Introduction: Ovulation pain is a common occurrence during the menstrual cycle, during the actual ovulation process. The pain associated with it happens to 1 in 5 women, as studied by Medline Plus. Rachel Gurevich reports that 50% of all women will have ovulation pain at least once in their lives, and 20% of women will have it monthly while menstruating. The following article will discuss the facts surrounding ovulation pain and how you can get ahead of it.

1. What is Ovulation? Ovulation is the event in which the body signals for the release of an egg for fertilization. It begins between the first and second stage of the menstrual cycle. At the end of the follicular phase, after FSH (follicle-stimulating hormone) stimulates and once the follicle matures, there is a rise in estrogen, consequently triggering the release of LH (luteinizing hormone). Exposure to these two hormones triggers the start of ovulation, in which the ovary then releases an ovum, or mature egg, that travels via the Fallopian tubes where it will be available for fertilization.

• Symptoms. Typically, the pain is noted to be unilateral or one-sided; however, it can be bilateral, as noted by Symcat. Their research shows 74% of women note bilateral lower abdominal pain versus 32% who note one-sided pain. The pain is generally in the pelvic/lower abdominal region in relation to the reproductive organs, causing this issue. It can feel sharp (84% of women report this symptom), dull, and/or cramp-like. It is more commonly stated to range from mild to moderate levels of pain. However, this can be dependent upon the individual’s perception of pain and how they process it. Nausea and/or vomiting can also occur with worse pain. Mild vaginal bleeding or discharge may occur as well. The pain can last as quickly as a few minutes, or it can be as long as approximately 48 hours.

• Other names for Ovulation pain. Less common terms like “intermenstrual pain” and “cyclic pelvic pain” are other terms that describe this timely pain. However, “mittelschmerz” was the most common, almost more than ovulation pain itself. This is the German phrase meaning “middle pain” or “mid pain”. The actual definition of it is “abdominal pain occurring between the menstrual periods and usually considered to be associated with ovulation” per the Merriam-Webster Dictionary. It dates back to the late 19^th century, as noted by the Oxford Dictionary. There is no noted origin or history of how this word came to fruition.

• What causes it? Ovulation begins sometime in the middle of the menstrual cycle. The menstrual cycle is approximately 20 to 40 days long, with an average time noted to be 28 days. So, on average, it occurs approximately 14 days into the menstrual cycle when it does occur. It is not definitively explained what the cause is, however, there are prospective thoughts on what the cause or causes could be. When the egg is released and travels up the Fallopian tubes, it possibly could be stretching this tissue, thus causing pain. Mayo Clinic also gives reasons first stating that when the follicle is in the maturation phase, it can stretch the outside tissue of the ovaries, thereby causing pain. Another potential option being upon release, the egg tears tissue, which drains fluid or blood. This can irritate the lining of the abdomen, as shown in other illnesses such as Endometriosis. G. Willy Davila, MD, also notes that pain is due to leakage of prostaglandin-containing follicular fluid at the time of ovulation.

• Who can get it? The first and most obvious answer to this is women. When digging deeper, age and ethnicity can also play a role per Symcat research tools. Girls aged 14 years and younger, only those who have had their first menstrual cycle, are two times more likely to have ovulation pain. It increases with girls and women, ages ranging from 15 years old to 29 years old, to 2.7 times more likely to have pain with ovulation. It then drops down to 1.4 times more likely or, as described by Symcat, “an average chance” for women aged 30 to 44 to have painful ovulation. Risk of ethnicity has African American women at the forefront, with 1.4 times more likely to have it. Hispanic women are 1.2 times more likely to have pain with ovulation, and Caucasian women, as well as all other ethnicities, are 0.9 times more likely to have pain with ovulation.

• How is it diagnosed? Due to the commonality of this issue, it routinely goes undiagnosed. Women tend to have pain so mild it does not concern them to be seen by a physician. If the pain is severe enough to see a doctor, the first study would most likely be an ultrasound of the abdomen to evaluate for any visible abnormalities. A pelvic exam may also be done to check for abnormalities. Lab work, including blood work (CBC, BMP), urinalysis, and cultures, may be ordered to assess for infection, kidney function, blood loss, etc. When all other alternatives are ruled out, as well as having the common symptoms, a diagnosis of ovulation pain may be given.

• What you can do. There are a few different ways to treat your pain or symptoms as needed. Applying ice or heat (depending on the individual’s preference and sensitivity tolerance) every 20 minutes is one way to treat any inflammatory pain. A warm bath can help soothe and rest the area, preventing further irritation. Anti-inflammatories, like over-the-counter NSAIDs or acetaminophen (Tylenol), are usually appropriate to take to help minimize the pain. It should not require prescription pain medication. When taking any medications, you should always consult a physician to ensure it is appropriate for you with regard to your health history. Nutritionist Emily Kennedy from NW writes about some natural remedies for ovulation pain, including a recipe for a mellowing tea, yoga, and essential oils.

• When to see a physician. You should see a doctor if you have pain that is severe and uncontrolled with over-the-counter pharmacological or non-pharmacological treatments. Pain that lasts longer than 3 days, such as ovulation pain, does not last longer than approximately 48 hours. Heavy bleeding or discharge is a concerning symptom that does not correlate with ovulation and should be evaluated by a physician sooner rather than later. If you notice any symptoms accompanying the pain, like fever, nausea, vomiting, etc., that are unusual, this could be indicative of something more serious, such as an infection. It is always better to be seen if you have any concerns rather than ignore your body. These symptoms could be something more serious or treatable than ovulation pain, including cysts, scar tissue, infection, appendicitis, etc.