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Is Ovulation Pain an Accurate Way to Know When You Ovulate? Not Really.

About one in five women experience ovulation pain, a recurring monthly discomfort on either side of the abdomen. Many woman assume that the pain is associated with exactly when ovulation occurs, but surprisingly, this is not always the case; ovulation pain can happen at many points throughout the ovulation process.

Sometimes, ovulation pain is referred to as mittelschmerz, a German word that means “middle pain.” (Those Germans have a word for everything!)

What does ovulation pain feel like?

Different women experience ovulation pain (also called mittelschmerz) differently. Some of the ways that women describe it include:

  • The pain usually occurs on one side of the abdomen
  • It may alternate sides from cycle to cycle (this alternation happens randomly, because ovulation happens on a random side each cycle).
  • For some women, the pain is a dull ache that persists for a few minutes to a few hours.
  • For other women, the pain is sudden, sharp, and lasts for only a moment.
  • The pain is usually mild, but when it is severe, it can sometimes be mistaken for appendicitis.

What causes ovulation pain?

There are several hypotheses for what actually causes ovulation pain / mittelschmerz:

  • Swelling of ovarian follicles prior to ovulation: early in your cycle, multiple follicles begin maturing, with one of them eventually becoming dominant. Because follicles mature on both sides of the ovaries before dominant follicle selection, this may explain why ovulation pain is occasionally experienced on both sides of the abdomen.[1.Weschler, Toni (2002). Taking Charge of Your Fertility (Revised ed.). New York: HarperCollins. pp. 65–68, 228. ISBN 0-06-093764-5.]
  • Ovarian wall rupture: at the time of ovulation, the egg breaks through the walls of the ovaries. This may cause pain for some women.[2.Weschler, Toni (2002). Taking Charge of Your Fertility (Revised ed.). New York: HarperCollins. pp. 65–68, 228. ISBN 0-06-093764-5.]
  • Fallopian tube activity: After ovulation, the fallopian tubes contract to help the egg travel toward the uterus. This contraction may cause cramping.[3.Kippley, John; Sheila Kippley (1996). The Art of Natural Family Planning (4th ed.). Cincinnati, OH: The Couple to Couple League. pp. 83–84. ISBN 0-926412-13-2.]
  • Muscle contractions: At the time of ovulation, smooth muscles in the ovaries and its surrounding ligaments go through contractions in response to increased levels of prostaglandins[4.Michael H. Ross; Wojciech Pawlina (2006). Histology: A Text and Atlas (5th ed.). Hagerstown, MD: Lippincott Williams & Wilkins. p. 788. ISBN 978-0-7817-7221-1.] (these are lipid-compounds that are also responsible for period cramps).

Is mittelschmerz a reliable way to detect your fertile window?

In a word, no. There are many different things that can cause pain in the abdomen, and some of them are completely unrelated to your menstrual cycle (digestive issues—like gas!—for example). Without ultrasound evidence, it’s impossible to know for sure that pain is associated with ovulation.

Even if mittelschmerz pain is associated with ovulation, evidence is mixed that ovulation pain happens at the precise moment of ovulation. The pain might happen before, during, or after ovulation, and there is no easy way to know how the pain you experience correlates to ovulation.

But even if you knew for sure that your mittelschmerz pain happened at the precise moment that the egg bursts out of the follicle, it wouldn’t be very helpful in knowing when to have sex to get pregnant. That’s because the best time to have sex is in the days leading up to ovulation, not the day of ovulation itself (see our complete fertility calendar here). Once the egg is released, it has a short lifespan of 12 – 24 hours maximum. Chances of pregnancy are much higher when sperm is already waiting in the fallopian tubes at the time of ovulation.

That doesn’t mean you should ignore ovulation pain if you happen to experience it. But it should be considered one among many fertility signs. The most accurate predictions are made when looking at the overall picture given by multiple different fertility signs such as temperature, resting pulse rate, and cervical mucus. (Or you can measure multiple signs at once with the Ava bracelet!)

How do you know it’s ovulation pain and not implantation cramps?

If you’re tracking your cycle, telling the difference between possible ovulation pain and implantation cramps should be easy. Implantation usually occurs nine days after ovulation. So if you know when you ovulate, you can prevent confusion about the source of the pain you’re experiencing. (And speaking of implantation … read our post on the truth about implantation bleeding.)

How do you know it’s ovulation pain and not something else?

Pelvic pain during the menstrual cycle can be caused by many different things, including:

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