Ovulation Pain: What Does Mittelschmerz Feel Like?

Nearly every person with a period recognizes the dull cramps that can accompany menstruation. As it turns out, about 40% of menstruating people also experience pain during ovulation, known as mittelschmerz (a German word meaning "middle pain").

Here’s everything you need to know about ovulation pain, including the causes and why you don't usually need to worry.

What Causes Pain During Ovulation?

Ovulation usually occurs around 14 days before a period, says Staci Pollack, M.D., an OB-GYN for the Division of Reproductive Endocrinology & Infertility at Montefiore Health System in Hartsdale, New York.

The ovaries grow about 20 eggs in fluid-filled sacs (called follicles) during the first half of the cycle (known as the follicular phase). In a typical cycle, one dominant egg matures fully and releases from the ovary during ovulation before traveling down the fallopian tube for 12–24 hours. If sperm fertilizes the egg during this time, the person can become pregnant. Otherwise, the egg absorbs into the uterine lining and is shed during the person's period.

Some people experience temporary discomfort during ovulation (when the mature egg is released from the ovary). Doctors don’t know exactly what causes this ovulation pain, but the following factors could trigger it:

• The egg stretching the ovary as it grows, then rupturing the follicle during release
• The fallopian tubes contracting when the egg travels to the uterus
• Fluid from the follicle irritating the abdominal cavity

What Ovulation Pain Feels Like

“Some women experience no ovulation pain at all,” says Rashmi Kudesia, M.D., an OB-GYN and reproductive endocrinology and infertility specialist at Houston Methodist and Houston IVF. But those who do report feeling a sensation that’s either dull, crampy, or sharp.

Since there is typically just a single egg released during ovulation, only one ovary is affected by the stretching and rupturing associated with ovulation. This means that ovulation pain usually centers on one side of the abdomen or pelvis (so don’t be alarmed if ovulation pain switches sides between cycles—this is expected).

Ovulation pain can range from mild to severe. Some people also notice a bit of spotting or discharge during mittelschmerz.

How Long Does Ovulation Pain Last?

Ovulation pain can last anywhere from minutes to a couple of days, says Dr. Kudesia. Some people feel mittelschmerz during every cycle, while others only notice it occasionally. According to research, the pain doesn't usually start until several years after a person gets their first period, once their ovulatory cycle has matured. The pain usually lasts for the duration of an ovulation cycle, which is roughly 12 to 24 hours.

Using Ovulation Pain to Conceive

Wondering whether you can use mittelschmerz to help get pregnant? Timing sex to conceive is all about timing sex with ovulation, after all. The short answer is that while it's certainly possible, there are more effective ways to time sex for pregnancy.

First, pain in your abdomen can have many different causes, and people who experience ovulation pain don't always experience it consistently with every cycle. Secondly, and perhaps most importantly, since sperm can survive in the reproductive tract for up to five days, a menstruating person's fertile window is actually much wider than just the day of ovulation. In fact, experts suggest that the chances of conception are best when baby-making sex is timed in the days leading up to ovulation.

So if you're timing sex to get pregnant, you can optimize your chances by taking advantage of this whole fertile window rather than waiting until you've ovulated. To help you identify your most fertile days, consider using tools like ovulation predictor kits (OPKs), fertility monitors, and other fertility markers like cervical mucus quality and basal body temperature.

How to Treat Ovulation Pain

Most people don't need treatment for ovulation-related pain that is mild and fleeting. For mild to moderate discomfort, however, home remedies such as the following can help:

• Using a hot compress or hot water bottle
• Soaking in a warm bath
• Self pelvic massage
• Yoga poses that specifically target pelvic pain, such as the Happy Baby pose

For more moderate ovulation pain that doesn't respond to home remedies, you may also try using over-the-counter painkillers like Tylenol (acetaminophen) or Advil (ibuprofen) for relief. Consult a health care provider to determine what is safest for you.

People who experience ovulation pain also find relief with contraceptives like estrogen-progesterone hormonal birth control pills that suppress ovulation (no ovulation means no ovulation pain). However, these medications are not typically prescribed specifically to treat mittelschmerz.

Should I Worry About Ovulation Pain?

When ovulation-related pain is mild, it's not usually worrisome and some degree of ovulation pain is considered "normal" for many people. But mid-cycle abdominal cramping could also signal other conditions that warrant treatment, such as:

• Ovarian cysts
• Ectopic pregnancy
• Endometriosis
• Pelvic inflammatory disease
• Appendicitis
• Infection

Additionally. if the pain occurs shortly before your expected period (instead of about two weeks before) and it's possible that you could be pregnant, the pain may be implantation cramps.

See a health care provider if you experience severe pain that lasts for days, fever, heavy bleeding that isn’t your period, trouble breathing, painful urination, vomiting, or diarrhea.

The Bottom Line

Mittelschmerz, or ovulation pain, is a common condition that affects 40% of people who menstruate. While it may be uncomfortable, it is often harmless and will resolve on its own. And luckily, for those who do experience ovulation pain, it doesn't always happen every cycle.

If you experience ongoing pain especially accompanied by other symptoms such as bleeding, fever, or vomiting, however, see a health care provider to screen for other conditions.