Endometriosis and Ovulation Pain

About 20% of women experience pain during ovulation, which is also known as Mittelschmerz or mid-cycle pain. Ovulation pain is typically a nagging pain that lasts for a few minutes up to 48 hours. However, severe pain lasting longer than usual may indicate an underlying medical condition such as endometriosis. 

Endometriosis can cause severe ovulation pain, heavy periods, severe period cramping, painful sexual intercourse, chronic pelvic pain, infertility, and more.

This article reviews typical ovulation pain, how endometriosis can cause ovulation pain, how to find relief, and when to seek medical care.

Woman in pain while working on laptop

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Should Ovulation Be Painful?

About 1 out of every 5 women experiences mid-cycle, ovulation pain. While some discomfort is not atypical or abnormal, you should not experience severe pain. 

What Is Ovulation?

Ovulation occurs when the ovary releases an egg. It is a normal part of the menstrual cycle. Most people with a uterus ovulate once per month, 10 to 14 days after menstruation (period bleeding) ends. They shed their endometrial (uterine) lining if ovulation does not result in pregnancy. This happens about 14 to 16 days after ovulation and causes bleeding during a menstrual period.

Mid-cycle pain doesn't always occur at the exact time of ovulation; it can be a day or two before or after, depending on the cause. Experts note that ovulation pain may occur when:

  • The egg follicle stretches the surface of the ovary. 
  • A ruptured egg releases blood or fluid.
  • The fallopian tubes spasm.

Other signs of ovulation include:

  • Increased, thin, clear, and slippery vaginal discharge
  • Mild change in temperature
  • Increased libido (sex drive)

How Endometriosis May Cause Ovulation Pain

Endometriosis occurs when the endometrial-like tissue that lines the uterus grows outside the uterus. Endometriosis lesions respond to changing hormone levels throughout the menstrual cycle.

When endometriosis lesions grow and bleed, they don’t have anywhere to go. They are not shed like the uterine lining. This can cause inflammation, pain, and heavy periods.

Endometriosis often causes intense pain during ovulation because lesions commonly grow around the reproductive organs, including the ovaries. Ovulation pain from endometriosis may occur when:

  • Lesions affect the ovaries and fallopian tubes.
  • Lesions cause nerve inflammation. 
  • Scar tissue or adhesions from endometriosis affect the ovaries or cause nerve pressure.
  • Endometriosis causes an endometrioma (a type of ovarian cyst called a chocolate cyst). 

What Does Ovulation Pain Feel Like?

Ovulation pain is typically mild and lasts for a few minutes up to 48 hours. It is located in the lower abdomen (belly) or pelvis (between the hips). Other ovulation pain characteristics include:

  • A dull, nagging, cramping pain (it may be sharp for a few moments)
  • Pain that starts about halfway through the menstrual cycle 
  • Pain on one side of the body (can alternate each month or be worse on one side)

During ovulation, you may also experience 

  • Headaches
  • Upset stomach
  • Malaise (not feeling well) 

Endometriosis Pain Location

Endometriosis lesions can grow anywhere in the body and cause pain. However, endometriosis pain is typically in the lower abdomen or pelvis. 

If the lesions press against nerves in the pelvis, pain can radiate to the buttocks, legs, and hips. Nerve damage or irritation can also cause neuropathy, which leads to tingling, numbness, muscle spasms, and weakness.

Signs That Endometriosis Is Causing Ovulation Pain

Ovulation pain due to endometriosis is typically more severe and lasts longer than is considered normal. Other signs that ovulation pain may be due to endometriosis include:

  • Intense, long-lasting pain (over 48 hours)
  • Pain with sexual intercourse
  • Painful urination
  • Painful bowel movements
  • Pain accompanied by vomiting or diarrhea
  • Bleeding during ovulation (more than light spotting)
  • Pushing, stabbing, tugging, or pulling pain
  • Pain that is not relieved with interventions 

Endometriosis Pain Relief and Treatment

In addition to ovulation pain, endometriosis can cause heavy menstrual (period) bleeding, excessive cramping, chronic fatigue, infertility, and more. Endometriosis treatment depends on the symptoms and severity. It ranges from lifestyle modifications to surgery. 

Lifestyle Changes

Lifestyle changes include:

  • Eating a healthy diet: An anti-inflammatory diet may be helpful.
  • Hydration: Drink plenty of water and avoid alcohol and caffeine (which are dehydrating).
  • Exercise: Movement helps relax muscles, increases circulation, and produces endorphins (naturally occurring pain reliever). 
  • Stress reduction: Reducing stress helps with muscle relaxation and oxygenation.

Over-the-Counter (OTC) Pain Relief 

Over-the-counter (OTC) pain relief includes Tylenol (acetaminophen) and nonsteroidal anti-inflammatory drugs (NSAIDs) such as:

Remember to check with your medical provider before taking any new medications or supplements.

Heat Therapy 

Heat therapy can help relax muscles and stimulate blood flow. You can try a: 

  • Warm bath
  • Heating pad
  • Hot water bottle
  • Disposable hot packs

However, your healthcare provider may recommend cold packs if endometriosis is causing nerve inflammation in your lower back.

Topical Medications

Rubbing topical medications on your lower back may help relieve nerve inflammation from endometriosis. If lidocaine is an active ingredient, it can help numb the pain fairly quickly. 

Topical medications come in patches, creams, or gels and include: 

  • Aspercreme (trolamine salicylate)
  • Bengay (menthol, camphor, or methyl salicylate)
  • Icy Hot (methyl salicylate-menthol)
  • Voltaren (diclofenac
  • Salonpas (methyl salicylate, menthol and tocopherol acetate (vitamin E), and camphor)

Complementary and Alternative Medicine (CAM) Treatments

CAM treatments include:

  • Chiropractic care
  • Acupuncture 
  • Supplements, including vitamin B1, magnesium, omega-3 fatty acids, cinnamon twig, or licorice root
  • Isoflavones (plant-based compounds that mimic estrogen)
  • Boiron, Naturopathica (arnica) cream or pellets

Medical Interventions

If the pain is severe or progressing, your healthcare provider may suggest the following:

  • Prescription anti-inflammatory or pain medications
  • Nerve blocks
  • Muscle relaxers
  • Vaginal Valium (diazepam)
  • Injections, such as Chirocaine (levobupivacaine) or Botox, BTXA, Dysport (onabotulinumtoxinA)
  • Physical therapy 
  • Surgery

Hormone Therapy

Hormone therapy can help reduce the growth of new endometriosis lesions and regulate the menstrual cycle. This includes:

Can Birth Control Help?

Hormonal birth control is a common treatment for people with endometriosis. It can help by: 

  • Preventing ovulation 
  • Reducing bleeding time (some stop periods) 
  • Lessening the intensity of cramps

The important thing to remember about hormonal birth control is that not all of it works for everyone the same. You must find the right one for your body. 

When to Seek Medical Care

Mild cramping or discomfort that goes away within a day or two during ovulation is considered normal. But debilitating pain is not normal and requires medical attention.

You should notify your healthcare provider if ovulation pain:

  • Keeps you from your normal day-to-day activities
  • Lasts longer than usual
  • Gets worse or doesn’t go away with prescribed treatment
  • Occurs along with vaginal bleeding (more than light spotting)
  • Is sudden, sharp pain that lasts for more than a few hours
  • Occurs with other symptoms such as fever (greater than 100.4 degrees F), nausea, or vomiting


The most common type of ovulation pain is called Mittelschmerz or mid-cycle pain. While some mild mid-cycle pain due to ovulation is normal, severe pain or pain lasting more than 48 hours may signify a more serious condition. If you experience pain that keeps you from your daily activities, notify your healthcare provider. 

Severe ovulation pain that lasts longer than 48 hours could be due to endometriosis. Other signs of endometriosis include painful periods, heavy periods, painful sexual intercourse, and more. Treatment for endometriosis varies based on symptoms and severity. It includes lifestyle changes, pain medications, hormones, and possibly surgery. 

13 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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Additional Reading

By Brandi Jones, MSN-ED RN-BC
Brandi is a nurse and the owner of Brandi Jones LLC. She specializes in health and wellness writing including blogs, articles, and education.