You are weeks away from your period. You’re pretty sure you’m not pregnant. And yet, something in your middle section hurts. It’s sharp, like menstrual cramps, only the pain is different … and only on one side. What. Is. Happen?
If you are about halfway through your cycle and suddenly experience strange cramps, you are probably ovulating.
Ovulation pain happens to about 20 percent of people who ovulate, so if your fertile window feels less than pleasant, you are not alone. In fact, ovulation pain is so common that the Germans came up with a word for it: medium pain. (This translates cleverly to “middle pain,” btw.)
Most of the time, ovulation pain is transient and harmless. (Wow.) But there are a few things you need to know about it – and about pelvic pain in general.
Let’s first look at what happens during ovulation, to understand why it can be painful.
At birth, your ovaries contain every egg you will ever have. Then, every month during your menstrual years, your body shifts hormones to increase your levels of follicle-stimulating hormone (FSH) and luteinizing hormone (LH), as your ovaries prepare to release an adult egg around the middle of your cycle.
That timeline looks like this:
Days 6 to 14: FSH begins to rise, causing a follicle in one of your ovaries to begin to mature.
Days 10 to 14: That follicle grows into a fully mature egg.
Around day 14: LH rises, causing the release of the egg in your fallopian tube to your uterus.
As a follicle matures, it stretches and grows, causing pain and discomfort – and even spots or light bleeding. When the egg is released and the follicle that held it bursts, you can sometimes feel it.
So why is ovulation sometimes a real pain in the ovary? There is not a single answer. The growth of the follicle can cause the pain, but your ovum must also come out through the ovary wall (there is no secret door or easy way out) to begin its journey through the fallopian tube to your uterus. Any one can be what you feel.
How do you know it’s ovulation pain? Symptoms include:
- it’s been a few weeks since your period
- just felt on one side
- lasts for a few minutes to a few hours, or up to 24 or 48 hours
- sharp, like a cramp (but different – IYKYK …)
- happens about halfway through your menstrual cycle
- striking but rarely serious
- can change sides every month
- light spots (sometimes)
- mild nausea (sometimes)
- accompanied by other signs of ovulation, such as “egg white” cervical fluid, change in the position of your cervix or a slightly lower (then higher) basal body temperature
Apart from run-of-the-mill medium pain, middle cycle pelvic pain and bleeding can have other, more serious causes. They include:
Ovarian cysts are fluid-filled sacs that develop on or in an ovary. Usually these small, common cysts form during ovulation, and then go away after an ovum is released. You may even have one and never know it existed!
Sometimes cysts continue to grow, which can cause bloating, pressure, swelling and pain on one side of your pelvis. When they tear, cysts can cause sudden, severe pain. Most cysts are not cancerous, but your doctor can diagnose them.
Cysts also cause symptoms such as:
- pain while pooping
- fullness and / or pressure in your abdomen and / or bladder
- nausea and / or vomiting
- sore or tender breasts
Polycystic ovary syndrome, which affects 1 in 10 people with ovaries, also causes cysts to develop. Your doctor may use imaging such as ultrasound or a CT scan to diagnose PCOS and its related cysts.
With endometriosis, tissue similar to your uterine lining grows elsewhere in your pelvis and beyond, which can lead to pain that looks like ovulation pain. However, endopine pain is usually worse than ovulation pain, and it can happen during your period or at any time during your cycle.
Endo symptoms include:
- painful periods
- painful bowel movements
- heavy bleeding during your period and at other times in your cycle
- diarrhea or constipation
Endo can lead to scar tissue and adhesions, and that tissue can become more irritated and painful as your hormones fluctuate throughout your cycle.
Surgery is the only way to confirm that you have endometriosis, but your doctor can help you manage suspected endopine pain based on a pelvic exam, imaging tests, your symptoms and medical history.
Pelvic inflammatory disease
Pelvic inflammatory disease is an infection that can be sexually transmitted, but it can also occur naturally. PID, a leading cause of infertility, affects the ovaries, fallopian tubes and uterus and is most common in women between the ages of 15 and 25.
Sometimes it appears without symptoms, but when PID does flare up, it can be confused with ectopic pregnancy or ovarian cysts – or ovulation pain.
PID symptoms include:
- pain and inflammation in your pelvis
- nausea and / or vomiting
- irregular bleeding (outside your period)
- changes in your vaginal discharge
- fever and / or chills
- pain during urination and / or intercourse
An ectopic pregnancy is a serious condition that occurs when a fertilized egg implants itself somewhere other than the uterus, such as in a fallopian tube (this is why it is also called a tubal pregnancy), your cervix or an ovary.
The pregnancy is not viable, but if the egg continues to grow, it can rupture the fallopian tube, which can cause heavy internal bleeding.
Bleeding and pelvic pain (often on the one hand, similar to ovulation pain) are common early symptoms of an ectopic pregnancy, so seek medical help immediately if you experience these or more intense symptoms:
- severe pain in your abdomen or pelvis, especially on one side
- abnormal bleeding
- dizziness or fainting
- press into your rectum
Pelvic pain can also be a symptom of sexually transmitted diseases or bacterial infections. If your pain is accompanied by vaginal discharge or fever, consider getting tested. (Even if you are in a committed relationship, regular STD tests can provide peace of mind.)
Uterine fibroids are benign growths that develop in or on the walls of the uterus. They can cause both severe pain and abnormal (usually heavy) bleeding, although the pain is usually closer to the uterus than the ovaries.
Pain in your abdomen or pelvis can sometimes be difficult to diagnose. Irritable bowel syndrome can also cause bloating and pain, although it is usually associated with digestive problems such as diarrhea or constipation.
Interstitial cystitis is a chronic condition characterized by bladder pain, which can be confused with pelvic pain (since your reproductive organs and bladder are close neighbors).
IC may also feel you need to pee everyone the time, and you may even sometimes struggle to hold on to it. Your bladder pain may get worse at certain times during your cycle.
You can treat your ovulation pain the same way you treat menstrual pain and cramps.
- Take over-the-counter (OTC) painkillers, such as naproxen (Aleve) or ibuprofen (Advil or Motrin).
- Use a heating pad or take a hot bath.
- Talk to your doctor about hormonal birth control options that can prevent ovulation (thus eliminating the associated pain).
On its own, ovulation pain is not a sign that something serious is going on in your body. And, no matter how annoying it is, ovulation pain does help you fix your fertile window.
Accept the glass-half-full POV and think of your ovulation pain as a way to stay connected to your fertility and menstrual cycle.
However, you should contact your healthcare provider if your ovulation pain:
- changes over time
- lasts more than 1 to 2 days
- comes with bleeding (more than spotting)
- interrupt your daily activities
You should also talk to your healthcare provider if you suspect anything more serious, in addition to ovulation pain.