Many women say that they experience no obvious physical side effects during ovulation. Many are however accustomed to having some cramping and other pains throughout their menstrual cycle. But not all cramps during the month are a direct result of menstruation. However, approximately 20% of all women will experience some cramps during ovulation and even during the implantation if the egg is fertilized. Mittelschmerz (German word meaning “middle pain”) is a medical term for “ovulation pain” or “midcycle pain”.
There are some symptoms and time frames that can be clues as to whether or not the cramping is due to an impending menstrual cycle or if ovulation is causing the cramping.
Cramping that starts approximately two weeks prior to start of menstrual bleeding. This is typically when ovulation occurs. Pains and cramps occurring in the lower abdominal area, typically toward the side in the area the ovaries would be found.
Cramping or pains that are only on one side of the lower abdomen. This is due to the egg being released on that side of the reproductive system. In some women, the mittelschmerz is localized enough so that they can tell which of their two ovaries provided the egg in a given month. In some women, the mittelschmerz is localized enough so that they can tell which of their two ovaries provided the egg in a given month. The pain lasts less than 48 hours, typically anywhere from a few minutes to about 24 hours.
Diagnosis of mittelschmerz is generally made if a woman is mid-cycle and a pelvic examination shows no abnormalities. If the pain is prolonged and/or severe, other diagnostic procedures such as an abdominal ultrasound may be performed to rule out other causes of abdominal pain. The pain of mittelschmerz is sometimes mistaken for appendicitis and is one of the differential diagnoses for appendicitis in women of child-bearing age.
Doctors have not determined exactly why ovulation causes cramping but they do suspect that some medical conditions can be the cause. Follicles are one of them. Follicles are the sacs or containers that the eggs are in prior to becoming mature. Two of the main theories involving cramping and follicles are:
Emergence of the Follicle and their swelling. Every month the hormones in a woman’s body cause it to create many follicles which ultimately mature into eggs. However, there is usually only one follicle that reaches maturity and passes through the fallopian tubes. It is thought that the growth of the follicles causes the ovary to stretch and thus produce cramps.
Ovarian Wall Rupturing. Once an egg is mature and ready to be released, the follicle carrying it has to erupt. The ovaries have no openings so the egg must break free. When this occurs, there may be some cramping and possibly even light bleeding.
Fallopian tube contraction. After ovulation, the fallopian tubes contract, which may cause pain in some women.
Irritation. At the time of ovulation, blood or other fluid is released from the ruptured egg follicle. This fluid may cause irritation of the abdominal lining.
Women may notice other physical symptoms associated with their mittelschmerz. Cervical mucus is one of the primary signs of ovulation. Other symptoms are can include:
Mid-cycle or ovulatory bleeding, thought to result from the sudden drop in estrogen that occurs just before ovulation. This drop in hormones can trigger withdrawal bleeding. The rise in hormones that occurs after ovulation prevents such mid-cycle spotting from becoming as heavy or long lasting as a typical menstruation. Spotting is more common in longer cycles.
A woman’s vulva may swell just prior to ovulation, especially the side on which ovulation will occur.
One of the groin lymph nodes (on the side on which ovulation will occur) will swell to about the size of a pea, and may become tender.
There are medical reasons that can cause the abdominal pain around ovulation time, including:
Swollen, irritated, or inflamed fallopian tubes. This condition is known as salpingitis and usually is the result of an infection.
Endometriosis, a gynecological medical condition in which cells from the lining of the womb (uterus) grow in other areas of the body. This can lead to pain, irregular bleeding, and problems getting pregnant.
PID or chronic pelvic inflammatory disease. PID can cause severe inflammation and pain during ovulation.
Ectopic Pregnancy. If an egg becomes fertilized while it is still in the fallopian tube, the resulting embryo will cause cramping, pain and bleeding. This condition must be treated at the hospital urgently.
Cysts. Ovarian cysts can cause ovulation to be painful due to the egg expanding and stretching in an area that is already being stretched by the cyst.
Women should pay close attention to their bodies and carefully monitor their menstrual cycles. It is important that you alert your doctor when you feel that something other than ovulation is causing abdominal pain.
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