Ovulation Pain

Is Ovulation Pain Normal?

About 40% of women experience pain during their ovulation, also known as Mittelschmerz. Knowing when to expect it, how it may change during your lifetime, and when pelvic pain could be a sign of something more serious helps you make better decisions about your care. 

Is Ovulation Pain Normal or a Cause for Concern?

A typical female ovulates on approximately day 12 to 14 of the 28-day cycle. Some women can feel this and know exactly when it occurs, and others do not feel it at all.

Does Ovulation Pain Change With Age?

The symptoms of ovulation pain can vary distinctly among individuals. It’s always very difficult to objectify pain in individuals, as one person’s pain level of two can be a 10 in another person. 

In general, ovulatory pain seems to be more significant or noticeable in teens and in women in their early 20s. While many women still can tell when they ovulate, it is typically not as painful of an experience as women age.

Complications Linked to Ovulation Pain

Ovulatory pain is usually temporary and mild, common, and usually harmless. 

If the ovulation pain lasts more than a couple of days or gets more severe, it gives us a higher index of suspicion for something called an ovarian torsion. That’s where there’s a mass on the ovary and it twists upon itself and causes excruciating pain and endangers the viability of that ovary. That level of pain can mean there is a surgical emergency for which someone should go to the emergency room immediately.

Conditions Often Mistaken for Ovulation Pain

Ovarian pain frequently can be mistaken for other conditions such as endometriosis, pelvic inflammatory disease, ruptured ovarian cyst, ovarian torsion, appendicitis, or even ectopic pregnancy. It’s always important, if a symptom lasts more than a day or two, to at least look for other causes with a healthcare provider, as well as to obtain a urine pregnancy test.

Endometriosis is usually very painful in the days leading up right up to the period and through the period. This is typically something that can be followed up on in a clinical setting (a healthcare provider’s office) and is not an emergency. Treatment would include an anti-inflammatory oral medication such as Motrin. There are several other prescription treatments that could be offered by your gynecologist, as well. Many times, pain from endometriosis that is not adequately treated with medications will require surgical exploration and treatment.

Appendicitis characteristically is a pain in the lower right quadrant that increases in intensity. It’s also associated with nausea, fever, relentless pain and a loss of appetite. This can be a life-threatening emergency and requires immediate medical/surgical attention.

An ovarian cyst can be managed in an outpatient setting with your gynecologist by following the size and characteristics of this cyst by ultrasound. Usually if these are simple, their rupture will result in alleviation of the pain and symptoms and not require any further treatment. Sometimes, they can grow quite large and will require surgical intervention. There’s something called a hemorrhagic corpus luteal cyst, which involves bleeding at the site of ovulation which is usually self-limited. However, in rare circumstances the bleeding can continue, causing increasing pelvic pain and sometimes shoulder pain. If left unchecked, the patient could develop weakness and dizziness from loss of blood, which would be an emergency requiring immediate gynecologic surgical expertise.

An ectopic pregnancy is a pregnancy that is not in the uterus and is usually in the fallopian tube.  This can cause an inordinate amount of pain but is also always associated with a positive pregnancy test. Any pain or bleeding in early pregnancy should be evaluated in a timely fashion. If the symptoms are severe, a visit to the emergency room is always warranted.

Pelvic inflammatory disease is a condition where there’s an infection in the uterus and tubes. This typically presents as a foul vaginal discharge along with pelvic pain, fever and an elevated white blood cell count. Many cases can be initially treated with antibiotics, usually as an inpatient setting. Sometimes surgery is necessary. Any fever, combined with abdominal pain and foul vaginal discharge should necessitate a visit to a gynecologist within a day or so or to an emergency room if an outpatient gynecology visit is not available.

When to See a Doctor for Ovulation Pain

There are various other conditions that can cause pelvic pain in females, such as acute viral illness and other gastrointestinal issues. The key takeaway is that Mittelschmerz should be mild and only last a day or two and go away.  Any pain that is more severe or sustained should be evaluated.

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