Definition

Ovulation is a process that occurs within the menstrual cycle. This process typically happens around the middle of the menstrual cycle, approximately 14 days before menstruation, during which the ovary releases an egg. The days leading up to and following ovulation are considered a woman's fertile period.

During ovulation, some women may experience pain known as ovulation pain or mittelschmerz, a German term that means "middle pain." This refers to the discomfort felt when an egg is released from the ovary.

Ovulation pain is normal and a related side effect of the menstrual cycle. It is usually experienced in the abdomen and lower back, in the middle, or on one side. The pain might resemble menstrual cramps but occurs about two weeks (14 days) before menstruation.

Most women do not feel anything during ovulation, but some may experience ovulation pain. Approximately 40% of women of reproductive age who ovulate experience ovulation pain.

Causes

Ovulation pain is caused by the development and release of an egg from the ovary. The pain can be explained in several ways:

• As the egg develops in the ovary, it is surrounded by follicular fluid.
• Just before ovulation, the growth of the follicle where the egg develops can stretch the surface of the ovary, causing pain.
• During ovulation, the egg, fluid, and some blood are released from the ovary.

The exact cause of ovulation pain is unknown, but it is thought that the fluid or blood causes irritation in the abdomen, leading to pain. The pain usually subsides once the egg is released or when the body absorbs the fluid or blood.

Risk Factor

Several factors may contribute to ovulation pain, including:

• Hormonal factors
• Hormonal factors that drive the ovulation process and cause pain during the development of the egg until the follicle sheds
• The number of follicles also affects ovulation pain
• An excessive increase in estrogen levels
• Polycystic Ovary Syndrome (PCOS), a hormonal disorder that causes irregular menstrual periods
• Conditions or diseases of the uterus
• Ovarian cysts
• Endometriosis is a condition where the uterine lining grows outside the uterus, usually causing pain
• Sexually transmitted infections, where ovulation pain is accompanied by unusual or foul-smelling discharge, fever, and burning sensations during urination
• Ectopic pregnancy, where the fetus develops outside the uterus, can cause ovulation pain due to similar symptoms like pelvic pain on one side
• Age, with women under 35 years being at higher risk
• Low body weight. People with underweight are at a higher risk of experiencing ovulation pain

Symptoms

The main symptom of ovulation pain is discomfort in the abdomen and lower back, ranging from mild to severe, accompanied by a sense of discomfort. The pain usually occurs on one side and lasts from a few minutes to several hours, typically lasting between 3 and 12 hours. Women who have recently had ovarian surgery may also experience pain until their next menstrual period. Other symptoms may include:

• Light vaginal bleeding
• Vaginal discharge
• Nausea if the pain is severe
• Pain lasting a few minutes to hours, up to 24 to 48 hours
• Severe pain (rare)
• Pain that alternates sides each month
• Dull pain, similar to menstrual cramps
• Sharp, stabbing pain that can be severe
• Mid-cycle pain or cramping

Diagnosis

Doctors diagnose ovulation pain based on the timing of the pain. Ovulation generally occurs 14 days before menstruation. If pain occurs mid-cycle, it may be due to ovulation pain.

Doctors may ask patients to track their menstrual cycles, including noting any pain and its location. An examination of the abdomen and lower back may be conducted to determine the cause of the pain, such as endometriosis or ovarian cysts.

Additional Examinations

If necessary, patients are also advised to undergo an ultrasound examination (USG) through the vagina or x-rays to help determine the cause of the pain. If the doctor notices anything abnormal during your examination or the pain is severe, the patient will be advised to carry out further examinations to find out the cause of the pain. The doctor will discuss further with the patient regarding the next stages.

Management

Most women with ovulation pain do not require treatment. The pain typically subsides on its own within a day. Patients can use over-the-counter medications like NSAIDs (e.g., paracetamol or ibuprofen) to reduce the pain. Additionally, patients can apply warm compresses or take a hot bath to relieve the pain.

Birth Control Pills

For severe ovulation pain, discuss with your doctor the possibility of taking birth control pills. Hormonal birth control pills can prevent ovulation, so you won't experience ovulation pain. However, taking these pills will prevent pregnancy, so talk to your doctor if you plan a pregnancy.

Complications

Ovulation pain generally does not lead to complications, but the underlying causes of the pain can be harmful. Some potential complications include:

• Fluid accumulation in the abdomen and sometimes the chest
• Electrolyte imbalances in the blood (sodium, potassium, and others)
• Blockage of large blood vessels, usually in the legs
• Kidney failure
• A rupture of an ovarian cyst, which can cause severe bleeding
• Breathing difficulties
• Miscarriage
• Death (rare)
• Twisting of the ovary

For additional information about twisted ovarian cysts, click this link: Torsio And Ruptur Kista Ovarium - Understanding, Cause, Symptoms, And Treatment.

Prevention

Ovulation pain can be prevented by preventing ovulation itself. Hormonal contraceptives like birth control pills can prevent ovulation. Consult your doctor if you plan to become pregnant or have children.

When to See a Doctor?

You should see a doctor if you experience any of the following symptoms during ovulation:

• A fever higher than 38°C
• Pain during urination
• Redness or a burning sensation in the painful area
• Severe nausea or vomiting
• Severe pain mid-cycle that lasts more than a day or occurs in most cycles
• Over-the-counter pain relievers do not reduce the pain
• You miss your menstrual period
• Heavy vaginal bleeding between periods

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