Ovulation pain is normal and generally happens because when the egg is released by the ovary (about 14 days after menstruation) a small amount of fluid and blood that protect the egg are also released. This can irritate the abdominal cavity and lead to cramping. This type of cramp resolves as soon as the egg is released or once the body has absorbed the fluid.

If the pain is very intense, lasts for several days or occurs with other symptoms like fever, nausea, or a vaginal discharge with foul odor, it may be a sign of another illness, like endometriosis, ectopic pregnancy, appendicitis or an STI. These symptoms should be assessed by a gynecologist.

Ovulation pain can occur in any women of fertile age and usually does not require any treatment. However some interventions can help to relieve discomfort, like placing a warm compress on the abdomen or taking a warm bath. In some cases, the doctor may prescribe anti-inflammatories, birth control pills or even surgery.

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Main symptoms

Ovulation pain starts about 14 days before menstruation, as this is generally when the egg is released by the ovary. It can cause light to moderate cramping on the left or right side, depending on the ovary involved. Although it is rare, some women may feel pain on both sides.

This cramping can be accompanied by a stabbing or more intense pain, which can be confused for gas. It usually lasts for up to 24 hours.

In addition, ovulation pain can be accompanied by scant amounts of vaginal bleeding. Other women also feel nauseous, especially if the pain is strong.

Possible causes

Ovulation pain occurs due to the release of the egg from the ovary down the fallopian tools. These structures contract for the egg to move and meet a sperm cell to become fertilized. When the egg is released, a small amount of fluid and blood can also be released, which can irritate the tissues around the ovary and cause abdominal pain.

This type of pain is common during ovulation. However is pain is very intense or lasts for more than a day, it may be a sign of another condition, like:

1. Endometriosis

Ovulation pain can occur due to endometriosis, which is a condition characterized by the growth of endometrial tissue (that usually lines the uterus) on other abdominal organs, like the ovaries or fallopian tubes. It causes inflammation, abdominal pain, and intense cramping. Learn more about the symptoms of endometriosis.

2. Endometrioma

An endometrioma is a type of benign ovarian cyst composed of endometrial cells that have implanted on the surface or within the ovaries. This condition leads to the accumulation of blood and fluid within the ovary, causing intense abdominal cramping that can occur at any point of the menstrual cycle.

3. Polycystic ovarian syndrome

PCOS is characterized by the formation of small cysts on the ovaries due to an increased production of testosterone in the body. It can cause intense cramping during ovulation or at any point of the menstrual cycle.

This syndrome can lead to irregular periods, difficulty getting pregnant, infertility and excess growth of facial and body hair.

4. Dermoid cyst

A dermoid cyst, or a teratoma, is a benign cyst that can be present on one or both ovaries since birth. It is formed from embryonic cells and therefore may contain hair, skin, teeth, keratin, sebum, and rarely, cartilage.

Although this type of cyst generally does not cause pain, it can be found during imaging tests. Very large cysts can cause ovulation pain due to inflammation and intense cramping.

5. Cystadeoma

A cystadenoma is a type of benign ovarian cyst characterized by the growth of epithelial tissue on the external surface of the ovary. It can cause abdominal pain and cramping outside of a period, including during ovulation.

In addition, this type of cyst can cause changes to period, like a long cycle, breakthrough bleeding, intestinal changes like constipation or diarrhea, and urinary changes like retention.

6. Sexually transmitted infection

STIs are spread through unprotected sex with a partner who is affected. Common infections include gonorrhea, chlamydia or HPV. They can cause pain during inflammation as these infections are associated with inflammation and can lead to scarring of the ovaries and fallopian tubes. Infections can cause cramping as well as a foul-smelling discharge, fever or burning with urination.

STIs require immediate medical attention and treatment. Learn more about common STIs and how they are treated.

7. Scar tissue

Ovulation pain can also occur following a C-section or appendix surgery, due to the formation of scar tissue around the ovaries, fallopian tubes and uterus. In can cause stiffness between these structures, leading to pain and cramping.

8. Ectopic pregnancy

An ectopic pregnancy is characterized by the implantation of an embryo outside of the uterus. It most commonly occurs in the fallopian tubes, but can also occur in the ovary, cervix or abdominal cavity. This condition can cause intense pelvic pain on one side and can also cause pain during ovulation.

An ectopic pregnancy requires immediate treatment from a gynecologist with medication or surgical removal. Learn more about ectopic-pregnancies and how they are treated.

9. Appendicitis

Ovulation pain can occur with appendicitis, which involves inflammation of the appendix. This structure is present in the intestine and can cause right-sided abdominal pain when it is swollen, as well as lack of appetite, nausea, vomiting and fever. This condition requires urgent medical attention. Understand what can cause appendicitis and how it is treated.

How to get rid of pain

Generally, ovulation pain lasts for up to 24 hours and does not require any treatment. However, you can place a warm compress on the abdomen or take a warm bath to relieve any discomfort.

In some cases, if the pain is very intense, your doctor may recommend anti-inflammatories like naproxen or ibuprofen. Women who frequently experience ovulation pain may be advised to start treatment with a birth control pill.

When to see the doctor

Although ovulation pain is a normal finding, very intense, unexpected pain should be assessed by a doctor to rule out another condition.

You should also seek medical attention immediately if your ovulation pain occurs with symptoms like:

Fever
Pain or burning with urination
Foul-smelling discharge
Yellow, gray or greenish discharge
Redness or burning abdominal skin, where you feel pain
Nausea or vomiting
Loss of appetite
Vaginal bleeding
Delayed period
Pain that lasts for over 1 day
Pain that does not improve with anti-inflammatories

In these cases, to determine the cause of ovulation pain, the gynecologist will complete a physical exam, evaluate the health history of the patient, collect a vaginal swab and order blood work and other imaging tests, like a pelvic ultrasound, MRI or CT. Treatment can be started with birth control pills or antibiotics, and in some cases, surgery will additionally be advised.