Painful Ovulation-(Mittelschmerz)

UP until the onset of menopause, once every month most women, except in the case of pregnant and breastfeeding mothers, experience a phase in their menstrual cycle known as ovulation. This process involves the release of an egg from one of the two ovaries, and is generally painless in most cases. However, according to Dr Shantell Neely-James, consultant obstetrician and gynaecologist at Trade Medical, Portmore, some women experience Mittelschmerz (painful ovulation) every month.

“Mittelschmerz, German for “middle” and “pain”, is a phenomenon of one-sided lower abdominal pain occurring during the mid-menstrual cycle. Up to 80 per cent of menstruating women will experience ovulatory pain at least once in their lifetime. Approximately 20 per cent of women experience this mid-cycle each month,” Dr Neely-James revealed.

She explained that ovulation pain is believed to signal ovulation, which usually occurs two weeks before menstruation, and can range from a dull, cramp-like pain to severe and debilitating pain with mild vaginal bleeding or discharge.

“What happens is that during the menstrual cycle there is follicular development, with a dominant follicle which is surrounded by fluid and blood. At the time of ovulation, when the egg is released from the dominant follicle, the surrounding fluid and blood are released and it is believed to cause irritation of the lining of the abdominal cavity, which usually resolves within 24 hours,” Dr Neely-James underscored.

Since there are many possible causes of pelvic pain which can occur during or near the period, abdominal and pelvic examinations can be used to rule these out and to diagnose painful ovulation.

“Endometriosis, which usually causes severe pain near or during the menses, can be associated with heavy bleeding. Appendicitis is a potentially life-threatening cause of pelvic pain that can coincide with ovulation. Pelvic inflammatory disease can occur at any time during the menses, and these can be heralded by a sudden sharp pain and vaginal discharge. With the increasing popularity of fertility-enhancing drugs, there has been an increase in the severity of ovulatory pain which can result in ovarian hyperstimulation syndrome, which is where multiple follicles mature, and when ruptured can contribute to increased peritoneal irritation,” Dr Neely-James explained.

In order to diagnose Mittleschmerz, she said that the doctor would need the menstrual cycle history, location and description of pain. An ovulatory kit can be used to confirm ovulation that coincides with the onset of the pain, while radiologic imaging can be used to rule out other causes of pelvic pain.