Identifying Signs of Ovulation Pain

Ovulation pain, also known as “mittelschmerz,” is pain usually experienced on the right side of the pelvis during the ovulation phase of the menstrual cycle. In a 28-day cycle, ovulation usually occurs around day 14. If your cycle is longer than 28 days, ovulation likely occurs later than day 14. If it’s shorter, ovulation likely occurs earlier than day 14.

Not everyone experiences pain during ovulation, but it’s common. It affects about 40% of people who ovulate. The pain is usually mild or moderate, but it can sometimes be severe. People who have ovulation pain may experience it with most of their cycles or only intermittently.

Ovulation pain is not harmful. Still, it’s important to mention to your healthcare provider if this pain is new to you to rule out more serious causes of pelvic pain.

Most of the time, ovulation pain is felt on one side of your pelvic region. It’s more likely to occur on the right side, but it can occur on both sides. Since people tend to ovulate from one ovary and then the other from month to month, ovulation pain often alternates from one side to another each month.

Ovulation pain usually lasts about 3-12 hours. However, some people experience discomfort for up to 24 hours. The pain can resemble menstrual cramps but also may feel like shooting pains. Some people report having a backache along with one-sided pelvic pain.

Ovulation pain typically occurs alongside other signs of ovulation. These signs may include:

• More cervical fluid (vaginal discharge)
• Cervical fluid that’s slippery and resembles egg whites
• Increased sex drive
• Increased energy
• Tender breasts
• Bloating
• Light bleeding or spotting
• Heightened senses, like a heightened sense of smell

Experts aren’t entirely sure what causes ovulation pain, but it likely has to do with the mechanics of the egg being released from your ovary during ovulation. Here are some possible mechanisms that may be at work.

Follicle Stretching

Each egg in your ovary is surrounded by a sac called a follicle. As ovulation draws near, the follicle must stretch in preparation for releasing an egg. It’s thought that follicle stretching may contribute to ovulation pain.

Fluid or Blood Released

When you ovulate, some fluid and blood are released when the egg bursts out of its follicle. Fluid and/or blood may irritate the lining of your uterus or abdomen, resulting in pain and discomfort.

Smooth Muscle Contraction

Around ovulation, a hormone called luteinizing hormone (LH) is released. Hormones called prostaglandins increase as well. Together, these may cause contractions in the smooth muscle cells of your ovary, resulting in pain.

If you are experiencing mild to moderate pain on one side and no other concerning symptoms, you can discuss this the next time you visit your gynecologist (a healthcare provider who primarily treats health concerns related to female sex organs and hormones.) Like menstrual cramps, ovulation pain is normal for most people and is a benign condition.

However, it’s important to visit your provider if you are experiencing severe pain or other concerning symptoms along with pain. Symptoms to be aware of include:

• Severe pelvic pain
• Pain that doesn’t go away after a day or so
• Pain accompanied by vomiting, nausea, sweating, or fever
• Feeling lightheaded or like you are about to faint
• Fainting
• Racing heartbeat along with signs of low blood pressure, such as dizziness
• Severe vaginal bleeding (as opposed to bleeding like your usual period)

Seek emergency medical care if your symptoms are severe, such as severe bleeding, severe vomiting, high fever, or fainting.

People usually describe their ovulation pain to their healthcare providers during a routine gynecological visit.

If it’s clear that you are experiencing pain in the middle of your cycle, the pain is manageable and is not accompanied by other symptoms, and the pain goes after ovulation, it’s unlikely that your provider will need to perform any further tests. They will likely assure you that the pain is a normal part of your cycle and discuss pain relief strategies.

However, testing may be needed if your provider suspects other conditions. For example, other gynecological causes of pelvic pain include pelvic inflammatory disease, or PID (an infection of the female reproductive organs), fibroids (tumors, usually noncancerous), and endometriosis (when tissue similar to the lining of the uterus, or endometrium, grows outside the uterus).

In this case, your provider may perform tests and exams, such as:

• Pelvic exam
• Abdominal ultrasound (uses sound waves to generate images of areas inside your abdomen)
• Transvaginal ultrasound (a probe is inserted into the vagina to see the uterus and ovaries)

More Serious Conditions

Some causes of one-sided pelvic pain are serious and require emergency care. Conditions that can be mistaken for ovulation pain include:

• Appendicitis: Inflamed or infected appendix
• Ectopic pregnancy: When a fertilized egg (embryo) implants outside the uterus
• Ovarian torsion: Twisting of an ovary
• Ruptured ovarian cyst: A cyst in the ovary breaks
• Ruptured abscess from an infection: Pus in the abscess spreads after the rupture, possibly leading to infection
• Intestinal tear: A tear in the lining of the small intestine or large intestine (colon)
• Pelvic hernia: Weakening of tissue or muscle in the abdomen or pelvis, which causes the tissue to tear or rip and allows the contents of your abdomen to poke through
• Abdominal aortic aneurysm (AAA): Weakness and bulging of the aorta (main blood vessel) in your abdomen

If your one-sided pain is caused by one of these conditions, you will typically have other symptoms, like severe pain, bleeding, and fever. Seek emergency care if you have any of these symptoms.

If your provider suspects one of these conditions, they will check your vital signs (e.g., blood pressure, oxygen levels, heart rate) and perform a pelvic examination. They may perform other tests, such as ultrasounds or magnetic resonance imaging (MRI) scans, to determine the cause.

For most cases of ovulation pain and discomfort is mild enough to manage without treatment. If the pain is bothersome and you have trouble getting through your daily activities, you can ask your provider for recommendations for an over-the-counter (OTC) pain reliever.

In cases of more painful or persistent ovulation pain, providers might prescribe an oral contraceptive (birth control) to treat the pain long-term.

Ovulation pain can be uncomfortable and painful at times. However, it is not dangerous and not a sign that you have a serious condition.

If you are concerned, you can talk to your provider about the pain at your next gynecological visit or sooner. Contact your provider immediately if the pain is severe or won’t subside after a day or so, or if it is accompanied by symptoms like vomiting, fever, or bleeding. This might be a sign that a more serious condition is causing your symptoms.