What is ovulation pain?
Pain in your lower belly can make your mind reel with possible causes. Are you getting your period early? Did you eat something that didn't agree with you? Could it be something serious?
Lower belly discomfort in the middle of your menstrual cycle could simply be ovulation pain –the feeling of your ovary releasing an egg. You might not think you'd be able to feel something so small, but the sensation is real. Ovulation cramps usually happen right at the midway point of the menstrual cycle, around day 14 if you have an average 28-day cycle.
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You might hear ovulation pain referred to as mittelschmerz, which is the German word for "middle pain." Mittelschmerz is pretty common, affecting more than 40 percent of women during their reproductive years.
Cramping during ovulation is perfectly natural. It's not a sign that anything is wrong. In fact, if you're trying to get pregnant, ovulation pain could be a helpful tool for pinpointing your window of fertility. Still, if this is a new feeling for you, it makes sense to check it out with your provider.
What does mittelschmerz feel like?
Mittelschmerz pain can feel like a mild cramp or pain in your belly. It may be dull and achy, much like period cramps. Or it can be sharp and sudden. Rarely, the pain is severe.
You'll feel the pain on either the left or right side of your abdomen, depending on which ovary released an egg. The discomfort can alternate sides from month to month, but you'll only feel it on one side at a time. Some women have ovulation pain every month, others feel it only occasionally, and some not at all. Not having ovulation pain doesn't mean you're infertile. Some women just simply don't have the pain, and that's okay.
Ovulation cramping is usually most intense when it first begins. Mittelschmerz symptoms usually subside over a few minutes or hours, but sometimes the pain can stick around for up to two days. Along with ovulation pain, you may have very light spotting or discharge.
You may have nausea, too if the pain is bad. Because these symptoms can also be signs of appendicitis, it's important to call your doctor if the pain is severe or it doesn't go away in a day or two.
What causes ovulation cramping?
No one really knows what causes mittelschmerz pain. Even the experts haven't come to an agreement on its origins. One theory is that the egg stretches the ovary as it grows, causing discomfort. Another possibility is that when the egg finally does burst out of its follicle, fluid or blood comes out along with it. The fluid or blood irritates the lining of your abdomen, causing pain in that area.
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Pain at other times during your cycle isn't mittelschmerz. It's more likely normal period cramps, or something else entirely.
By the way, you won't have ovulation pain if you're taking the Pill or you have a hormonal IUD, because these birth control methods stop you from ovulating.
Will ovulation cramping happen before or after the egg is released?
The timing of mittelschmerz can vary from one woman to the next. When you feel a twinge likely depends on whether you get ovulation cramps when your ovary stretches, or when the egg pops out of its follicle.
Some women have pain before they ovulate. Others experience cramping during ovulation. And still others have pain after ovulation once the egg has already been released from its follicle.
Differences in timing can make it harder to pinpoint the source of the pain. You may want to start tracking when you feel ovulation cramps on a calendar each month, so you can talk about it with your provider.
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Ovulation pain and pregnancy success
Mittelschmerz might not be the most pleasant feeling, but it can actually work to your advantage in certain situations. Some women use ovulation pain to help them get pregnant or avoid a pregnancy.
Pain can be one way to tell that you're ovulating. Your fertility peaks when you ovulate. That happens right at the middle point of your menstrual cycle, which is also when you're most likely to experience ovulation cramps.
Tracking this symptom every month can help you get a better sense of your menstrual cycle and learn which times of the month you're most fertile. Just keep in mind if you're trying to avoid a pregnancy that using ovulation pain alone to guide you isn't enough. Sperm can keep on swimming for up to seven days after you have sex – long after the pain subsides.
What to do about mittelschmerz
You may not need to do anything about ovulation pain if it doesn't bother you. Taking a type of birth control that stops ovulation, like the pill or implant, is one way eliminate mittelschmerz for good. Yet you won't be able to get pregnant while you're on it.
If your ovulation cramping is very uncomfortable, you can try:
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- Taking an over-the-counter pain reliever, such as acetaminophen (Tylenol) or an NSAID like ibuprofen (Advil, Motrin)
- Holding a heating pad on the painful spot
- Soaking in a warm bath
If the pain is severe, ask your doctor about other possible treatment options.
When to call your doctor about ovulation cramping
Call your doctor if your ovulation pain is severe or it lasts for more than three days. Also call if you have:
- A fever higher than 100.4 degrees Fahrenheit
- Pain when you urinate
- Heavy bleeding from the vagina
- Nausea and/or vomiting
- Red or burning skin in the area of the pain
- Diarrhea or constipation
- Early signs of pregnancy or a positive pregnancy test
- Missed periods
- Foul-smelling or otherwise unusual vaginal discharge
Abdominal pain that's severe or doesn't go away could be a sign of these other conditions:
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- Ectopic pregnancy (when the fertilized egg grows outside the uterus)
- An ovarian cyst (a fluid-filled sac or pouch in the ovary)
- Endometriosis (when the tissue that normally lines the uterus grows outside it)
- Appendicitis (inflammation of the appendix, which is a small organ at the top of the large intestine)
- STIs or other infections
- Pelvic inflammatory disease (PID, an infection in the upper genital tract)
- Scar tissue from surgery such as a c-section
You may need a pelvic exam, an abdominal exam, an abdominal or vaginal ultrasound, or other tests to rule out causes other than ovulation pain.