Why does pain occur?
By the middle of the cycle, one follicle becomes dominant and increases to about two centimeters. Its growth stretches the ovarian capsule, rich in nerve endings, and this can already feel like heaviness. At the moment of ovulation, the wall of the follicle ruptures, and follicular fluid with a small amount of blood comes out into the abdominal cavity, irritating the peritoneum. Additionally, the fallopian tubes contract, promoting the egg. The combination of these processes gives the characteristic pain, which is felt on the right or left, depending on in which ovary ovulation occurred.
- Stretching of the ovarian capsule by a growing follicle
- Rupture of the follicle wall
- Irritation of the peritoneum by fluid and blood
- Fallopian tube contractions
- The side of pain varies from cycle to cycle
What does she look like normally?
Usually the pain occurs approximately in the middle of the cycle, 12-16 days before the start of the next menstruation. It is pulling, aching or stabbing, of moderate strength, felt in the lower abdomen on one side, sometimes radiating to the lower back or rectum. Most often it lasts from several hours to one or two days. It may be accompanied by scant spotting, an increase in clear mucous discharge, increased libido and slight engorgement of the breasts. Normal ovulatory pain does not interfere with normal activities and is well relieved with simple painkillers or heat.
- Falls in the middle of the cycle
- Unilateral, moderate
- Lasts from several hours to 2 days
- Scanty spotting is possible
- Increased clear mucous discharge
- Does not interfere with daily activities
When is it not ovulation?
Conditions that require medical evaluation give similar sensations. Ovarian apoplexy - rupture of a vessel with bleeding into the abdominal cavity - is manifested by sudden severe pain, weakness and dizziness. Torsion of the cyst causes increasing pain with nausea and vomiting. Inflammation of the appendages is accompanied by fever and purulent discharge. Appendicitis begins with pain around the navel, moving to the right and down, with loss of appetite. An ectopic pregnancy occurs when menstruation is delayed and causes one-sided pain with spotting. In all these cases, help is needed urgently.
- Ovarian apoplexy
- Torsion or rupture of the cyst
- Inflammation of the appendages
- Appendicitis
- Ectopic pregnancy
- Exacerbation of endometriosis
- Cystitis and renal colic
Do I need to be examined?
If the pain is moderate and repeats the same way from cycle to cycle, a separate examination is usually not required - just talk about it at a scheduled appointment. You should contact us if the pain intensifies, changes in character, lasts longer than three days, or is accompanied by alarming signs. The doctor conducts an examination and ultrasound of the pelvis: in the middle of the cycle it shows a dominant follicle or a fresh corpus luteum and a small amount of fluid behind the uterus. Folliculometry helps confirm the fact of ovulation, which can be important when planning pregnancy.
- Examination by a gynecologist
- Ultrasound of the pelvic organs
- Folliculometry when planning pregnancy
- Pregnancy test during delay
- General analysis of blood and urine if inflammation is suspected
- Keeping a cycle and pain diary
What helps
Most often, simple measures are enough: rest, a warm heating pad on the lower abdomen if you are sure of the cause of the pain, a quiet regimen during this day. In case of severe discomfort, over-the-counter painkillers from the group of non-steroidal anti-inflammatory drugs help, but they should not be taken for a long time and without reason. If ovulatory pain unsettles you every month, the gynecologist may suggest combined hormonal contraceptives: they suppress ovulation and the pain disappears, but this option is not suitable when planning a pregnancy. If there is severe pain, you should not warm your stomach.
- Rest and peace during ovulation days
- Heat to the lower abdomen for a known cause of pain
- Non-steroidal anti-inflammatory drugs if necessary
- Combined contraceptives for severe syndrome
- Cycle diary to track patterns
- If there is severe pain, do not apply heat and consult a doctor.
