Author: Dr. Kimberlee Leishear, Pelvic Pain Specialist in Troy, Michigan
What is ovulation pain?
Ovulation pain is pelvic pain that occurs prior, during, or after ovulation when an egg is released from an ovary, and it may affect over 40% of women of reproductive age. The pain is usually located on one side of the lower abdomen related to the ovary that is releasing the egg.
The pain can feel:
- dull
- achy
- sharp
- like menstrual cramps
This pain can last a few minutes up to a few days. The pain can occur around ovulation every month or occur occasionally. Ovulation pain can be mild to extremely severe which can impact a patient’s function and quality of life.
Ovulation pain can be distinguished from other types of pain due to having pain in the middle of your menstrual cycle around ovulation which is about two weeks prior to your period. Ovulation pain is often called “mittelschmerz” which is German for “middle pain”. Also, the pain is usually one sided in the lower abdomen that can also indicate that the pain is from ovulation.
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How does ovulation pain occur?
Ovulation pain occurs during the ovulation phase of the menstrual cycle because that is when the egg is being released from the ovary. There are many different aspects of ovulation that can contribute to pain. Prior to ovulation, there is a peak in luteinizing hormone (LH) levels when the follicle is growing but has not yet ruptured. Increased levels of LH can cause ovarian smooth muscles to contract which may cause pain. The stretching of the follicle prior to being released may contribute to the pain.
Also, the “eruption” of the egg from the ovary can cause fluid and blood to be released which can irritate nearby nerves that can also contribute to the pain.
What underlying conditions can cause ovulation pain?
If you have severe pain with ovulation, there may be underlying factors contributing the pain. It is important to have an evaluation from your health care provider including a pelvic exam especially if the pain is interfering with your daily functioning as it may be an indication of other conditions such as endometriosis.
There may also be underlying muscle and nerve dysfunction that is contributing to the pelvic pain. There may be muscle tightness in the pelvic area including the pelvic floor as well as in the abdominals, low back, and hips contributing to pelvic pain. This muscle tightness can irritate nerves in the pelvis that can make the nerves act abnormally and cause pain when there shouldn’t be any pain or cause a lot of pain when there should only be a little bit of pain. Essentially, the “volume gets turned up” and makes the nerves more sensitive than they should be.
Our treatment approach at Pelvic Rehabilitation Medicine focuses on relaxing the tight muscles and making space for the inflamed and irritated nerves of the pelvic floor to calm down. This approach, the PRM Protocol™, is a crucial part of treating the muscle and nerve dysfunction and pain.
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How can ovulation pain be managed?
Some ways that ovulation pain can be managed include using a heating pad or taking warm baths. Medications can be helpful including acetaminophen or nonsteroidal anti-inflammatory drugs such as ibuprofen or naproxen. Hormonal birth control pills can help with ovulation pain by preventing ovulation.
Can ovulation pain be treated without medication?
The other major and very important part of a holistic, multimodal approach is lifestyle changes. Anything you can do to calm down the nervous system is helpful including mindfulness meditation, cognitive behavioral therapy, and diaphragmatic breathing.
The goal is to get our bodies out of the sympathetic “fight or flight” mode into the parasympathetic “rest and digest” mode. Other lifestyle modifications including exercise and getting enough sleep are also important. Reducing the amount of inflammation in the body is important through an anti-inflammatory diet or plant-based diet. Supplements including magnesium can also be helpful.
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