Most women are accustomed to period pain, whether they suffer with it themselves or know of other women who do. For some it is just part of menstruation. While there may be mild discomfort, period pain itself is not the norm. It can be a symptoms of various gynecological problems. But what about mid-cycle pain? What could be causing it and does it signal a problem? There are some gynecological reasons for mid-cycle pain but there are also some non-gynecological causes that need to be considered.
It is important to differentiate period pain from mid-cycle pain. There is a common misconception that the end of menstrual bleeding means the end of the menstrual cycle. But the menstrual cycle actually commences on the first day of menstrual bleeding (menstruation). It ends the day before the next menstrual bleed starts. Normally this cycle is 28 days although it may be a few days longer or shorter in some women and still be normal. Menstruation is only one phase of the menstrual cycle but there are a host of other processes occurring throughout the cycle.
Pain around this time, from a few days before the onset of bleeding and throughout menstruation, is what is considered as period pain. Usually there is mild discomfort or mild cramping but overt pain especially when it is severe and affect daily functioning is considered as dysmenorrhea. As the name suggest, mid-cycle pain occurs midway through the menstrual cycle. So a woman with a 28 day cycle may experience lower abdominal or pelvic pain around day 14 of the the cycle.
Many people also refer too pain anywhere during the menstrual cycle away from the time of menstruation as mid-cycle pain. It could therefore occur a few days after menstruation or well before menstruation. The first and most important consideration when evaluating mid-cycle pain is whether you are pregnant or not. It is not uncommon for a woman to be pregnancy and experience discomfort or mild pain in the early stages despite being unaware of the pregnancy. Severe or worsening pain may be a sign of an ectopic pregnancy which is a medical emergency.
Once pregnancy is excluded, other causes of mid-cycle menstrual pain should then be considered.
Ovulation pain as it is sometimes called occurs around mid-cycle. It is also known as Mittelschmerz pain. This is usually mild abdominal discomfort and cramping that occurs more on one side. It can last anywhere from a few minutes to several hours. Ovulation is when the ovary releases an egg cell (ovum) into the fallopian tubes. Usually ovulation occurs around day 14 to 16 of a 28 day menstrual cycle but can occur slightly earlier or later. Some women do not experience ovulation. This is known as anovulation and the cycle is said to be an anovulatory cycle. Mittelschmerz pain is not abnormal although it does not occur in every woman.
There are other reasons why mid-cycle pain may occur in the female reproductive organs. It is seen in conditions like polycystic ovarian syndrome (PCOS), endometriosis and uterine fibroids. Pain may also occur with pelvic inflammatory disease (PID). Most of these conditions present with pain throughout the menstrual cycle or pain that worsens during periods. There are also other symptoms such as alterations in menstrual bleeding, abnormal vaginal discharge and often it is associated with difficulty falling pregnant. In these cases it is pelvic pain that is the issue and not specifically mid-cycle pain.
Pain of the urinary tract may also be confused with mid menstrual cycle pain. The close proximity of the urinary organs to the female reproductive organs makes it difficult to differentiate between one another. The urinary symptoms apart from pain are important indicators that the problem lies with the urinary organs. This includes frequent urination, difficulty urinating, burning on urination and changes in the color or odor of urine. Urinary tract infections are a common cause of pain and these infections are more frequently seen in women. In some conditions like endometriosis, there is worsening of the pain during menstruation as well as pain during urination thereby adding to the confusion of whether it is gynecological or urinary pain.
As with the urinary system, parts of the gastrointestinal tract lies close to the female reproductive organs especially the colon. The abdominal cavity is mostly occupied by the digestive organs and sometimes lower abdominal pain due to problems with these digestive organs may be mistaken for menstrual pain. The various causes of constipation or diarrhea, excessive intestinal gas, inflammatory bowel disease, irritable bowel syndrome, appendicitis, diverticulitis and other conditions particularly of the lower gastrointestinal tract may be responsible for pain that is associated with mid-cycle menstrual pain. Read more on right lower abdominal pain and left lower abdominal pain.
There are various muscles, tendons, bones, joints and ligaments in the lower abdominal and pelvic area that could be responsible for pain. Many musculoskeletal conditions can cause pain between periods. Muscle strain is one of the most common but often overlooked causes of musculoskeletal pain. Most of us would think that lower abdominal muscle strain would arise with abdominal exercises or lifting heavy weights but even walking or running for long hours can cause it. The lower abdominal and pelvic muscles stabilize the torso during walking and running. Round ligament pain is another cause that occur during and after pregnancy.
Lower Back Pain
Although lower back pain is often musculoskeletal in nature, it is so common that it is worth mentioning on its own. Lower back pain is not uncommon with menstruation. Muscle strain, ligament sprain and pinched nerves are some of the likely causes of lower back pain. But it may also occur with urinary tract infections, ectopic pregnancy, endometriosis, diverticulitis and other lower colon disorders. Lower back pain that starts or worsen around the same time in the menstrual cycle on a regular basis is very likely due to a gynecological cause. Read more on persistent low back pain for other gynecological and non-gynecological causes.