Horrible ovulation pain: what to know

Ovulation pain, also called mittelschmerz, can feel like a twinge, cramp or ache on one side of the lower abdomen around the middle of a cycle. It may switch sides between cycles and can last briefly or for longer. Pain that is severe, worsening, present outside the expected timing or associated with other symptoms should not be assumed to be ovulation pain. Endometriosis and ovarian cysts are examples of conditions that can also cause pelvic pain, but pain alone cannot identify its cause.

Record the date, side, duration, severity and relationship to bleeding, sex, bowel movements or urination. Rest, warmth and a pain medicine that is safe for you may help mild familiar symptoms; follow the label and avoid medicines that a clinician has told you not to use. If pain keeps returning or interferes with daily activities, arrange a pelvic assessment. A clinician may ask about cycles, pregnancy possibility, bowel or urinary symptoms and previous pelvic conditions.

Seek urgent care for sudden severe pain, fainting, marked dizziness, fever, repeated vomiting, a rigid or swollen abdomen, heavy vaginal bleeding or pain with a possible pregnancy. Prompt assessment is also needed for pain with new discharge, pain during sex or symptoms that do not settle. These warning signs can point to problems that require treatment beyond routine ovulation care.

Does the timing and pattern fit ovulation pain? Should I have an examination or imaging? Could endometriosis, an ovarian cyst, infection or pregnancy-related pain explain it? What safe plan should I use if it returns?