Experiencing abdominal discomfort or a cramping sensation midway through your menstrual cycle could be indicative of ovulation pain.
This pain is also known as mittelschmerz, a term of German origin that translates to “middle pain”, aptly coined to describe the timing of this symptom during the menstrual cycle.
The phenomenon of mittelschmerz arises during ovulation, which is when a follicle – a small, fluid-filled pouch within the ovary that nurtures the developing egg – bursts open to release the egg.
The sensation associated with this part of the cycle can vary substantially in intensity. For some, it manifests as a mild and brief pinch or a fleeting twinge, while for others, it escalates to a more pronounced and prolonged cramping that can endure for several hours.
This discomfort is typically localised to one side of the lower abdomen. The side experiencing the pain correlates with the ovary that is actively releasing an egg during that particular cycle.
It is noteworthy that the release of an egg from the ovary – i.e. ovulation – does not always produce noticeable sensations. A portion of women report no discernible change during this time, while others may start to feel cramping days before the onset of their menstrual period.
Approximately one in five women will encounter some form of pain related to ovulation. This suggests that while mittelschmerz is a common reproductive occurrence, its presence and severity can greatly differ among individuals.
Mittelschmerz vs dysmenorrhoea
The exact mechanisms behind the cramping or ovulation pain that some women endure are not definitively understood, but there are several prevailing theories. As ovulation approaches, the growth of the ovarian follicle may exert a stretching effect on the ovary’s surface, potentially leading to discomfort.
Furthermore, when the follicle bursts to release the egg – a necessary step in ovulation – it is thought that the accompanying spillage of blood and other fluids into the surrounding tissue could cause transient irritation.
However, this should subside once these fluids are absorbed back into the body. Given that the ovaries do not have distinct openings, the physical process of the egg penetrating the ovarian wall may also be a source of pain.
In contrast, dysmenorrhoea is the cramps experienced just before or during the onset of menstruation, which can last for several days. It is often described as a diffuse, sometimes severe, pain across the lower abdomen.
It is primarily caused by uterine contractions facilitated by prostaglandins. Secondary dysmenorrhoea, which may be associated with more severe pain, is often due to underlying conditions such as endometriosis or uterine fibroids.
Below are some of the characteristics that can help differentiate ovulation pain from the menstrual cramps that typically herald the start or arrival of the menstrual period:
- Localisation: Ovulation pain is usually felt on only one side of the lower abdomen, aligning with the ovary that is releasing an egg.
- Onset: This type of pain can arise abruptly and unexpectedly.
- Nature: The sensation is often described as a sharp pain or twinge, contrasting with the more generalised, dull ache of menstrual cramps.
- Duration: The discomfort might be brief, sometimes just lasting a few minutes, but it can also extend for several hours, and in some cases, up to a full day.
- Variability: The side on which the pain is felt may alternate with each menstrual cycle.
- Timing: It typically manifests around two weeks prior to the commencement of the menstrual period.
Accompanying signs may include light bleeding or spotting, and vaginal discharge. Nausea can also accompany ovulation pain, particularly when the intensity of cramping is significant.
While this mid-cycle pain is most frequently reported by younger women – notably adolescents and those in their 20s – it is not exclusive to this demographic and can be experienced by women up to the age of 45.
A sign of fertility
For those seeking to conceive, recognising the nuances of ovulation pain can be quite beneficial. The sensations of cramping that emerge during the interlude between menstrual periods are indicative of ovulation, signalling a window of heightened fertility.
Hence, timing intercourse immediately before, during or just after ovulation enhances the chances of conception. Conversely, individuals not wishing to become pregnant might use the presence of ovulation pain as a supplementary indicator of fertility.
However, caution is advised as this should not be the sole form of contraception. This is as sperm can survive within the female reproductive tract for up to five days, meaning that the potential for conception exists even from sexual activity that occurs before the onset of ovulation pain.
Relieving the pain
For transient or mild ovulation pain, medical intervention may not be necessary. However, if your cramping persists or causes significant discomfort, common over-the-counter painkillers (e.g. non-steroidal antiinflammtory drugs or NSAIDs) like ibuprofen or naproxen, are often effective in providing relief.
Localised application of heat, whether through a heating pad directly on the area of pain or through a warm bath, can promote blood flow, relax muscles and alleviate cramping.
Should the mid-cycle pain be a recurrent and disruptive issue, hormonal contraceptives – available in various forms such as pills, patches or rings – may be utilised to suppress ovulation, thereby eliminating the pain associated with it.
Severe or prolonged mid- cycle abdominal pain warrants a professional medical evaluation. Conditions with similar symptoms, such as appendicitis, ovarian cysts and ectopic pregnancies, need to be differentiated from typical ovulation pain, as they require urgent care and may pose significant health risks.
Through a comprehensive medical examination and necessary diagnostic testing, a healthcare provider can exclude other medical concerns. In most instances though, mid-cycle abdominal cramps are a normal aspect of the ovulatory process and are likely to pass without issue.
By Datuk Dr Nor Ashikin Mokhtar
Published in Star Newspaper, 08 Jan 2024
