Ovulation Pain (Mittelschmerz) Symptoms

Ovulation pain, also called mittelschmerz (a German word that means “middle pain”), is relatively common and typically harmless. The pain is usually mild and occurs during ovulation, or when the ovary releases an egg.

However, ovulation pain symptoms can sometimes affect a person's quality of life or signal a more severe issue.

The sensation of pelvic pain during ovulation is quite variable and can be anything from a mild twinge to severe, stabbing pain, says Hugh Taylor, MD, chair of obstetrics, gynecology, and reproductive sciences at Yale University in New Haven, Connecticut. “’Twinge’ is the most common word I've heard,” he says. “Sometimes ‘pressure,’ sometimes a pulling or stretching feeling.”

In some instances, the mid-cycle pain can be felt in the lower back, as well, says Sharifa Menon, MD, section chief of general obstetrics and gynecology at Westchester Medical Center in New York.

Menon adds that, for some people, mittelschmerz may be severe enough to cause nausea. “Those who experience nausea typically have more intense ovulation pain than others,” she says.

Menon says that ovulation pain symptoms vary from person to person, and there's no definitive evidence that certain demographics experience different symptoms than others.

However, research indicates certain factors may increase the likelihood of experiencing pelvic pain during ovulation, says Shanna Combs, MD, associate professor of obstetrics and gynecology at Burnett School of Medicine at Texas Christian University in Fort Worth, Texas. These include:

• Younger Age Women between the ages of 15 and 25 are most likely to report ovulation pain.

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• Past Surgeries Scar tissue or adhesions from pelvic or abdominal surgery may increase discomfort during ovulation.

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• Health Conditions Women with underlying gynecologic conditions such as endometriosis or ovarian cysts are more likely to experience painful ovulation. (More on that later.)

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However, she says severe mittelschmerz may affect a person's quality of life. “It also can have indirect consequences, such as missed days at work or school and decreased socialization during this time,” Dr. Stark says. “Significant ovulation pain may lead to more use of urgent or emergency care and higher healthcare costs.”

Taylor advises talking to your doctor if ovulation pain is persistent, severe, or gets progressively worse month after month.

“If it's the same sensitivity to ovulation they've had since they got their first period, I'm less worried about it than if it's something that's been gradually getting worse and worse over time,” he says. “That's a sign that it may be some other underlying issue; ovulation sensations shouldn't get worse over time.”

Other potential causes of severe, worsening, or persistent pain around the time of ovulation include pelvic inflammatory disease (PID, an infection of one or more upper reproductive organs) or an ectopic pregnancy (where a mature egg grows outside the uterus, usually in the fallopian tube), Combs says.

PID and ectopic pregnancies are treatable but require immediate medical attention, as they can be life-threatening and cause complications if ignored.

Appendicitis (a medical emergency that happens when the appendix becomes infected and inflamed, causing acute abdominal pain) can also be mistaken for mittelschmerz.

“Any combination of sudden and intense abdominal pain, nausea, vomiting, fever, and dizziness is a reason to visit the emergency room,” Menon says.

• Abdominal discomfort is the hallmark symptom of mittelschmerz, but some people also experience nausea or lower back pain.
• Sometimes, underlying conditions like endometriosis and ovarian cysts can exacerbate or mimic ovulation pain symptoms.
• See your doctor if your ovulation pain is severe, gets progressively worse with time, or is accompanied by other symptoms.
• Seek emergency medical attention if you experience sudden and intense abdominal pain, nausea, vomiting, fever, or dizziness.