometriosis, so if you have had a scan and think that you have been checked for endometriosis – you haven’t. The only way to assess the pelvic cavity properly is through laparoscopy. It is the gold standard of investigations for gynaecological conditions. I always get so worried when I see comments where people have pain and think they are okay because they have had a scan. Just to repeat: scans cannot pick up endometriosis and other crucial pathology… and pain of any kind is not normal.”
This is what was missed by 3 doctors. A woman went to her GP (for a second opinion) and she told him she was getting rib pain, abdominal pain and shortness of breath. He sent her for a scan of the gallbladder, which found nothing. A week later the pain and shortness of breath were worse – and her stomach started getting bigger.
She went back to the GP, who sent her to a gastrologist. After an endoscopy, she was told she had reflux, which was causing her asthma, and that she should lose weight. This was the gastrologist’s definitive diagnosis – and she was sent away.
Two weeks later the poor woman was in excruciating pain and went back to the GP, who said he couldn’t help, because she needed to lose weight (as the specialist had said). He suggested she try a complementary medicine practitioner. She called Dr Orr’s clinic and explained her symptoms. Dr Orr immediately arranged for her to see his surgeon. They both decided that she needed to be investigated – and the mass, pictured above, is what was removed. So much for ‘there’s nothing wrong’. The anaesthetist joked afterwards, saying, “Well that will fix her asthma, won’t it?”
“Three primary care physicians missed a 5kg mass, and this woman was written off as a whinger. This is why you should never, ever, take pain as nothing and always get a second opinion when it comes to pain or any medical matter…. Get a third, fourth or fifth opinion if that’s what it takes for someone to listen,” says Dr Orr.
The reason Dr Orr has shared this story is not to berate doctors, but because he sees things like this often. It is easy to feel undermined by doctors, and to take their decisions as the final answer. But if you are in pain, you must seek help until you find someone who can help you.
If You Think This Is A Load Of Rubbish…
Unfortunately, we tend to become complacent about things that are common. If you think ovulation pain is normal, Dr. Orr has this to say:
“As a specialist in this field of reproductive medicine and women’s health, I can tell you that you aren’t meant to get pain. Sure, some slight bloating and a bit of pressure… but not pain. Many women are conditioned to the urban myth that period pain is normal, when it isn’t. Being a male doesn’t mean I don’t understand what women go through. I see hundreds of women every year, and have helped over 10,500 couples have babies. All of the women had period pain and other issues causing infertility – and this is what can happen.
I would much rather see women right away, for ovulation or period pain, than see them when they are trying to conceive, and some of the bad pathology has actually left permanent damage. People don’t realise that good bacteria in the vaginal tract can get into the cervix and turn infectious, and then travel up into the fallopian tubes and cause major problems (tubal blockage, tubal scarring and hydrosalpinx).
Worse yet, severe pain can be due to cervical or ovarian cancer. Many women die each year from cancers that could be prevented or treated through early intervention. But sadly, too many women leave it too late, thinking that pain is normal.
This is by no means meant to cause panic or sensationalism. This is a very serious issue that I see every day in my practice. I just want to help women relieve this unnecessary pain – or stop believing that pain is normal for them.
The pain you're experiencing might be normal, but then again it might not be. Just get it checked, for peace of mind. It could save you in the long run.”
Do You Get Ovulation Pain?
Ovulation pain needs to be checked out by a professional. But, as you’ve read, finding someone who ‘gets it’ can be a minefield.
Some doctors give erroneous advice about ovulation pain. Some will even say that you're lucky because knowing when you're ovulating can help you to get pregnant!
It can be helpful initially to see a practitioner of traditional Chinese medicine who specialises in fertility and gynaecological issues. They not only diagnose and treat any underlying health issues, but they often know of great gynaecologists. Then you can ask your local doctor for a referral, so you can get the treatment you need and deserve.
“Don’t just see a GP for gynaecological issues – always see a specialist. Get the referral and go”, says Dr Orr.
As drastic as it might sound, sometimes surgery is needed to diagnose and treat disease states in the pelvis. After it is cleared up, via laparoscopy, there is also an increased success rate for pregnancy.
See our list of Australian Chinese medicine practitioners.
Do You Get PMS (Pre-Menstrual Syndrome) Too?
Then you must read our article on PMS here.