Doctor's Notes on Painful Ovulation
Painful ovulation (also termed Mittelschmerz) is discomfort or pain that appears on either side of the lower abdomen in the midpoint of a woman’s menstrual cycle, about two weeks before a period begins. Some women do not experience any painful ovulations. The signs and symptoms of painful ovulation are that pain occurs on one side of the lower abdomen (pain can occur one side or the other, depending upon which ovary is ovulating), pain occurs during ovulation, pain can occur every month and may last anywhere from a few hours to 2-3 days. For most women, the pain is a mild annoyance but in rare instances, it can be severe. The pain quality and intensity vary from person to person; some will feel mild pressure, some feel twinges of pain, in a few women, pains can be intense and long-lasting.
During ovulation an egg is released by the ovary and during that time, it stretches the membrane covering the ovary. This stretching results in symptoms of pressure and/or pain and may contribute to the cause of painful ovulation. In addition, the fluid from the follicle and the blood released from the follicle when the egg is released may also contribute to the cause of painful ovulation.
Pain associated with ovulation may take on various forms:
- Pain occurs on one side of the lower abdomen (can be either side).
- Pain occurs midway between menstrual periods (during ovulation).
- Pain can occur every month.
- Pain lasts anywhere from a few hours to 2-3 days.
Just before the follicle ruptures and an egg is released by the ovary, it stretches the membrane covering the ovary. This follicular stretching results in symptoms like pelvic pressure and pain. The fluid from the follicle and blood released when the egg is released from the ovary may cause discomfort. Blood may be very irritating to the tissues lining the abdominal cavity and could be responsible for the mid-cycle pain. The amount of pain varies tremendously from person to person. Many women do not have any discomfort. Others feel symptoms such as mild pressure or twinge lasting a few minutes to a few hours. For a rare few, the pain is intense and can last for days. In severe cases, the pain may be mistaken for that of appendicitis.
A week or two before your period starts, you may notice bloating, headaches, mood swings, or other physical and emotional changes. These monthly symptoms are known as premenstrual syndrome, or PMS. About 85% of women experience some degree of PMS. A few have more severe symptoms that disrupt work or personal relationships, known as premenstrual dysphoric disorder (PMDD).
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Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.