During ovulation, when an egg is released from an ovary follicle, some women experience a sensation commonly referred to as ovulation pain. Ovulation pain is also known as mittelschmerz, which is German for mid pain.
Here’s a summary of what you really need to know about pain during ovulation:
- Ovulation pain symptoms
- Severe ovulation pain
- How long does ovulation pain last?
- 5 most common causes of pain during ovulation
- “But I’ve had children, so it shouldn’t be a problem…”
- “But my doctor/friend/other said ovulation pain is normal…”
- “But I had a scan and it came up fine!”
Ovulation pain symptoms
So, what does ovulation pain feel like? Women usually describe ovulation pain as a sudden twang, pop, twinge or feeling of pressure in the lower abdomen.
This coincides with the ovulatory stage of the menstrual cycle and usually occurs on one side – the side where ovulation is occurring. However the pain may switch sides month to month.
While ovulation pain is considered by many to be common, it might come as a shock to hear that pain during ovulation is actually not normal.
Yes, many women will feel it when they ovulate, and for them, it isn’t a big deal. But some women would describe ovulation as being painful, and in some cases, it can be severe or debilitating.
Severe ovulation pain
Acute, severe, stabbing or debilitating pain during ovulation is not normal.
If the level of pain you experience requires pain killers, or if the pain stops you from getting on with your day, then you need to see your healthcare professional as soon as possible.
You should ask for a referral to see a reproductive specialist who can get to the bottom of the issue for you, rather than just offer you some stronger pain killers, or a hormonal contraceptive to stop you from ovulating. Doing so just masks the underlying problem, and risks further damage or deterioration to your mental and physical health, and possibly your fertility.
How long does ovulation pain last?
For most women, ovulation pain may last for around 6-12 hours. Other women might experience this in minutes, and others around a day or two at most.
If you experience ovulation pain for three days or longer, see your healthcare professional as soon as possible, especially if the pain is accompanied with other unexpected symptoms. Request a referral to a reproductive specialist and ask them to look at for the underlying cause of the pain.
Pain during ovulation – 5 most common causes
Painful ovulation is a warning that you have an underlying health issue that should be addressed.
In fact, some of the underlying causes of ovulation pain can result in fertility problems, which might 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 strongly advises women with ovulation pain to be investigated by a professional reproductive specialist.
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.
Sugar and grains in the diet cause spikes in blood sugar levels, and also cause inflammation in the body.
Significantly reducing or eliminating sugars and grains can be highly beneficial.
Doctor Orr recommends following a diet containing low GI foods, or a paleo or low carb style of eating.
Find out more information on how to possibly reverse polycystic ovaries with low carb at the Diet Doctor website.
Endometriosis is an inflammatory disease which affects the ovaries and fallopian tubes.
It can also cause pain during the ovulatory period.
Other symptoms of endometriosis include: pain during intercourse, migraines, constipation, headaches, and dizziness.
Some women with endometriosis can be asymptomatic.
This is why it’s important to see a specialist if you’re experiencing any fertility issues.
If you suspect you may have endometriosis, or your doctor has mentioned this to you, please see our article about endometriosis treatments.
#3: Adhesions from prior surgery
Perhaps you’ve had a c-section, your appendix out, or other abdominal surgery.
Adhesions are hard to avoid after having surgery, and are quite common. Unfortunately, it can result in ovulation pain.
How? Sometimes, an ovary can adhere to the bowel or other internal parts, which can cause pain during ovulation.
I’ve personally experienced this. As a teen, I had my appendix out, followed by a subsequent abdominal surgery a few years later.
In my 30s, I began to experience ovulation pain, which was strong enough to need pain medication.
After speaking with Doctor Orr, I asked a gynaecologist to perform a laparoscopy. During the procedure, he helped to mobilise my ovary, which was stuck due to adhesions.
Unfortunately, I had to insist before my laparoscopy was booked. At first, the gynaecologist strongly suggested that I should go on the pill. He wanted to prevent ovulation from occurring, so I wouldn’t experience ovulation pain.
This bandaid solution would certainly not have fixed the adhesions and freed my ovary.
#4: Bacteria from medical procedures
Bacteria can be introduced into the pelvic cavity through catheters, during surgery, and even in childbirth.
The bacteria can cause inflammation and infection, resulting in ovulation pain.
#5: Sexually transmitted infections
Sexually transmitted infections (STIs) are also possible causes of ovulation pain.
One example of an STI is chlamydia.
It can cause inflammation in the fallopian tubes, scarring, and pelvic inflammatory disease (PID).
Chlamydia can also cause another condition, which results in the fallopian tubes being blocked with pus, causing inflammation and pain.
“But I’ve had children, so it shouldn’t be a problem…”
Even if you’ve had children, there are still some potential problems you might not be fully aware of.
You might have heard of secondary infertility.
In these cases, a couple might just have been lucky to get pregnant previously. Or perhaps the condition had developed after the first pregnancy, or an existing condition had worsened.
Any surgery you have had while giving birth, or after giving birth, can create an opportunity for fertility complications later.
Ultimately, if there’s a risk of a condition that might eventually lead to infertility, and it causes you pain, are you comfortable about gambling with that?
“But my doctor/friend/other said ovulation pain is normal…”
Doctor Orr says that you should never let anyone tell you that pain during ovulation is normal.
“Many general practitioners don’t know that much about gynaecology. Remember, it’s not their field of expertise; they are general practitioners. Always get a referral to see a specialist”, he insists.
“But I had a scan and it came up fine!”
Unfortunately scans don’t pick up everything – especially scar tissue, adhesions, and endometriosis. It can take a highly trained eye to pick up certain gynaecological issues, so if you need to have an ultrasound, it should at the very least be at a women’s gynaecological specialist ultrasound clinic.
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’ve had a scan and think that you’ve been checked for endometriosis – you haven’t.”
He continues, “The only way to assess the pelvic cavity properly is through laparoscopy. It’s the gold standard of investigations for gynaecological conditions. I always get so worried when I see comments where women have pain and think they’re okay because they’ve had a scan.”
Misdiagnosed by five doctors
This is what was missed by five doctors – four specialists and a general practitioner (GP).
A woman went to her GP for a second opinion.
She told him she was having rib and abdominal pain, as well as experiencing shortness of breath.
The GP began the process of diagnostic tests and referrals.
He sent her for a scan of her gallbladder; it found nothing.
A week later, the woman’s pain and shortness of breath were worse, and her stomach had started getting bigger.
She went back to her GP, who then sent her to a gastrologist.
The gastrologist performed an endoscopy, and told her she had reflux. He said this was causing her asthma, and she should lose weight.
So that was the gastrologist’s definitive diagnosis, and the woman was sent away.
Two weeks later the poor woman was in excruciating pain and went back to the GP. He said he couldn’t help her, because she needed to lose weight (as the specialist had said).
He suggested she try a complementary medicine practitioner.
It was at this point the woman called Doctor Orr’s clinic and explained her symptoms.
Doctor Orr immediately arranged for the woman to see his surgeon.
They both decided that she needed to be investigated.
The mass you can see in the image is what was removed from the woman’s body.
We need to listen to women more often and take their pain seriously
“Three primary care physicians missed a 5kg mass, and this woman was written off as a whinger. This is why you should never, ever, assume pain is there for no reason. Always get a second opinion when it comes to painful ovulation or any other medical matter…. Get a third, fourth or fifth opinion if that’s what it takes for someone to listen,” says Dr Orr.
The reason Doctor Orr shared this story is not to berate doctors. He shared it because he sees things like this far too often.
It’s easy to feel undermined by doctors, and to take their decisions as the final answer. But if you are in pain, keep seeking help until you find someone who will listen to you, and investigate thoroughly, to get to the root cause of the pain.
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 says, “As a specialist in the field of reproductive medicine and women’s health, I can tell you, you aren’t meant to experience painful ovulation. Sure, some slight bloating and a bit of pressure… but not pain. Many women are also conditioned to believe the urban myth that period pain is normal, when it isn’t. 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.”
He continues, “I would much rather see women right away, for ovulation pain or period pain, than see them when they are trying to conceive, and some of the bad pathology has actually left permanent damage. This is by no means meant to cause panic or sensationalism. This is a very serious issue I see every day in my practice. I just want to help women relieve this unnecessary pain – and stop believing painful ovulation or painful periods is normal for them.”
Do you get ovulation pain?
If so, it’s worth getting checked out by a switched on healthcare professional.
The pain you’re experiencing might be normal, but then again it might not be. It’s always best just to get it checked, for your peace of mind. It could save you in the long run.
Do You Get PMS (Pre-Menstrual Syndrome) Too? Read our article on PMS here.
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