What is ovulation pain?

What is ovulation pain?

The female body signals ovulation through many different physical and psychological signs. These signs are also called ovulation symptoms. Ovulation pain is a secondary sign of fertility that can indicate the fertile days in the menstrual cycle. This means that the symptom does not occur in all women, does not clearly indicate ovulation and is therefore considered unreliable.

What does ovulation pain feel like?

Ovulation pain makes itself felt through discomfort in the pelvic area or lower abdomen and can last from one to several days. There may also be months without any discomfort.³

The following symptoms are typical:

• Pulling sensations or twinges in the lower abdomen, cramps or cramp-like pain
• Pelvic pain
• Back pain and/or aching limbs
• A feeling of pressure in the perineal area⁴
• A feeling of heaviness in the pelvic region⁵

The symptoms can last a few seconds, minutes or even hours. Some women suffer severe, cramp-like pain for several hours. Every woman who experiences ovulation pain describes it a little differently. Most of the time, ovulation pain is clearly felt on the left or the right side of the lower abdomen. If the pelvic pain can be felt on a particular side, this often corresponds to the side on which ovulation is taking place. The side can change from month to month.³

When does ovulation pain occur?

The symptoms of ovulation pain appear around the time of ovulation in the cycle, i.e. from a few days before it until shortly afterwards. In most cases, women feel it one day before ovulation actually takes place.

If you bring the various ovulation symptoms together, you can assume that ovulation pain occurs about 2 days before the rise in basal body temperature.⁵ It often occurs alongside ovulation bleeding. This is a bleed most probably triggered by fluctuations in the hormone oestrogen.⁶

The relationship between basal body temperature, oestrogen level and ovulation pain in the cycle

The occurrence of ovulation pain can be documented with cyclotest mySense and cyclotest myWay. This lets you recognise a possible connection between ovulation pain and ovulation.

What triggers ovulation pain?

The causes of the pain have not been clearly established. Scientific studies have identified the following triggering mechanisms:

• Tension on the tissue caused by the growing egg:
  The symptoms or discomfort can be traced back to tension in the capsule of the ovary when the follicle grows rapidly.⁷
• Bursting follicle in the ovary:
  The cause could be the bursting of the vesicular follicle, or follicle, during ovulation.⁸
• Irritation of the peritoneum:
  The fluid escaping from the follicle could irritate the peritoneum. The pain could therefore be connected with this irritation.¹
• Contraction of the fallopian tubes:
  After the follicle bursts, the fallopian tubes contract. In this way they help the egg to move towards the uterus. This contraction can lead to pain, stabbing sensations and cramps in the lower abdomen.

Ovulation pain: does the pulling sensation indicate ovulation?

Does ovulation pain really indicate ovulation? The answer is no! The reasons are that the interval between ovulation pain and the moment of ovulation cannot be pinned down precisely and that every woman experiences the symptoms individually. Ovulation pain therefore cannot give an exact indication of the day of ovulation, only an approximate one.¹

Study on ovulation pain & the timing of ovulation

Ovulation pain occurs differently from woman to woman, as the chart below shows:

The relationship between ovulation pain and ovulation

In this study, 26 women were asked about their ovulation pain. Ovulation was determined by ultrasound and LH measurement. The y-axis lists the 26 women, the x-axis the cycle days before and after the day of ovulation. A purple dot means that ovulation pain was felt at exactly that point in time; an arrow marks the period during which it was felt.

The chart makes clear that only 5 of the 26 women actually felt ovulation pain on the day of ovulation. In 15 of the 26 women, the ovulation pain had already ended at least one day before ovulation. In most cases ovulation pain lasts only a short time. Very rarely is it felt over several days or even a week. These results suggest that ovulation pain is often an event that coincides with the oestrogen peak and subsequent drop shortly before ovulation.⁹

Using ovulation pain when trying to conceive and for cycle tracking

Identifying ovulation pain can nevertheless be very helpful if you want to have a child, as the probability of fertilisation is particularly high during this phase. For one thing, it has been shown that ovulation pain is usually felt before the moment of ovulation. For another, the greater interval before the day of ovulation is an advantage, as this is when the probability of a pregnancy is highest. You can find out how likely it is to get pregnant on particular days around ovulation in our article “When can you get pregnant”.

However, abdominal discomfort of this kind should not be regarded as a reliable symptom for natural contraception.

Documenting ovulation pain with cyclotest mySense

The reasons for this are as follows:

• Ovulation pain varies both in timing and in intensity
• Ovulation pain occurs regularly in only some women

If you use ovulation pain in combination with cervical mucus and basal body temperature (symptothermal method), you can narrow the fertile phase down to a few days.

Documenting ovulation pain

If you want to determine your fertile days reliably, the cyclotest mySense basal thermometer together with the cycle app can help you analyse your cycle. Besides the primary symptoms, the cyclotest mySense app also lets you document various cycle-relevant signs such as ovulation pain. This allows you to track your cycle and see whether you are one of the women who regularly feel ovulation pain.

How painful can ovulation be?

Ovulation pain is a natural pain and generally requires no treatment. It is normally harmless to your health. If very severe pain occurs, however, this could be unsettling for some women.

At the same time, some women find it worrying if they feel no pain or pulling at all, or not every month. Do not worry if you do not feel ovulation pain, or do not feel it in every menstrual cycle.

Ovulation pain: how to tell it apart from other pains in the menstrual cycle & from illnesses

Other pains can also occur in the course of the menstrual cycle or in certain circumstances, and these should not be confused with ovulation pain:

• Implantation pain: while the fertilised egg attaches to the wall of the uterus, some women feel a pain similar to ovulation pain. It therefore cannot be clearly distinguished by the type of pain alone. However, implantation pain occurs about 4–7 days after ovulation.
• Period pain: unlike menstrual pain during your period, ovulation pain tends to occur on one side only. Typical period pain is also often more intense and appears more regularly. Menstrual complaints also differ in when they occur. Ovulation pain makes itself felt roughly in the middle of the cycle, whereas discomfort during the period appears at the start of the cycle.

When ovulation pain and other pains occur in the female cycle

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When do you get pregnant: when are the chances best?

To answer this question, you have to determine a woman’s individual fertile days. Sex at the right time increases the chances of a pregnancy.

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The following illnesses may need to be distinguished from ovulation pain by differential diagnosis:

• Endometriosis: this can likewise cause regularly recurring pain.
• Appendicitis: unlike appendicitis, which is felt only in the lower right abdomen, ovulation pain can alternate, occurring sometimes on the left and sometimes on the right. In addition, an inflamed appendix is often accompanied by loss of appetite, vomiting and a slight fever.
• Irritation of the peritoneum
• Ovarian cysts, tumours or fibroids: these can likewise cause a feeling of pressure and pain in the area of the ovary and the back. If fluid escapes from the egg into the free pelvic cavity, for example, this can lead to pain.
• Inflammation of the fallopian tubes or of the ovaries: Severe pelvic pain can stem from this. However, inflammation of the fallopian tubes or the ovaries is usually accompanied by fever, nausea and vomiting.¹²

So the rule is: when in doubt, have your symptoms checked by your doctor!

What can you do about severe ovulation pain?

Some women suffer intense ovulation pain in the middle of the cycle. If the discomfort subsides just as spontaneously as it appeared, or quickly eases off again, you can assume that this is ‘regular ovulation pain’. There are symptomatic treatment options for it.⁶ 

• Rest
• Hot water bottle
• Painkillers
• Medicinal plants, e.g. lady’s mantle or silverweed tea¹⁰

For women affected by very intense pain, medication such as ovulation inhibitors (for example the pill) can be considered as a form of therapy. Alternatively, GnRH analogues can help, e.g. Buserelin, Synrelin or Decapeptyl. GnRH analogues are synthetically produced derivatives of the natural gonadotropin-releasing hormone; they inhibit the production of the hormones LH and FSH.¹¹

If these do not relieve the pain, the gynaecologist has to check whether another illness is present.