While ovulation pain is harmless, it’s worth knowing what else might be causing your lower abdominal pain so you know when to take action.
Worried about belly pain? From periods to appendicitis, there are a number of potential causes for lower abdominal pain in women. But if it happens every month in the middle of your menstrual cycle, it could be ovulation pain.
Most women are unaware when one of their ovaries releases an egg. It happens painlessly, as part of a normal menstrual cycle. However some women may experience discomfort and even severe pain during this time.
While ovulation pain is harmless, it’s worth knowing what else might be causing your lower abdominal pain, so you know when to take action and what you can do to ease the pain. Dr Juliet McGrattan looks at ovulation pain causes, symptoms and treatment options:
What is ovulation pain?
We don’t really know why ovulation can cause pain and why some women experience discomfort in the middle of their menstrual cycle.
There’s a theory that when the egg bursts out of the follicle it was growing in, there may be a small amount of fluid or blood released that irritates surrounding tissues and nerves.
What does ovulation pain feel like?
Every woman is different but here are some key facts about ovulation pain:
- Ovulation pain is usually a sharp pain.
- Sometimes ovulation pain is a dull cramp.
- The pain is usually in the lower abdomen and concentrated on one side.
- Ovulation pain may be on the right or the left, according to which ovary has released an egg.
- Sometimes the pain can spread more generally across the lower abdomen.
- Ovulation pain tends to come on fairly quickly and can last from a few minutes to one or two days.
- Ovulation pain might be very mild or it may feel extremely painful.
- Ovulation pain can hurt when you move around, press on the sore area, cough or jump.
- Mild backache is not uncommon with ovulation pain.
You might notice other changes in your body that go along with ovulation such as an increase in the amount and consistency of your vaginal discharge. If it becomes more slippery and resembles egg-white, then this is a sign that ovulation may have occurred.
You may also have a small amount of vaginal bleeding called ‘spotting’ around ovulation too.
When do you get ovulation pain?
Ovulation pain usually happens in the middle of the menstrual cycle. In fact, it is also known as mittelschmerz which is the German word for ‘middle pain’.
The menstrual cycle is controlled by a range of female hormones including oestrogen and progesterone. Day 1 of your menstrual cycle is when your period bleeding starts. At this point oestrogen and progesterone levels are both quite low. Over the next couple of weeks, the oestrogen level rises as your ovaries get ready to release an egg. The rising oestrogen triggers a surge in a hormone called luteinising hormone (LH) which sparks ovulation. This happens around day 14 in a woman with a 28-day menstrual cycle.
Ovulation pain is also known as mittelschmerz – which is the German word for middle pain.
Not all women have a 28-day cycle and ovulate on day 14. It can vary from month to month and woman to woman. Some women have a shorter or longer cycle. Some women don’t ovulate in every cycle, such as those who have polycystic ovary syndrome. If you want to know when you ovulated, then a better calculation is 14 days before your period rather than 14 days after it began.
Who gets ovulation pain?
Any menstruating woman can have pain when an egg is released from the ovary. This may happen every month, every now and then or as a one-off.
Not all women get pain from ovulation. The majority of women are unaware they have ovulated or any discomfort they feel is minor and goes unnoticed or is attributed to something else such as wind or a twinge from a muscle.
The majority of women are unaware they have ovulated or any discomfort they feel is minor.
You are more likely to get ovulation pain if you have any scarring of the tissues around the ovaries and fallopian tubes. Scarring, also called ‘adhesions’ can happen as a result of a sexually transmitted infection such as chlamydia or as a result of surgery to the womb, ovaries or bowel. Ovulation pain is also more common in women who have endometriosis because the ovaries and fallopian tubes can be inflamed and sensitive.
What else could the pain be?
There are many causes of lower abdominal pain in women. It can be hard to work out what the pain is. Other potential causes include:
- Urine infection
- Irritable bowel syndrome
- Ovarian cyst
- Muscular pain
- Pelvic infection eg sexually transmitted infection
- Ectopic pregnancy
If you are in acute or worsening pain don’t try to self-diagnose any of the above, make an urgent appointment with your doctor if you are concerned.
How is ovulation pain diagnosed?
Thankfully, ovulation pain isn’t usually severe. It’s most commonly a niggly pain that doesn’t last long enough and isn’t severe enough for you to be concerned enough to see a doctor. Looking at the timing of the pain in relation to your menstrual cycle is the key to diagnosing it. You’ll realise that each time it happens it’s a couple of weeks before your period.
If you are tracking your menstrual cycle for fertility reasons and trying to spot ovulation by measuring your temperature, checking your vaginal discharge or using an ovulation kit, then it will be easy to link the pain to your mid-cycle.
Looking at the timing of the pain in relation to your menstrual cycle is the key to diagnosing it.
Occasionally ovulation pain can be severe and you may end up seeing a doctor as an emergency worrying that something else is going on. The doctor will ask you lots of questions and examine you to work out the cause of the pain. Unless it is impossible for you to be pregnant they will do a pregnancy test to rule out an ectopic pregnancy. This is unlikely if you haven’t missed a period but because an undiagnosed ectopic pregnancy (where the foetus grows in the fallopian tubes) can be life threatening to the mother, they will need to exclude it.
If you have severe abdominal pain, you should be assessed by a doctor. Sometimes admission to hospital is needed for further urgent investigations such as blood tests and scans to look for ovarian cysts or appendicitis.
Ovulation pain treatment
There are a few things you can do if you have ovulation pain:
✔️ Gent plenty of rest
Ovulation pain can sometimes make it hurt to walk around so take things easy.
✔️ Distract yourself
Pain is always worse when you focus on it so do things to keep your mind off it.
✔️ Use heat
A hot water bottle or a warm pack held on your lower tummy can ease ovulation pain and so can a nice warm bath.
✔️ Try pain relief
Paracetamol is a good first step. If this isn’t giving you any relief after two hours then try ibuprofen, check with your pharmacist to make sure it is safe for you to take.
Can you prevent ovulation pain?
Ovulation pain isn’t dangerous but it can be annoying. If you’re someone who is recurrently or badly affected by it then talk to your doctor about taking a hormonal contraceptive to stop ovulation. This is not suitable if you are wanting to get pregnant.
Many hormonal contraceptives prevent pregnancy precisely because they stop ovulation. The combined oral contraceptive pill, the contraceptive injection and implant are all examples of contraceptives that stop ovulation.
Some forms of the mini-pill (progesterone-only pill) will stop ovulation on some cycles but other types of mini-pill don’t prevent it.
Coils such as the copper coil or Mirena coil work by stopping a fertilised egg implanting into the womb rather than by stopping ovulation so these are unlikely to help. The hormone released by a Mirena coil can suppress ovulation in some women. Speak to your doctor to help you decide which method suits you best