We all know about the period pain that hits just before and during our bleed, when our uterus cramps to shed its lining and the unfertilised egg. And while there’s still not enough support for PMS, things are changing: there are conversations about menstrual leave at work and pads, pills and supplements designed specifically to ease the pain that preempts or coincides with our periods.

But for many women, pain doesn’t only occur around the bleed itself, but at ovulation. Ovulation pain, known as mittelschmerz (which translates to ‘middle pain’, as it occurs in the middle of the cycle), is thought to impact 40% of women. 

“It’s felt in the lower abdomen, usually on the same side as the ovary that is releasing the egg,” explains Le’Nise Brothers, a registered nutritionist and author of You Can Have A Better Period. 

“Ovulation can be quite a violent process,” says Brothers. “When the mature egg is released from the ovary during ovulation, it has to break through and rupture the follicle.”

After the egg is released, muscles of the fallopian tube also contract to push the egg towards the uterus. With all this going on, it’s no surprise we can feel some sensation in our stomachs at this time of the month. 

“Mittelschmerz can feel differently depending on the person, their levels of inflammation and even how the rest of the menstrual cycle is being managed. For some, ovulation can feel like a pinch or a dull ache. For others, it can feel like a red-hot burning poker on the ovary or a sharp, stabbing pain,” says Brothers

Dr Melanie Bone, OBGYN and board member for gynaecological health company Daye, agrees, saying: “The release of an egg from the ovary can cause mild to moderate discomfort or pain in the lower abdomen, which may last from a few minutes to a few hours. 

“Some women can even experience extreme ovulation pain, but the reason why is poorly understood.”

According to a 2022 report, some women are even misdiagnosed with appendicitis during ovulation – especially when the egg is released from the right ovary – because of the extreme pain experienced. 

A lack of knowledge around ovulation and stomach pain isn’t because you happened to miss that sex ed class. In fact, there are hardly any conversations or research into mittelschmerz.

Despite being referenced in journals as far back as 1949, there are virtually no studies looking at the causes, symptoms or management of mittelschmerz. As the New York Times recently reported, there’s a history of looking at women’s biological functioning “as sort of inherently pathological”, meaning that periods are seen as a kind of illness or disease rather than a functional reality. And when pain presents without physical proof of bleeding as it does in ovulation, it is potentially even more easily dismissed.

Hopefully, this is changing. Conversations online are allowing women to give a name to many of the under-discussed symptoms of the menstrual cycle, including ovulation pain, and know they aren’t alone. 

“This, alongside the fact that many more women and people with periods are tracking their menstrual cycles, is allowing people to identify when they experience cyclical pain with more accuracy and then have more of a vocabulary for when they do seek help,” says Brothers. 

“More often than not, ovulation pain is not a sign of a serious health condition,” says Dr Bone.

However, in some cases, mid-cycle pain can also be caused by other conditions. “Ovarian cysts (a pouch of fluid that develops on the ovaries), uterine polyps or endometriosis lesions on the ovaries can cause similar pain. It can also be a symptom of inflammation, ovarian or pelvic scar tissue or another condition such as adenomyosis, fibroids or pelvic inflammatory disease,” explains Brothers.

It is hard to differentiate between any of these conditions, explains Dr Bone. “However, ovulation pain is typically characterised by mild to moderate pain or discomfort that occurs on one side of the lower abdomen and lasts for a short time. Ovarian cysts, on the other hand, may cause similar pain, but it’s typically more extreme and persistent. Other stomach pains may have different characteristics, such as location, severity or duration.” 

While the word ‘pain’ is often used to describe the discomfort we experience, the menstrual cycle should actually never be unbearably painful. “People should see a doctor if ovulation pain is severe or persists for more than a few hours, if it is accompanied by other symptoms such as fever or vomiting or if they have a history of ovarian cysts. A doctor can help determine the underlying cause of the pain and recommend the appropriate treatment,” advises Dr Bone.

Medication and heat

“At home, you can manage discomfort by taking over-the-counter pain relievers such as ibuprofen. Applying heat to the lower abdomen or taking a warm bath may also provide relief.”

Magnesium supplements

Brothers recommends long-term, holistic solutions to minimise ovulation pain too. “Magnesium glycinate is a relaxing mineral, so it’s a fantastic all-rounder for pain relief and easily absorbed by the digestive system,” she says. 

“Try taking two 100mg capsules of magnesium glycinate in the morning with your breakfast all throughout your menstrual cycle. On days you experience ovulation pain, you may also want to topically apply a magnesium spray on any areas that are painful, such as your abdomen, legs or back, as this will have more of a local effect.”

A paper from last year found that with dysmenorrhea – extremely painful periods – those who supplemented with 200mg of magnesium were less likely to need additional painkillers. It’s thought to help by reducing prostaglandins and muscle cramps, which is why it might be similarly useful during ovulation.

Whether or not you experience mittelschmerz, it’s clear that we need more conversations and, in particular, scientific research into the condition to support those who struggle. 

“It is important to speak up if you are experiencing ovulation pain so we can work towards normalising the condition and get it the attention it deserves,” agrees Dr Bone. 

Images: Getty