All women are familiar with cramping, headaches, bloating, and constipation or diarrhea that accompany periods every month. But some women also experience mid-cycle ovulation pain. This is absolutely normal and surprisingly common. Painful ovulation or mid-cycle pain affects about twenty percent of women. Although the pain may feel like something serious is wrong, painful ovulation or is rarely serious.

Painful ovulation, when severe, is referred to as mittelschmerz, a German word that means “middle pain.” Most women who experience painful ovulation usually report a nagging pain that begins as a sharp twinge and diminishes into a dull ache for the next day or so. But for some women, the pain can be severe enough to be disabling and can even be confused with appendicitis. Occasionally, in addition to mid cycle pain and cramping, some women may experience nausea, and/or light menstrual spotting. Mittelschmerz lasts for 6 to 8 hours in most women; however, occasionally it can last as long as twenty-four to forty-eight hours.

While the discomfort can occur on either side of the abdomen, it is more commonly experienced on the right. Pain in the abdomen can occur during intercourse or it can be aggravated by intercourse, working out or other physical activity. In addition to pain, some women also experience gastrointestinal symptoms and increased frequency of urination. Painful ovulation may occur every month, but more typically occurs every third to fourth cycle.

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What causes painful ovulation / mittelschmerz?

Painful ovulation/mittelschmerz is believed to be caused by a small leakage of blood from the ovary that occurs at the time of ovulation. This blood, which is later reabsorbed, is thought to cause an irritation of the abdominal wall which causes pain. The degree of pain you feel depends on your individual pain threshold and the volume of blood that is released, among other factors. The amount of space that exists between a woman’s ovary and her abdominal wall can also affect the severity of the irritation. While painful ovulation does not lead to other problems, other medical conditions can cause painful ovulation, such as PCOS or fibroids on the ovaries. If you are concerned, it is suggested that you visit your doctor to discuss your issues.

How is painful ovulation / mittelschmerz diagnosed?

Ovulation usually occurs about two weeks after the first day of each menstrual cycle, so the timing of the pain makes mittelschmerz easy to recognize. The best way to diagnose your painful ovulation is to keep a chart or diary showing when the pain occurs in relation to the start of your menstrual periods. Your doctor will use this diary in conjunction with your medical history, a physical exam, and perhaps some other medical tests to rule out other possible causes of your pain before making a diagnosis of mittelschmerz.

Occasionally some women may require laparoscopy, in which a narrow tube with a fiber-optic light on the end is introduced through a small incision below the navel and into the abdominal wall. This procedure allows for a direct view of the pelvic organs. If your pain is severe or if the doctor notices any irregularities on the exam, he or she may order blood tests or X-rays to help determine the cause of your pain.

Because the pain of ovulation can be anxiety-provoking and, if severe enough, can be confused with appendicitis, you should be careful not to get misled into undergoing unnecessary gynecologic surgery when dealing with painful ovulation.