Illustration by Katrin Friedmann
What is ovulation pain and how do I know if I’m having it?
Up to 40% of people with cycles feel pain around the time an egg is released from their ovary. Here's how to identify it.
Top things to know about ovulation pain:
Around 1 in 3 Clue users report ovulation pain
Ovulation pain is usually felt in the lower abdomen
Ovulation pain can range from mild to severe experiences
Ovulation pain is most likely due to a surge in the luteinizIng hormone (LH) before ovulation
Menstrual cycles and ovulation times vary from person to person and cycle to cycle
Ovulation pain should not be used as a method to prevent pregnancy or the only method when trying to conceive
Where do you feel ovulation pain?
Do you ever notice an ache or sharp pain on one side of your lower abdomen near the middle of your menstrual cycle? It could be ovulation pain, also known as mittelschmerz (1). Ovulation pain is felt in the middle of the pelvis or in the lower abdomen on the same side as the ovary that is releasing an ovum (immature, unfertilized egg) (1).
What causes ovulation pain?
Ovulation pain most likely happens when the chemical hormone called luteinizing hormone (LH) increases quickly in the body (1). LH is the hormone that causes a follicle (fluid filled sac) in the ovary to release an ovum (immature, unfertilized egg) (2). This quick surge causes muscles in or near the ovary to tighten (1). LH surges about 24-36 hours before ovulation, and this is when ovulation pain is thought to happen (1-3).
Caregiving guidelines that healthcare providers use to care for people with cycles usually report ovulation happening about 14 days before the period starts (2). This is not true for every person and every cycle (4). Ovulation varies from cycle to cycle even for those with a predictable 28 day cycle (4). Research shows that there is a broader range for ovulation—about 7-19 days before the next period (4).
If ovulation pain happens at the same time as the LH increase that causes ovulation, you may feel pain a day or so before ovulation happens (1).
What does ovulation pain feel like?
Many of those that feel ovulation pain feel only a mild ‘twinge’ or dull ache that is short-lived (1, 3). Some people describe ovulation pain as severe and find that it interferes with their daily functioning when it happens (1).
Tracking ovulation pain in the Clue app can help you determine when to expect it.
How to treat ovulation pain
There are no official treatment recommendations for ovulation pain. For people with mild discomfort, they may find it reassuring and a reminder of their body’s activities. Others may want to manage the pain the same way they would period cramps: with heat, massage, or over-the-counter pain medications, such as nonsteroidal anti-inflammatories. Some people may benefit from using oral hormonal birth control to decrease ovulation pain (1).
If the pain is severe, consider talking to your healthcare provider. No one needs to live in constant or recurring pain that gets in the way of their day-to-day life.
How to know whether you’re feeling ovulation pain
Tracking when, where, how long, and how severe the pain you feel around ovulation can help you watch out for any health concerns and possibly predict ovulation.
Track the timing of it with your cycle
Ovulation pain typically begins a few years after a person starts menstruating (1). For those that experience ovulation pain, it is often not felt every cycle (1).
Track whether you feel it on the left side, right side, or both
Ovulation pain is typically felt on the side of the ovary that is releasing an egg that cycle; it may be felt in the middle or on the opposite side of ovulation (5).
For about half of women, ovulation alternates between the left and right ovary (6), which may explain why some people report that it alternates from side to side (5).
For some people with ovaries, the ovary that ovulates is random, but overall, both ovaries end up ovulating just as much as the other (6).
Track how long it occurs
Ovulation pain often lasts between 6 and 12 hours (3). Clue has found that the majority of people who track ovulation pain do so for only one day. Others track it for two or more days. It is difficult to know to what extent other factors play a role, such as ovulatory pain due to endometriosis.
Track the sensation or severity
The sensations or pain of ovulation is as unique as the person who experiences it. For some, it’s not painful, but just uncomfortable—some have described it as a sense of fullness or tension (1). For others, it’s been described as cramp-like, sharp, dull, and intermittent. It’s mild for most but more acute and painful for others (1).
Jotting down details of ovulation pain in an organized way can help you track what you are feeling and guide you when or if to reach out to a healthcare provider.
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Other causes of pain in the general area of your ovaries
An appendicitis, ectopic pregnancy, or complications of an ovarian cyst can all have similar symptoms as ovulation pain, but tend to be more severe and unexpected (1, 7, 8). These conditions require immediate medical treatment.
Ongoing pelvic pain can be a sign of a condition or infection such as pelvic inflammatory disease or endometriosis, which also require treatment or management from a healthcare provider (9, 10).
Clue’s research finds that 1 in 3 people regularly track ovulation pain
Ongoing research by Clue collaborator Ruben Arslan at the Max Planck Institute has found that about 1 in 3 people—36% to be exact—regularly track ovulation pain in Clue. (This is of Clue users not taking hormonal birth control who track relatively consistently). Other research shows that more than 40% of people experience it (1).
Can ovulation pain help predict the timing of ovulation?
Statistically, the timing of ovulation pain tracked in Clue seems to be fairly promising as a predictor of ovulation.
People in Clue most often tracked ovulation pain on the day just before an estimated ovulation. Others track ovulation pain on the same day as their estimated ovulation in Clue, or outside of that window altogether.
Ovulation pain can be a useful tool to track ovulation for those that experience it consistently (1, 3). Most people do not feel ovulation pain (11). Of those that do feel it, it may not be consistent. Because of this, ovulation pain should not be used as a method to prevent pregnancy or the only method when trying to conceive.
Ovulation prediction tests/kits (OPKs) detect LH surges through urine tests and can track ovulation with an accuracy of 97% (12).
An earlier version of this article was published May 23, 2019.
