Table of ContentsView AllTable of ContentsShould It Be Painful?How Endo Causes PainWhat Pain Feels LikeSignsTreatmentWhen to Seek Medical Care
Table of ContentsView All
View All
Table of Contents
Should It Be Painful?
How Endo Causes Pain
What Pain Feels Like
Signs
Treatment
When to Seek Medical Care
About 20% of women experience pain during ovulation, which is also known asMittelschmerzor mid-cycle pain.Ovulation pain is typically a nagging pain that lasts for a few minutes up to 48 hours. However, severe pain lasting longer than usual may indicate an underlying medical condition such as endometriosis.
Endometriosiscan cause severe ovulation pain, heavy periods, severe period cramping, painful sexual intercourse, chronic pelvic pain, infertility, and more.
This article reviews typical ovulation pain, how endometriosis can cause ovulation pain, how to find relief, and when to seek medical care.
Jacob Wackerhausen / Getty Images
Ovulation Pain and Relief Options
Should Ovulation Be Painful?
About 1 out of every 5 women experiences mid-cycle, ovulation pain. While some discomfort is not atypical or abnormal, you should not experience severe pain.
What Is Ovulation?Ovulationoccurs when the ovary releases an egg. It is a normal part of the menstrual cycle. Most people with a uterus ovulate once per month, 10 to 14 days after menstruation (period bleeding) ends. They shed their endometrial (uterine) lining if ovulation does not result in pregnancy. This happens about 14 to 16 days after ovulation and causes bleeding during a menstrual period.
What Is Ovulation?
Ovulationoccurs when the ovary releases an egg. It is a normal part of the menstrual cycle. Most people with a uterus ovulate once per month, 10 to 14 days after menstruation (period bleeding) ends. They shed their endometrial (uterine) lining if ovulation does not result in pregnancy. This happens about 14 to 16 days after ovulation and causes bleeding during a menstrual period.
Mid-cycle pain doesn’t always occur at the exact time of ovulation; it can be a day or two before or after, depending on the cause. Experts note that ovulation pain may occur when:
Other signs of ovulation include:
How Endometriosis May Cause Ovulation Pain
Endometriosisoccurs when the endometrial-like tissue that lines the uterus grows outside theuterus. Endometriosis lesions respond to changing hormone levels throughout the menstrual cycle.
When endometriosis lesions grow and bleed, they don’t have anywhere to go. They are not shed like the uterine lining. This can cause inflammation, pain, and heavy periods.
Endometriosis often causes intense pain during ovulation because lesions commonly grow around thereproductive organs, including the ovaries. Ovulation pain from endometriosis may occur when:
What Does Ovulation Pain Feel Like?
Ovulation pain is typically mild and lasts for a few minutes up to 48 hours. It is located in the lower abdomen (belly) or pelvis (between the hips). Other ovulation pain characteristics include:
During ovulation, you may also experience
Endometriosis Pain Location
Endometriosis lesions can grow anywhere in the body and cause pain. However, endometriosis pain is typically in the lower abdomen or pelvis.
If the lesions press against nerves in the pelvis, pain can radiate to the buttocks, legs, andhips. Nerve damage or irritation can also causeneuropathy, which leads to tingling, numbness, muscle spasms, and weakness.
Signs That Endometriosis Is Causing Ovulation Pain
Ovulation pain due to endometriosis is typically more severe and lasts longer than is considered normal. Other signs that ovulation pain may be due to endometriosis include:
Endometriosis Pain Relief and Treatment
In addition to ovulation pain, endometriosis can causeheavy menstrual (period) bleeding, excessive cramping, chronic fatigue, infertility, and more.Endometriosis treatmentdepends on the symptoms and severity. It ranges from lifestyle modifications to surgery.
Lifestyle Changes
Lifestyle changes include:
Over-the-Counter (OTC) Pain Relief
Over-the-counter (OTC) pain relief includesTylenol (acetaminophen)and nonsteroidal anti-inflammatory drugs (NSAIDs) such as:
Remember to check with your medical provider before taking any new medications or supplements.
Heat Therapy
Heat therapy can help relax muscles and stimulate blood flow. You can try a:
However, your healthcare provider may recommendcold packsif endometriosis is causing nerve inflammation in your lower back.
Topical Medications
Rubbingtopical medicationson your lower back may help relieve nerve inflammation from endometriosis. Iflidocaineis an active ingredient, it can help numb the pain fairly quickly.
Topical medications come in patches, creams, or gels and include:
Complementary and Alternative Medicine (CAM) Treatments
CAM treatmentsinclude:
Medical Interventions
If the pain is severe or progressing, your healthcare provider may suggest the following:
Hormone Therapy
Hormone therapy can help reduce the growth of new endometriosis lesions and regulate the menstrual cycle. This includes:
Can Birth Control Help?
The important thing to remember about hormonal birth control is that not all of it works for everyone the same. You must find the right one for your body.
Mild cramping or discomfort that goes away within a day or two during ovulation is considered normal. But debilitating pain is not normal and requires medical attention.
You should notify your healthcare provider if ovulation pain:
Summary
The most common type of ovulation pain is called Mittelschmerz or mid-cycle pain. While some mild mid-cycle pain due to ovulation is normal, severe pain or pain lasting more than 48 hours may signify a more serious condition. If you experience pain that keeps you from your daily activities, notify your healthcare provider.
Severe ovulation pain that lasts longer than 48 hours could be due to endometriosis. Other signs of endometriosis include painful periods, heavy periods, painful sexual intercourse, and more. Treatment for endometriosis varies based on symptoms and severity. It includes lifestyle changes, pain medications, hormones, and possibly surgery.
13 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.National Library of Medicine (NIH).Mittelschmerz.American College of Obstetricians and Gynecologists (ACOG).The menstrual cycle: menstruation, ovulation, and how pregnancy occurs.Nezhat C, Vang N, Tanaka P.Optimal management of endometriosis and pain.Obstetrics & Gynecology. 2019:134(4):834-839. doi: 10.1097/AOG.0000000000003461Abd El-Kader AI, Gonied AS, Lotfy Mohamed M, Lotfy Mohamed S.Impact of endometriosis-related adhesions on quality of life among infertile women.Int J Fertil Steril. 2019;13(1):72-76. doi: 10.22074/ijfs.2019.5572Drabble SJ, Long J, Alele B, O’Cathain A.Constellations of pain: A qualitative study of the complexity of women’s endometriosis-related pain.Br J Pain. 2021;15(3):345-356. doi:10.1177/2049463720961413American Society for Reproductive Medicine.Endometriosis - a patient education video.Awad E, Ahmed HAH, Yousef A, Abbas R.Efficacy of exercise on pelvic pain and posture associated with endometriosis: Within subject design.J Phys Ther Sci. 2017;29(12):2112-2115. doi:10.1589/jpts.29.2112Becker C, Bokor A, Heikinheimo O, et. al.ESHRE guideline: Endometriosis.Human Reproduction Open: 2022; 2022(2). doi: 10.1093/hropen/hoac009Johns Hopkins Medicine.Endometriosis.Derry S, Wiffen PJ, Kalso EA, Bell RF, Aldington D, Phillips T, Gaskell H, Moore RA.Topical analgesics for acute and chronic pain in adults - an overview of Cochrane Reviews.Cochrane Database Syst Rev. 2017;5(5):CD008609. doi: 10.1002/14651858.CD008609.pub2Maloney J, Pew S, Wie C, Gupta R, Freeman J, Strand N.Comprehensive review of topical analgesics for chronic pain.Curr Pain Headache Rep. 2021;25(2):7. doi: 10.1007/s11916-020-00923-2Newmark AL, Luciano DE, Ulrich A, Luciano AA.Medical management of endometriosis.Minerva Obstet Gynecol. 2021;73(5):572-587. doi: 10.23736/S2724-606X.21.04776-XPereira A, Herrero-Trujillano M, Vaquero G, Fuentes L, Gonzalez S, Mendiola A, Perez-Medina T.Clinical management of chronic pelvic pain in endometriosis unresponsive to conventional therapy.Journal of Personalized Medicine. 2022; 12(1):101. doi: 10.3390/jpm12010101Additional ReadingNational Library of Medicine (NIH).Mittelschmerz.Nezhat C, Vang N, Tanaka P.Optimal management of endometriosis and pain.Obstetrics & Gynecology. 2019:134(4):834-839. doi: 10.1097/AOG.0000000000003461
13 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.National Library of Medicine (NIH).Mittelschmerz.American College of Obstetricians and Gynecologists (ACOG).The menstrual cycle: menstruation, ovulation, and how pregnancy occurs.Nezhat C, Vang N, Tanaka P.Optimal management of endometriosis and pain.Obstetrics & Gynecology. 2019:134(4):834-839. doi: 10.1097/AOG.0000000000003461Abd El-Kader AI, Gonied AS, Lotfy Mohamed M, Lotfy Mohamed S.Impact of endometriosis-related adhesions on quality of life among infertile women.Int J Fertil Steril. 2019;13(1):72-76. doi: 10.22074/ijfs.2019.5572Drabble SJ, Long J, Alele B, O’Cathain A.Constellations of pain: A qualitative study of the complexity of women’s endometriosis-related pain.Br J Pain. 2021;15(3):345-356. doi:10.1177/2049463720961413American Society for Reproductive Medicine.Endometriosis - a patient education video.Awad E, Ahmed HAH, Yousef A, Abbas R.Efficacy of exercise on pelvic pain and posture associated with endometriosis: Within subject design.J Phys Ther Sci. 2017;29(12):2112-2115. doi:10.1589/jpts.29.2112Becker C, Bokor A, Heikinheimo O, et. al.ESHRE guideline: Endometriosis.Human Reproduction Open: 2022; 2022(2). doi: 10.1093/hropen/hoac009Johns Hopkins Medicine.Endometriosis.Derry S, Wiffen PJ, Kalso EA, Bell RF, Aldington D, Phillips T, Gaskell H, Moore RA.Topical analgesics for acute and chronic pain in adults - an overview of Cochrane Reviews.Cochrane Database Syst Rev. 2017;5(5):CD008609. doi: 10.1002/14651858.CD008609.pub2Maloney J, Pew S, Wie C, Gupta R, Freeman J, Strand N.Comprehensive review of topical analgesics for chronic pain.Curr Pain Headache Rep. 2021;25(2):7. doi: 10.1007/s11916-020-00923-2Newmark AL, Luciano DE, Ulrich A, Luciano AA.Medical management of endometriosis.Minerva Obstet Gynecol. 2021;73(5):572-587. doi: 10.23736/S2724-606X.21.04776-XPereira A, Herrero-Trujillano M, Vaquero G, Fuentes L, Gonzalez S, Mendiola A, Perez-Medina T.Clinical management of chronic pelvic pain in endometriosis unresponsive to conventional therapy.Journal of Personalized Medicine. 2022; 12(1):101. doi: 10.3390/jpm12010101Additional ReadingNational Library of Medicine (NIH).Mittelschmerz.Nezhat C, Vang N, Tanaka P.Optimal management of endometriosis and pain.Obstetrics & Gynecology. 2019:134(4):834-839. doi: 10.1097/AOG.0000000000003461
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
National Library of Medicine (NIH).Mittelschmerz.American College of Obstetricians and Gynecologists (ACOG).The menstrual cycle: menstruation, ovulation, and how pregnancy occurs.Nezhat C, Vang N, Tanaka P.Optimal management of endometriosis and pain.Obstetrics & Gynecology. 2019:134(4):834-839. doi: 10.1097/AOG.0000000000003461Abd El-Kader AI, Gonied AS, Lotfy Mohamed M, Lotfy Mohamed S.Impact of endometriosis-related adhesions on quality of life among infertile women.Int J Fertil Steril. 2019;13(1):72-76. doi: 10.22074/ijfs.2019.5572Drabble SJ, Long J, Alele B, O’Cathain A.Constellations of pain: A qualitative study of the complexity of women’s endometriosis-related pain.Br J Pain. 2021;15(3):345-356. doi:10.1177/2049463720961413American Society for Reproductive Medicine.Endometriosis - a patient education video.Awad E, Ahmed HAH, Yousef A, Abbas R.Efficacy of exercise on pelvic pain and posture associated with endometriosis: Within subject design.J Phys Ther Sci. 2017;29(12):2112-2115. doi:10.1589/jpts.29.2112Becker C, Bokor A, Heikinheimo O, et. al.ESHRE guideline: Endometriosis.Human Reproduction Open: 2022; 2022(2). doi: 10.1093/hropen/hoac009Johns Hopkins Medicine.Endometriosis.Derry S, Wiffen PJ, Kalso EA, Bell RF, Aldington D, Phillips T, Gaskell H, Moore RA.Topical analgesics for acute and chronic pain in adults - an overview of Cochrane Reviews.Cochrane Database Syst Rev. 2017;5(5):CD008609. doi: 10.1002/14651858.CD008609.pub2Maloney J, Pew S, Wie C, Gupta R, Freeman J, Strand N.Comprehensive review of topical analgesics for chronic pain.Curr Pain Headache Rep. 2021;25(2):7. doi: 10.1007/s11916-020-00923-2Newmark AL, Luciano DE, Ulrich A, Luciano AA.Medical management of endometriosis.Minerva Obstet Gynecol. 2021;73(5):572-587. doi: 10.23736/S2724-606X.21.04776-XPereira A, Herrero-Trujillano M, Vaquero G, Fuentes L, Gonzalez S, Mendiola A, Perez-Medina T.Clinical management of chronic pelvic pain in endometriosis unresponsive to conventional therapy.Journal of Personalized Medicine. 2022; 12(1):101. doi: 10.3390/jpm12010101
National Library of Medicine (NIH).Mittelschmerz.
American College of Obstetricians and Gynecologists (ACOG).The menstrual cycle: menstruation, ovulation, and how pregnancy occurs.
Nezhat C, Vang N, Tanaka P.Optimal management of endometriosis and pain.Obstetrics & Gynecology. 2019:134(4):834-839. doi: 10.1097/AOG.0000000000003461
Abd El-Kader AI, Gonied AS, Lotfy Mohamed M, Lotfy Mohamed S.Impact of endometriosis-related adhesions on quality of life among infertile women.Int J Fertil Steril. 2019;13(1):72-76. doi: 10.22074/ijfs.2019.5572
Drabble SJ, Long J, Alele B, O’Cathain A.Constellations of pain: A qualitative study of the complexity of women’s endometriosis-related pain.Br J Pain. 2021;15(3):345-356. doi:10.1177/2049463720961413
American Society for Reproductive Medicine.Endometriosis - a patient education video.
Awad E, Ahmed HAH, Yousef A, Abbas R.Efficacy of exercise on pelvic pain and posture associated with endometriosis: Within subject design.J Phys Ther Sci. 2017;29(12):2112-2115. doi:10.1589/jpts.29.2112
Becker C, Bokor A, Heikinheimo O, et. al.ESHRE guideline: Endometriosis.Human Reproduction Open: 2022; 2022(2). doi: 10.1093/hropen/hoac009
Johns Hopkins Medicine.Endometriosis.
Derry S, Wiffen PJ, Kalso EA, Bell RF, Aldington D, Phillips T, Gaskell H, Moore RA.Topical analgesics for acute and chronic pain in adults - an overview of Cochrane Reviews.Cochrane Database Syst Rev. 2017;5(5):CD008609. doi: 10.1002/14651858.CD008609.pub2
Maloney J, Pew S, Wie C, Gupta R, Freeman J, Strand N.Comprehensive review of topical analgesics for chronic pain.Curr Pain Headache Rep. 2021;25(2):7. doi: 10.1007/s11916-020-00923-2
Newmark AL, Luciano DE, Ulrich A, Luciano AA.Medical management of endometriosis.Minerva Obstet Gynecol. 2021;73(5):572-587. doi: 10.23736/S2724-606X.21.04776-X
Pereira A, Herrero-Trujillano M, Vaquero G, Fuentes L, Gonzalez S, Mendiola A, Perez-Medina T.Clinical management of chronic pelvic pain in endometriosis unresponsive to conventional therapy.Journal of Personalized Medicine. 2022; 12(1):101. doi: 10.3390/jpm12010101
National Library of Medicine (NIH).Mittelschmerz.Nezhat C, Vang N, Tanaka P.Optimal management of endometriosis and pain.Obstetrics & Gynecology. 2019:134(4):834-839. doi: 10.1097/AOG.0000000000003461
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