Ovulation Pain (Mittelschmerz)
What is ovulation pain?
Ovulation pain is pelvic pain that some women have during ovulation. Ovulation is the part of the menstrual cycle when an ovary releases an egg. Ovulation usually happens about halfway between your periods.
Ovulation pain is also called “mittelschmerz.” The term comes from the German words for “middle” and “pain.”
Where does ovulation pain occur?
You typically feel the pain in your lower abdomen and pelvis, in the middle or on one side. You may feel it on the side where the ovary is releasing an egg. (For most people, the ovaries take turns ovulating. Each ovary releases an egg every other month.)
So if the ovary on the right side is releasing the egg, that’s where you’ll feel the pain. Some people find that the pain switches sides from one cycle to the next.
Who gets ovulation pain?
Many women never have pain at ovulation. Others have midcycle pain every month. They can often tell by the pain that they are ovulating.
Is ovulation pain the same as period pain?
Ovulation pain may feel similar to period pain — like a cramp. But ovulation pain happens about two weeks before you get your period.
How common is ovulation pain?
Mittelschmerz may affect more than 40% of women who ovulate during their reproductive years — and it can affect them almost every month.
SYMPTOMS AND CAUSES
What causes ovulation pain?
The egg develops in the ovary. As it grows, follicular fluid surrounds it. During ovulation, the ovary releases the egg and fluid, along with some blood. Mittelschmerz may happen because of the egg enlarging in the ovary just before ovulation.
The pain may also be due to a ruptured follicle. The egg bursts from the follicle when it’s ready. The burst may cause some bleeding. The blood and fluid from the ruptured follicle may irritate the lining of the abdomen (peritoneum), causing pain.
This is a normal part of the menstrual cycle.
What are the symptoms of ovulation pain?
The pain may feel like a mild twinge, or you might have severe discomfort. It often hurts on just one side. The pain can last from a few minutes to a few hours. You may also experience:
- Light vaginal bleeding.
- Vaginal discharge.
- Nausea, if the pain is bad.
DIAGNOSIS AND TESTS
How is ovulation pain diagnosed?
Your healthcare provider might diagnose mittelschmerz based on the timing of the pain. Ovulation usually happens about two weeks into your menstrual cycle. So if the pain happens about midway between periods, it may be ovulation pain.
Your provider may ask you to keep a record of your menstrual cycles. Note whenever you have pain and where you feel the pain.
What tests will I need?
Your healthcare provider may perform an abdominal and pelvic examination. These tests can help rule out other causes of pain, such as endometriosis or an ovarian cyst. You may also need an abdominal or vaginal ultrasound.
If your healthcare provider notices something suspicious during the exam or your pain is severe, you may need more tests to find the cause. Your healthcare provider will discuss the next steps with you.
MANAGEMENT AND TREATMENT
How is ovulation pain treated?
Most people don’t need treatment for mittelschmerz. The pain typically goes away within a day. You can take medication available over the counter such as nonsteroidal anti-inflammatory medications, (ibuprofen, naproxen or Aleve) to help with the pain.
A heating pad or hot bath may also help provide pain relief.
For severe ovulation pain, talk to your healthcare provider about taking birth control pills. Hormonal birth control medications prevent ovulation. Without ovulating, you won’t have ovulation pain.
If you take birth control pills, you won’t be able to get pregnant. Talk to your healthcare provider if you wish to start or add to your family.
Can I prevent ovulation pain?
You can prevent ovulation pain by preventing ovulation. Many hormonal contraceptives, including the pill, prevent ovulation.
OUTLOOK / PROGNOSIS
What is the outlook for women with ovulation pain?
Ovulation pain is normal. It’s one of the side effects of your period. It’s not dangerous or a sign of a serious health condition. Ovulation pain doesn’t affect fertility, and it can help you be more aware of when you ovulate.
It’s always a good idea to talk to your healthcare provider about any pain you’re having. A healthcare provider can rule out a more serious condition that has similar symptoms.
Should I worry about ovulation pain?
Ovulation pain itself is nothing to worry about. But talk to your healthcare provider if you have severe pain. It could be a sign of a different, more serious condition, including:
- Endometriosis, an inflammatory condition affecting the ovaries and fallopian tubes.
- Scar tissue from a cesarean section (C-section) or other abdominal surgery that caused abdominal adhesions.
- Sexually transmitted disease (STD), such as chlamydia, which can cause inflammation that leads to painful ovulation.
- Ovarian cyst, a pouch of fluid that develops on an ovary.
- Ectopic pregnancy, when a pregnancy develops outside of the womb, often on one of the fallopian tubes.
- Appendicitis, when the appendix is inflamed.
- Other abdominal problems, such as inflammatory bowel disease.
Can I use ovulation pain to plan a pregnancy?
Some people use ovulation pain to plan or avoid a pregnancy. Your chances of getting pregnant are higher if you have sex during the ovulation period. So, paying attention to any ovulation pain can help you know when you’re ovulating if you’re trying to get pregnant.
However, don’t rely on mittelschmerz as a way to avoid pregnancy. Use other, more reliable birth control methods.
How do I take care of myself?
If you have ovulation pain, try at-home treatments such as a warm bath and over-the-counter pain relief. For severe ovulation pain, talk to your healthcare provider about other treatment options.
When should I contact my healthcare provider?
Call your healthcare provider if you missed your last menstrual period or have these symptoms during ovulation:
- Fever greater than 100.4 degrees Fahrenheit.
- Pain while urinating.
- Red or burning skin where the pain is located.
- Severe nausea or vomiting.
- Severe pain in the middle of your menstrual cycle that lasts longer than a day or occurs during most months.
- Over-the-counter pain medication is not providing relief from the pain.
- Missed period.
- Heavy vaginal bleeding between periods.
What else should I ask my healthcare provider?
If you have midcycle pain, ask your healthcare provider:
- What’s causing the pain?
- What can I do to relieve the pain?
- Is there a way to prevent ovulation pain?
- Will birth control pills help control the pain?
A note from Cleveland Clinic
Ovulation pain, also called mittelschmerz, happens when people experience ovulation cramps or other pain when they ovulate. Ovulation pain is not harmful. Most of the time, you can treat it with OTC medications, rest and warm baths. But talk to your healthcare provider if you have severe ovulation pain. Your healthcare provider may recommend birth control pills to prevent ovulation.