By Dr. Allyson Shrikhande
Ovulation pain syndrome, also known as Mittelschmerz, is a very common lower abdominal pain that occurs in the middle of the menstrual cycle (between days 7 and 24) in women. It affects over 40% of women of reproductive age, and it occurs almost every month in these patients. Pain varies in severity from a mild ache to agonizing pain and is generally felt in the lower abdomen near the ovaries on the same side as the developing follicle. Ovulation pain has been found to coincide with the peak in plasma luteinizing hormone (LH) levels, the LH rise increases ovarian perifollicular smooth muscle contractility via a prostaglandin-mediated pathway, potentially producing pain.
Endometriosis is a condition in which tissue, similar to the lining of the uterus, grows outside of the uterus. While the cause of endometriosis is unknown, the impact on patients’ health can be severe. Symptoms range from persistent pelvic pain to infertility – and from one patient to the next the impact can be different.
Endo can cause pelvic pain at any time, but often patients ask: Is ovulation more painful in patients who have endometriosis? Yes, it certainly can be, endometriosis symptoms vary from patient to patient.
Ovulation Pain and Endometriosis
In some cases Ovulation Pain can be a sign of underlying Endometriosis. Endometriosis is a condition in which tissue, similar to the lining of the uterus, grows outside of the uterus. Endometriosis lesions can attach to any location in the pelvis (and sometimes outside the pelvic cavity) and undergo cyclical inflammation followed by formation of scar tissue and adhesions. If the Endometriosis lesions form near your ovaries and fallopian tubes pain may occur in the area of your ovaries and fallopian tubes. Referred pain patterns from Endometriosis in other parts of your pelvis to the lower abdomen is also a possibility for Ovulation Pain.
In addition, patients with endometriosis can have ovarian cysts filled with menstrual blood called endometriomas which are often referred to as “chocolate cysts.”
At Pelvic Rehabilitation Medicine, 70% of our female patients have endometriosis. Many arrive at our clinics with symptoms of endometriosis without a diagnosis or any knowledge of the disease. Our providers are on the “front lines” of educating patients and healthcare providers throughout the country on the disease process.
Book a Consultation for Ovulation Pain Syndrome (Mittelschmerz)
Request an Endometriosis Consultation
Ovulation Pain
Understanding your cycle, and how it may impact you differently during ovulation is one step. Paying attention to your symptoms is another.
Ovulation pain symptoms may include:
- Intense or prolonged abdomino-pelvic pain for more than 48 hours
- Pain that causes nausea, vomiting or diarrhea
- Abnormal bleeding during ovulation
It is important to discuss and address these symptoms with your physician. As Ovulation pain is common we see and treat Ovulation Pain often at PRM. We take a very detailed history and specifically focus on your menstrual cycle bleeding patterns, abdomino-pelvic pain, regularity, and flow among other questions. This information is very important and helps us formulate an individualized treatment plan for you.
