Ovulation Pain (Mittelschmerz): Causes, Symptoms and Treatment

 Table of Content

• What is Ovulation?

• What is ovulation pain?

• Where does ovulation pain occur?

• 8 common characteristics of Ovulation pain symptoms

• What causes ovulation cramps or ovulation pain?

• How do you differentiate between period pain and ovulation pain?

• What is implantation bleeding?

• How to differentiate between ovulation cramps vs implantation cramps

• How to track your Symptoms of ovulation pain?

• Do I need any diagnostic tests for ovulation cramps?

• How is ovulation pain treated?

• What should I do if I experience ovulation pain symptoms?

• When should I consult a doctor?

• 6 Ovulation pain and underlying medical problems

• Take-home message

• FAQ on Ovulation Pain (Mittelschmerz )

Introduction

Have you ever asked yourself this question? Why am I cramping a week or two before my period? If yes, you’re at the right place to get your answers! The pain you experience is called ovulation pain. Ovulation pain is a dull ache or cramp in the lower abdomen around ovulation time, seen in fa ew females. It’s usually mild and can be treated by rest or over-the-counter drugs. If severe, it may point to an underlying disease. For knowing more about the symptoms and management of ovulation pain, read the blog below. 

What is Ovulation?

A lucid understanding of what ovulation is and what happens around the time of ovulation will help us understand the Symptoms of ovulation pain better.

• Ovulation is the process by which a mature ovum or egg is released from a female’s ovary. After its release, the mature egg is picked up by the Fallopian tube. Now the egg travels into the Fallopian tube and can stay there for a maximum duration of 12-24 hours, waiting to be fertilised by a sperm from the male partner when the female has sexual intercourse. When fertilisation occurs, that’s when the female gets pregnant.

• As we already saw, ovulation is the release of a mature egg from the ovary. But, before its release, the mature egg develops from a follicle cystic stage. So, to release the mature egg, this follicle has to rupture when the luteinizing hormone levels (LH) reach their peak during the mid-cycle.

• Blood and other fluid from the ruptured cyst are released into the abdominal cavity of the female. This is a very minimal amount of less than 5ml (gathered by Ultrasound studies) which is absorbed gradually and then vanishes.

What is ovulation pain? 

A small minority of females experience cramp-like pain during ovulation. These are called ‘Ovulation cramps‘ or Mittelschmerz (A German word meaning ‘pain in the middle). Ovulation usually occurs during the middle of a menstrual cycle, for example, around the 14th day in a 28-day cycle. Abdominal cramps during menstruation are quite common among females. But there is a difference between menstrual cramps and the lower abdominal pain that happens after ovulation. If you are having cramps other than the time when you have periods, then it could probably be because you are ovulating. Only a small fraction of females experience stomach pain after ovulation or lower abdominal pain or cramping after ovulation.

Where does ovulation pain occur?

The ovaries are present on both sides of your abdomen, so depending on the ovary which released the egg, your sides of your abdomen hurts. This pain can happen for a few minutes or even can continue for one to two days. Some women may notice vaginal bleeding when it happens. 

8 common characteristics of Ovulation pain symptoms

Painful ovulation can be described as follows:

1. Commonly occurs about 2 weeks before a period.

2. Maximum intensity is seen 24-32 hours before ovulation.

3. Usually, a dull ache, though rarely can be a sharp pain.

4. Felt on the lower abdomen, usually on the sides.

5. Can be associated with vaginal spotting or vaginal discharge.

6. Can be associated with breast tenderness.

7. If the pain is severe, the patient can even experience nausea.

8. Most women say that Symptoms of ovulation pain last for about 6-12 hours and not more than that. If the pain prolongs for more than a day or two, it’s important to receive medical attention.

What causes ovulation cramps or ovulation pain?

• Several reasons cause ovulation pain symptoms.

• The fluid and blood released into the abdominal cavity following the rupture of the follicle can irritate the peritoneum (the lining of the abdominal cavity). This is a common reason for abdominal cramping or stomach pain after ovulation.

• Before the release of the mature egg, the growing ovum in the follicle stage can stretch the ovary’s coverings. This stretching kick starts an inflammatory process, thereby causing the release of a substance called Prostaglandins. These substances cause contraction of the ovarian muscles surrounding the growing follicles, causing ovulation pain symptoms. This is a major reason behind the pain during ovulation or even before it.

How do you differentiate between period pain and ovulation pain?

• The number one factor will be the time of the cycle the cramps occur. Ovulation pain symptoms usually occur in the middle of the cycle, 2 weeks before a period. Also, stomach pain after ovulation is only rarely accompanied by vaginal spotting whereas, in menstruation, the bleeding is more significant.

• However, the cramping nature of the pain during ovulation and menstrual pain is similar.

What is implantation bleeding?

• We already saw that a female is said to be pregnant after fertilisation of the egg by the sperm has taken place. This fertilised egg is now called a zygote. This zygote undergoes multiple divisions and changes as it travels through the Fallopian tube to finally reach the uterine cavity. Now, in the uterine cavity, the zygote (now called the blastocyst stage) has to be embedded in the endometrium (the lining of the uterine cavity) for further growth into a baby. This embedding is called implantation.

• Plenty of hormones will be released following implantation that could sometimes cause several effects in the pregnant female like vaginal spotting, cramps,  headache, nausea etc.

How to differentiate between ovulation cramps vs implantation cramps

Both ovulation and implantation cramps have similar symptoms like abdominal pain and spotting. But in the case of ovulation pain, the pain is more on one side of the abdomen. 

How to track your Symptoms of ovulation pain?

The abdominal cramping pain during ovulation, if experienced, is considered to be an indicator of imminent ovulation. So, by tracking ovulation pain symptoms, it’s possible to predict upcoming ovulation. This knowledge will help the woman in planning or avoiding pregnancy, meaning women are most fertile during the ovulation window and any unprotected sexual intercourse during this period can help them get pregnant.

However do not rely on using painful ovulation as a detector of ovulation as a sole method of family planning, especially if you have irregular periods. This technique, like other natural family planning methods, is not reliable and has a high failure rate.

So, let’s talk about how to track your ovulation pain symptoms for better planning.

1. Track the timing according to your cycle

• Many people experience painful ovulation symptoms for the first time when they start menstruating. For some others, they start later in life. However, it is noted commonly among people below 30 years of age.

• If you have regular cycles, ovulation pain symptoms are noted around the middle of the cycle every time. However, if you have irregular menstrual cycles, it’s better to utilize it to assist you.

2. Track the side on which you feel pain

• Most women, if they experience ovulation pain, usually feel it on the sides of their abdomen, either on the right or the left. This is because both ovaries undergo ovulation alternatively during each cycle. So the pain is experienced on the side of the ovary that is ovulating in that cycle. This pain may keep switching from side to side every cycle.

• However, it's expected to experience ovulation pain symptoms on both sides of the abdomen.

3. Track for how long the pain lasts and its severity

As already discussed, the pain commonly lasts between 6-12 hours and is mild pain. If it persists beyond a day and it’s quite severe, it’s important to seek medical consultation at the earliest to rule out any underlying issues.

Do I need any diagnostic tests for ovulation cramps?

Rarely this need for diagnostic tests may occur, especially if the cramps are severe and are interfering with your day-to-day lifestyle. Such interventions are done to rule out any underlying issues with your reproductive system. This may include a detailed abdominal and pelvic examination by your gynaecologist, or even an ultrasound scan. Based on the findings of these tests, your gynaecologist may suggest further diagnostic tests if necessary.

How is ovulation pain treated?

For treating ovulation pain, you need to give warm compresses and gentle massages to the painful area of the abdomen. 

What should I do if I experience ovulation pain symptoms?

Usually, you’ll find relief through home remedies like taking a hot shower or using warm compresses or a hot water bottle. Or if necessary, you can take over-the-counter painkillers.

When should I consult a doctor?

When the stomach pain after ovulation is severe and won’t respond to the over-the-counter drugs, you should consult an obstetrician-gynaecologist.

• Any fever, nausea or vomiting.

• Heavy vaginal bleeding or discharge.

• Pain or irritation during urination.

• Associated with irregular cycles or missed periods.

6 Ovulation pain and underlying medical problems

Ovulation pain is a completely normal phenomenon that females experience and it’s nothing to worry about. But if the pain is severe, it needs immediate attention because it could point to several conditions like:

1. Endometriosis is a condition where the normal lining of the uterus starts growing outside the uterine cavity. This can cause complications like severe pain, menstrual abnormalities, infertility etc.

2. Ectopic pregnancy is a pregnancy that has developed outside the uterus, in the tubes. This could prove life-threatening if missed if it ruptures.

3. Adhesions are formed between abdominal structures due to previous surgeries. These adhesions are dangerous if formed with the bowels because they could cause obstruction or rupture.

4. Sexually transmitted diseases like Gonorrhoea and Chlamydia can be associated with severe ovulation pain.

5. Appendicitis pain, especially if severe pain is experienced on the right side.

6. Any cystic conditions of the ovaries etc.

Take-home message

• Ovulation pain is a normal phenomenon, though experienced only by a small fraction of females.

• It is usually mild and can be relieved by at-home remedies.

• If severe, please seek immediate medical assistance.

• Tracking can help you predict your ovulating days, though it’s not a reliable tool for planning or avoiding pregnancy.