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 the 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 it is actually not normal.
Yes, many women will feel ovulation, and it isn’t a big deal.
But acute, severe, stabbing or debilitating pain is not normal. If the level of pain you experience requires pain killers or stops you from getting on with your day, you need to get checked out by a reproductive specialist.
Ovulation pain is a red flag – a warning that you have an underlying health issue that should be addressed. In fact, some of the underlying causes of the pain can result in fertility problems that 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 warns ovulation pain could be the result of any number of problems – all of which should be investigated by a professional.
Ovulation Pain – The 5 Most Common Causes
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. Cutting them out can be highly beneficial.
Doctor Orr recommends following a diet containing low GI foods, or a paleo style of eating. This will get everything back under control — and keep it that way.
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, however, which is why it’s important to see a specialist if you are experiencing any fertility issues.
#3: Adhesions From Prior Surgery
If you’ve had surgery – for example, if you had a c-section or had your appendix out – adhesions and scar tissue can cause ovulation pain, by restricting the ovaries and surrounding structures.
Ovaries can sometimes adhere to the bowel and other organs. It will cause pain each time you ovulate.
This is something I’ve personally experienced. I had my appendix out, as a teenager, and in a subsequent abdominal surgery a few years later, it was discovered I had adhesions, which were dealt with.
In my 30s I began to experience ovulation pain, for which I needed pain medication. After speaking with Doctor Orr, I had a specialist perform a laparoscopy, which helped to mobilise my ovary which was stuck.
The specialist also checked for any other potential problems, such as endometriosis, which thankfully I didn’t have. I also switched to a LCHF (low carb, healthy fat) diet, and now the ovulation pain has completely gone.
Unfortunately, I had to insist, and persist, before my laparoscopy procedure was booked.
At first, the obstetrician/gynaecologist pushed for me to go on the pill, to prevent ovulation so I wouldn’t have pain. This ‘solution’ would certainly not have fixed the adhesions. And who knows what damage might have been done if the problem had become worse, or if there had been complications.
In my case, thankfully, I’m done having children. For women who are trying to conceive, though, any fertility complications can cost them the chance of a pregnancy.
#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 a hydrosalpinx – a condition in which 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’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 GP/Doctor/Friend/Other Said That Ovulation Pain Is Normal
Doctor Orr says that you should never 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”, he advises.
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 five doctors – four specialists and a GP.
The woman went to her GP (for a second opinion) and she told him she was having rib pain and abdominal pain, and experiencing shortness of breath.
The GP started the process of diagnostic tests and referrals. He was doing exactly what he was supposed to do.
He sent her for a scan of her gallbladder; it 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.
The gastrologist performed an endoscopy, and told her she had reflux. He said this was causing her asthma, and she should lose weight.
This was the gastrologist’s definitive diagnosis – and the she 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, pictured above, is what was removed.
So much for: “There’s nothing wrong, you just need to lose weight”. The anaesthetist joked after the surgery, 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, assume pain is there for no reason.
“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 Doctor Orr shared this story is not to berate doctors. It's because he sees things like this so often. It's easy to feel undermined by doctors, and to take their decisions as the final answer.
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 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, going in search of someone who ‘gets it’ can be like entering 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 get pregnant!
Initially, it might be helpful 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.
Do You Get PMS (Pre-Menstrual Syndrome) Too? Read our article on PMS here.