Ovulation Pain (Mittelschmerz) Causes, Other Symptoms, Remedies

Ovulation is a normal part of the menstrual cycle but can sometimes be accompanied by unpleasant symptoms similar to the way some women experience period pain and nausea during menstruation. Ovulation pain is one such example and should be investigated when it is recurrent and severe as it may indicate an underlying problem with the ovaries, fallopian tubes or uterus.

What is Ovulation Pain?

Ovulation pain is also known as mittelschmerz. It is the pain that occurs at the time that the ovary releases an egg cell (ovum) and occurs around 12 to 16 days before the start of menstruation. For women with a regular 28 day cycle, ovulation usually occurs 14 days prior to menstruation.  The word ‘mittelschmerz’ simply means “middle” and “pain” in German since the pain occurs mid-cycle.

It is important to note that ovulation is a normal physiologic process and should be painless. Only some women experience ovulation pain, which should not be confused with menstrual (period) pain. Mittelschmerz (ovulation pain) is not necessarily abnormal. While it can be uncomfortable, most cases are not due to any significant underlying problems. However, this pain may at times be indicate of gynecological problems.

How Ovulation Occurs?

It is important to understand how ovulation occurs to further understand why ovulation pain arises. The entire process of ovulation and menstruation, the two events that mark the menstrual cycle, are controlled by four hormones – luteinizing hormone (LH) and follicle-stimulating homorne (FSH) from the pituitary gland and estrogen and progrestrone from the ovaries.

  • Estrogen levels drop when menstruation starts.
  • Follicle-stimulating hormone (FSH) is then secreted by the pituitary gland.
  • Estrogen levels rise as an ovarian follicle matures in response to FSH.
  • Luteinizing hormone (LH) is secreted by the pituitary gland.
  • An egg cells is then released from a follicle.
  • The ruptured follicle then produces progesterone.

Read more on ovulation.

Not every woman is aware as to when they are ovulating. Women with irregular menstrual cycles may experience variations in the time when ovulation occurs, if it occurs at all during the cycle. Therefore diagnostic tests may need to be conducted in order to verify when ovulation is occurring. A surge in luteinizing hormone (LH) is usually indicative of impending ovulation which occurs about after the LH surge. Therefore pain during this time may be due to ovulation.

Why does ovulation pain occur?

The exact reason why ovulation pain occurs in some women is unclear. It is believed that the the rupture of the follicle releases a small amount of fluid of blood. It is this fluid and blood that may then irritate the lining of the abdominal cavity (peritoneum) and lead to pain. Another theory suggests that the enlargening of the follicle prior to rupture may stretches the suface of the ovary and results in pain.

However, in some instances there may be triggering or worsening of ovulation pain due to gynecological conditions. For example, in inflammatory conditions the pre-existing pain can worsen due to the events that occur with ovulation such as rupture of the follicle and passage of the egg cell down the fallopian tube. Therefore it is important to differentiate between ovulation pain on its own and ovulation pain or gynecological pain due to underlying diseases.

Signs and Symptoms of Mittelschmerz

Ovulation pain is a symptom. This ovulation pain varies from a mild ache to a cramping pain. It is uncommon for ovulation pain to be severe. Ovulation pain is typically one-sided and the pain may occur on alternating sides with every successive menstrual cycle. In most cases the pain resolves rapidly without any further complication. Ovulation pain may at most last for a day or two.

Unlike menstrual pain in some women who suffer with dysmenorrhea (painful periods), ovulation pain is usually not accompanied by other symptoms like a headache, nausea and irritability. However, there may be a vaginal discharge or vaginal bleeding along with the ovulation pain in some instances. It is important to note that a vaginal discharge during ovulation is not unusual even for women who do not experience ovulation pain or gynecological problems.

Other Causes of Ovulation Pain

Some gynecological conditions can cause ovulation pain and particularly exacerbate existing ovulation pain. At other times gynecological pain may be mistaken for ovulation pain. Therefore it is important to look at several conditions that may either cause, exacerbate or be mistaken for ovulation pain.

Read more on mid-cycle pain.

Always consult with a medical professional if ovulation pain is severe and occurring frequently. The pain may be due to other possible causes. Complications can arise by delaying the diagnosis and proper treatment of these conditions.

Polycystic Ovarian Syndrome

Polycystic ovarian syndrome (PCOS) is a common gynecological condition where there is pelvic pain. In PCOS, there is elevated levels of male hormones (androgens) leading to menstrual irregularities and even an absence of ovulation (anovulation). The pain may be felt towards the sides and can exacerbate ovulation and period pain. Many women with PCOS experience severe period pain.


Endometriosis is a condition where uterine tissue, specifically the inner lining of the uterus (endometrium), grows outside of the uterus. The tissue responds to hormonal changes in the same way as the inner tissue of the uterus and this results in severe pain. Therefore women with endometriosis may experience worsening of pain during ovulation although pain can occur at any time in the menstrual cycle.


Adhesions are scar tissue that forms around organs usually after surgery to an area. It is more commonly seen with abdominal surgery and tends to affect the bowels. These adhesions may also form around the ovaries and also bind the ovaries to adhesions around the bowels. Ovulation pain may therefore be more likely when adhesions are present although this has to be differentiated from pain caused by adhesions due to other reasons.

Pelvic Inflammatory Disease

Pelvic inflammatory disease (PID) is an infection of the female reproductive organs. Infections lower down the female reproductive tract, like in the vagina, can spread upwards to involve the uterus, fallopian tubes and even the ovaries. Some of these infections may be sexually transmitted. The pain in PID is usually throughout the menstrual cycle but may exacerbate during ovulation and menstruation.

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