Ovulation pain or Mittelschmerz is the pelvic and lower abdominal pain that some women experience during ovulation. Ovulation generally occurs about midway between menstrual cycles; hence the term mittelschmerz, which comes from the German words for “middle” and “pain.”

Many women never experience painful ovulation. Some women, however, have mid-cycle pain every month and can determine by the pain that they are ovulating.

The pain of ovulation can range from a mild twinge to severe discomfort and usually lasts from minutes to hours. It is generally felt on one side of the abdomen or pelvis and may vary each month, depending on which ovary is releasing the egg during that cycle. In some cases, a small amount of vaginal bleeding or discharge may occur. Some women experience nausea, especially if the pain is severe. I am one of the unlucky ones who experience both pain and very mild spotting during mid cycle / ovulation. On bad months, the pain will be accompanied with mild nausea and lack of appetite.

The pain of ovulation can range from a mild twinge to severe discomfort and usually lasts from minutes to hours. It is generally felt on one side of the abdomen or pelvis and may vary each month, depending on which ovary is releasing the egg during that cycle. In some cases, a small amount of vaginal bleeding or discharge may occur. Some women experience nausea, especially if the pain is severe.

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.

I used to have extremely bad ovulation pain and I thought it was a side effect of the uterine fibroid that I had. But after a laparoscopic myomectomy surgery to remove the fibroid, the ovulation pain did not go away. It was when I consulted my Ob&Gy for some prolonged bleeding issue late last year that the doctor did an ultrasound scan and discovered that one side of my fallopian tube was blocked / had an infection. I was given a very strong dose of antibiotic to clear the blockage / infection.  After the course of antibiotic, the stabbing pain during ovulation subsided. However, I still get discomfort / mild pain and bloating during ovulation and I suspect that it is caused by adhesions from prior surgeries. I have had three C-Sections and was told by my Ob&Gy during the second and third C-Sections that I had developed a lot of adhesions.

The 5 Common Causes Of Ovulation Pain:

#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.

#2: Endometriosis
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, 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 am personally experiencing.

#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.

If you are suffering from severe pain during ovulation, it is advisable to see your doctor to find out the cause of the pain. You may have recently gone for an ultrasound scan and everything seems to look OK. Unfortunately scans don’t pick up everything – especially scar tissue, adhesions, and endometriosis. 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.