Mittelschmerz: Can you ‘feel’ ovulation if you experience pain in the ovulation phase?

Some women report that they can “feel” their ovulation when it happens. But what exactly do they feel and is it really ovulation? This article is about the so-called mittelschmerz or intramenstrual pain, the cause, and its meaning.

Middle pain, ovulation pain, or intramenstrual pain is the term used to describe a feeling in the lower abdomen during the ovulation phase. The sensation is experienced very differently and includes:

• a slight pulling sensation in the lower abdomen
• a vague feeling of pressure in the pelvic area
• a feeling of pressure in the perineal area
• pain similar to that experienced during menstruation
• back and leg pain

The sensation can be bilateral or unilateral. The side of the center pain allows you to draw conclusions about the location of ovulation. That is, if you feel a pulling sensation in the left abdomen during ovulation, it means that ovulation is likely to occur in the left ovary during that cycle. The mittelschmerz can occur suddenly and last for a short moment or be felt over several days.

During ovulation, the membrane of the egg follicle bursts, and the egg is released. During this process, the ovary is also minimally breached so that the egg can move into the fallopian tube. This could be the reason for the pain. However, in most cases, this does not seem to be the cause of mittelschmerz. Studies show that mittelschmerz is felt in the majority of cases in the 1-2 days before ovulation and ends the day before ovulation.

It has not yet been scientifically determined definitively what causes mittelschmerz. There are four possible triggers that can be causes of mittelschmerz:

 

• The piercing of the egg through the ovarian wall during ovulation.
• The swelling of the follicles in the ovaries prior to ovulation
• An irritation of the peritoneum due to leakage of blood or fluid when the follicle bursts
• An increased contraction of the fallopian tube on the side of ovulation, with the goal of transporting sperm to the egg

One possible cause of mittelschmerz is swelling of the ovaries due to maturing follicles before ovulation. This egg maturation phase is very sensitive to external influences. In particular, stress or illness can temporarily interrupt the process. In these cases, there may be a mittelschmerz without ovulation taking place. 

Mittelschmerz is not observed very often. About 30-40% of women report ever feeling a mittelschmerz and only 17% notice it regularly. However, it is not clear if mittelschmerz is rare or if many women do not pay attention to it or misinterpret it. Women who monitor their menstrual cycle are significantly more likely to report feeling a mittelschmerz. Here, about 65% report ever have felt mittelschmerz. It is normal not to feel the mittelschmerz symptom every cycle. 

If within 12-18 hours after ovulation the egg has been fertilized, the fertilized egg travels towards the uterus. It nests there about 6-7 days after ovulation. This implantation sometimes causes slight bleeding (also called implantation bleeding) and may also cause a slight pulling sensation similar to mittelschmerz. To distinguish mittelschmerz from possible implantation, it is important to know approximately the time of ovulation. The mittelschmerz tends to occur before ovulation or immediately 1-2 days after. If you are already a few days past ovulation, the tugging is more indicative of implantation. However, the prerequisite for this is that you had unprotected intercourse during the fertile phase before or during ovulation. If you are already close to menstruation again, then a pulling sensation in the abdomen can also indicate this. 

Ovulation pain is usually harmless. However, sometimes it can be a symptom of an underlying condition. If the pain is severe or you’re concerned about it, you should see a doctor to be safe.

Some underlying causes may cause problems:

• Endometriosis: can also cause pain during ovulation.
• Scar tissue: for example, after a cesarean section or appendix removal, can cause ovulation pain because it may be constricting the ovaries and surrounding structures
• Sexually transmitted infections (STIs): STIs such as chlamydia can cause inflammation and scarring around the fallopian tubes, which can subsequently cause pain during ovulation

Mittelschmerz is related to ovulation. However, contrary to what is often assumed, the pain does not necessarily come from ovulation itself. In many cases, women feel the mittelschmerz already a few days before ovulation occurs. This is why mittelschmerz cannot be used as a reliable parameter for determining ovulation. It can be considered a so-called secondary fertility marker, which can be used in addition to primary symptoms like cervical mucus, cervix location, and others to determine the fertile window in the cycle.

Sources:

Raith-Paula, E.; Frank-Hermann, P. (2020) Natürliche Familienplanung heute. Modernes Zykluswissen für Beratung und Anwendung. (6), Springer Verlag, S. 59.

Raith-Paula, E.; Frank-Hermann, P. (2020) Natürliche Familienplanung heute. Modernes Zykluswissen für Beratung und Anwendung. (6), Springer Verlag, S. 60.