The idea that women are destined to experience pain simply because they have a menstrual cycle is not okay with me. It's true our bodies go through changes throughout the month that indicate hormone shifts, and sometimes this can cause discomfort, but that doesn't mean you should have to rely on painkillers to get through your cycle.
Ovulation pain, aka Mittelschmerz, is actually quite common. Up to 40% of women experience this pain before, during, or after ovulation—around halfway through their cycle. But you don't need to grin and bear it or mask pain with hormonal contraceptives that disrupt your body's natural cycle.
Addressing hormone balance and inflammation (while ruling out other reasons for pain) is the best plan of action for Mittelschmerz. In this article, we'll look at ovulation pain, what's normal and what needs further investigation, and steps you can take to address it naturally.
What is Ovulation Pain? “Mittelschmerz”
The word Mittelschmerz stems from a German phrase, meaning “middle pain,” as it usually occurs in the middle of the menstrual cycle. It's described as a one-sided lower abdominal pain that can happen every month during ovulation or come and go from month to month. Some women describe it as a dull ache, while others experience it as more severe or sharp.
To understand why it happens, let's quickly review ovulation. Ovulation is when the ovary releases an egg to be fertilized if it meets with sperm. This usually occurs around day 14 of a 28-day cycle but can vary depending on your hormone levels and cycle length.
During the first half of the menstrual cycle, follicle-stimulating hormone (FSH) and luteinizing hormone (LH) trigger the growth of ovarian follicles that contain eggs, but usually, only one will be released during ovulation.
Estrogen peaks about halfway through the cycle, which triggers the release of LH. LH tells the follicles to release the egg, and the corpus luteum—the remains of the follicle—produce progesterone to prepare the uterus for possible implantation.
Studies suggest that Mittelschmerz is linked to higher levels of LH right before the follicle ruptures and releases the egg.
What Causes Ovulation Pain?
Other reasons may include the following:
- As the egg continues to expand, it puts pressure on the ovary resulting in pain
- Fluid and blood released with the egg may cause irritation and inflammation
- Sensitive people may be able to feel the tissue rupture when the follicle releases the egg
- Contraction or spasms of the fallopian tubes or uterus create discomfort
How Long Can Ovulation Pain Last?
Mittelschmerz typically lasts 24-48 hours and can occur a few days before ovulation or up to two days after. Pain that lasts longer than 48 hours is likely unrelated to ovulation and should be checked out by a healthcare provider.
Ovulation Pain vs. Implantation Pain
Can you tell the difference between ovulation pain vs. implantation pain? First, let's look at implantation pain and what it means.
Not everyone who becomes pregnant will experience pain or even notice embryo implantation, but some women report cramping or pain in their lower abdomen. Typically this sensation would be a week or so after ovulation because you need time for the egg to release and travel down the fallopian tube to meet up with the sperm for fertilization and implantation.
There isn't much science examining either type of pain, so whether the pain is due to the embryo implanting or something else isn't known. What we do know is that both ovulation and implantation pain can be similar and difficult to distinguish.
Other Potential Causes of Abdominal Pain During Ovulation
Whenever a woman comes to me, I always check into other possible causes of abdominal pain during ovulation to rule out more serious causes. Here are some of the things that could be responsible.
I evaluate for endometriosis first when women come to me with persistent abdominal or pelvic pain. This hormone-driven condition occurs when tissue that usually lines the uterus grows outside of it, causing inflammation, scar tissue, and adhesions. The result is pain, pain, and more pain.
Pain and symptoms of endometriosis can range from mild to severe, depending on the size and location of the lesions. Since it's hormone-influenced, endometriosis symptoms can flare up right before and during ovulation (and during your period). Endometriosis pain is usually more intense than what you would experience from Mittelschmerz alone.
Appendicitis, the inflammation of the appendix, is another possible cause of abdominal pain, primarily on the right side. It may feel like a sharp or dull ache with tenderness in your lower abdomen and can be accompanied by nausea, vomiting, fever, and abdominal swelling.
Appendicitis can quickly become a medical emergency if it's not treated promptly. A ruptured appendix can cause infection and abscess. Unlike ovarian pain, this usually begins quickly and with greater intensity and wouldn't be something that occurs off and on each month.
Diverticulosis is a condition in which small, bulging pouches form along the wall of the large intestine. When these become inflamed and infected, it's called diverticulitis and can cause intense pain in the lower left quadrant of your abdominal area. Diverticulitis usually affects older adults (up to 65% of people over the age of 80 have diverticulosis), but it can occur in younger people too.
High-fiber diets, staying hydrated, and avoiding constipation can reduce the risk of developing diverticulosis in the first place, but complications can be serious, so it's important to rule it out. Since this condition has nothing to do with hormones, it can occur anytime, not only during ovulation.
Fibroids and Cysts
Another hormone-driven condition that can cause pain during ovulation is fibroids and ovarian cysts. Both can cause dull, throbbing pain in the lower abdomen or lower back pain, which may be worse during ovulation or your period simply because of the increased hormone activity.
Uterine fibroids are often driven by estrogen dominance, where someone either has low progesterone or the ratio of progesterone to estrogen is off. Ovarian cysts can also be caused by hormone imbalances (but not always), as seen with polycystic ovary syndrome (PCOS).
A simple but often overlooked cause of abdominal pain is a musculoskeletal injury, such as a pulled muscle in your abdomen or lower back. This can occur from lifting heavy objects, doing intense exercise, a wiggly toddler’s accidental kick, or even sleeping in an awkward position.
If you've been in pain for more than a few days and it's not getting better with rest, or if it's accompanied by swelling or bruising, then see your provider to rule out a serious musculoskeletal injury.
Natural Relief for Ovulation Pain
Addressing hormone balance through diet, lifestyle, and supplements is crucial, but in the meantime, you may want to find other ways to support ovulation pain, especially if it's impacting your quality of life.
Remember that, unlike medication, natural remedies for ovulation pain can take several cycles to find improvement. We're often so used to immediate results, but this isn't always possible when addressing the underlying cause of a condition. Staying consistent with your approach is key because it takes time for your body to respond.
Here are some of my favorite options.
Magnesium is always in my pain-relieving toolbox. Magnesium can relax tense muscles and help calm down inflammation by inhibiting signaling molecules that influence pain. It's also essential for hormone balance and can be taken orally, or sometimes people use topical magnesium for muscle pain.
Eating foods high in magnesium, such as spinach, chard, kale, pumpkin seeds, or black beans, can help you meet your magnesium needs. Still, many people don't get enough from their diet, especially in high enough doses to make a difference. Supplementing on top of diet sources can help you get the full benefits.
My free 7-day meal plan is full of nutrient rich foods that help with hormone balance and overall health!
Omega 3 Fatty Acids
Omega-3 fatty acids have been well studied for their impact on inflammation, supporting pain relief. One study found that omega-3 supplements were as effective, if not more, than over-the-counter pain relief options for supporting menstrual-related pain.
You can find Omega-3s in fatty fish such as salmon or in plant-based sources like walnuts and flaxseed, but supplementing with a quality product is often needed to get enough to see the full benefits.
Vitamin D isn't exactly a direct pain relief tool, but ensuring your vitamin D levels are healthy is essential to hormone balance and can influence pain related to the menstrual cycle. Low vitamin D levels are linked to a higher risk of menstrual pain because they can increase prostaglandin production.
It’s difficult to get your full requirement of Vitamin D from food alone, so a combination of safe sun exposure and supplementation can help get you there. It's ideal to know your baseline vitamin D levels so you can supplement accordingly, but generally, 4000 IU daily is typically a safe place to start.
Don't knock your grandmother's favorite remedy until you've tried it. Heat can be incredibly effective in reducing pain, especially with ovulation and menstrual-related pain. You can use a hot water bottle, heating pad, or even take a warm bath to get relief (add some Epsom salt for extra magnesium benefits).
Research on acupuncture and relief for cycle-related pain is promising. One study found acupuncture may help reduce menstrual pain as effectively as medication. It's thought acupuncture works by modulating pain pathways and supporting hormone balance, but further studies are needed to understand the full impact.
Like supplements, acupuncture may require multiple visits to see significant results, so don't be discouraged if you don't notice a difference in your first session.
Support Ovulation Pain By Addressing Hormone Balance
Mittelschmerz is common and can generally be addressed with natural support. But it's essential to talk with your provider if you're experiencing intense pain or if your symptoms are accompanied by other signs such as severe pain, heavy bleeding, fatigue, or infertility.
Supporting healthy hormones and reducing inflammation in your body can often be the most effective way to reduce ovulation and menstrual-related pain. Eating a healthy, anti-inflammatory diet and taking supplements can safely support hormone balance and pain relief.
I created my Period Problems Kit to address the most common symptoms associated with hormone imbalance, such as PMS, irregular cycles, and painful ovulation. It includes nutrients and herbs to help you find relief naturally without purchasing multiple bottles of supplements. Along with diet and lifestyle changes, this natural support system can help you find relief.
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