Does endometriosis cause ovulation pain?

Ovulation is a big moment in your menstrual cycle. It’s when your ovaries release an egg into your uterine (or fallopian) tubes. The majority of people don’t notice ovulation happening, but for up to 40% of us, egg release can lead to pain or discomfort called mittelschmerz.

Ovulation pain is usually mild, but it can sometimes indicate a health condition like endometriosis. Here, fertility doctor Dr. Tiffany Jones from Texas, US, shares what you need to know about the link between endometriosis and ovulation pain.

Key takeaways

• Up to 4 in 10 of us experience ovulation pain, or mittelschmerz. Our ovaries releasing an egg can sometimes cause a little discomfort, but in most people, the pain is usually mild, and it should be over within 48 hours. 
• Ovulation pain, especially if it’s long-lasting or severe, can sometimes indicate a health condition like endometriosis. Although endometriosis is associated with painful periods, it can cause pain at other points in your cycle, too.
• Endometriosis happens when tissue like the lining of your uterus grows in other places in the body. Because this tissue responds to the hormones that control your menstrual cycle, it can lead to inflammation, pain, and swelling as your hormone levels change. 
• If pain is getting in the way of your life — wherever it occurs in your cycle —  see your doctor. You don’t need to just live with it.
• A cycle-tracking app like Flo can help you log symptoms like cramping or pain so you can see if there’s a pattern around when they happen in your cycle.

Why endometriosis can cause ovulation pain

Endometriosis affects around 1 in 10 of us. It’s a condition where tissue similar to the lining inside your uterus (called the endometrium) grows in places it doesn’t usually, like your ovaries or uterine tubes. It’s often associated with painful periods and pelvic pain and can sometimes make getting pregnant more difficult — though there are lots of treatment options. 

“As the endometriosis is under exactly the same hormonal control as your uterus, it can cause tremendous inflammation and lead to bloating and cramping,” explains Dr. Jones.

And these symptoms might not be confined to when you have your period, she adds. Some people with endometriosis notice pain when they ovulate, too. 

Ovulation pain might happen with endometriosis because:

• Endometriosis can lead to inflammation in your pelvis. That’s because there is endometrial-like tissue in your pelvis that shouldn’t be there. When ovulation occurs, the tissue can flare up, which can further irritate this already sensitive area and cause pain.
• Endometriosis can sometimes cause scar tissue to form between organs (called adhesions). During ovulation, the natural movement of your ovaries and uterine tubes can tug on these adhesions, resulting in sharp pain.
• Endometriosis can lead to the formation of blood-filled cysts on the ovaries, known as endometriomas or “chocolate cysts.” These cysts can cause the ovaries to enlarge and become tender. And ovulation can aggravate these cysts, too.

Where you might feel pain caused by endometriosis

Endometriosis pain can be really different from one person to the next, which is part of what makes the condition tricky to diagnose, says Dr. Jones. But her patients often describe the pain in a few different ways. 

“Most of the time when I talk to patients, especially when they have confirmed endometriosis, it can be a sharp, ongoing, very intense pain and can even lead to nausea and vomiting,” she says. “But others describe it as a low, cramping-type pain.”

You’re most likely to feel endometriosis pain in your lower belly or back. But some people with endometriosis feel pain in other places like their bowel, chest, neck, or diaphragm, depending on where the endometriosis might be growing.

Where you feel pain could be a clue as to where the condition has developed, says Dr. Jones. So, tell your doctor as much as you can about the type of pain you’re feeling and where you’re feeling it. 

Signs that ovulation pain might be caused by endometriosis

Ovulation pain tends to be mild and typically only lasts up to 48 hours. You might notice a dull, nagging, cramping pain on one side of your body that starts halfway through your menstrual cycle.

But ovulation pain due to endometriosis might be more severe and last longer than a couple of days. Other signs of endometriosis can include:

• Painful or heavy periods 
• Painful sex 
• Pain when you pee
• Pain when you poop
• Pain accompanied by vomiting or diarrhea 

It’s always best to see your doctor if you’re concerned you might have endometriosis. 

How to ease the pain of endometriosis 

While endometriosis can be debilitating, there are lots of things you can do to take control of the pain. Managing endometriosis often requires a few different approaches and should always be guided by your doctor, but there are plenty of options that can relieve discomfort, says Dr. Jones. Your health care provider can recommend a treatment for endometriosis that best suits your needs if you do have the condition. Here are some of the pain relief options they might suggest:

Over-the-counter medication

“Typically, we’d recommend anti-inflammatory pain relievers as first-line treatment for endometriosis,” says Dr. Jones. Medicines like ibuprofen and naproxen can relieve pain and inflammation caused by endometriosis. But check with your doctor first whether they’re right for you because they may not be suitable for everyone.

Self-care

Being gentle with yourself is also really important if you have endometriosis, but some people find light exercise (think yoga or a walk) can help with the pain. You might find taking a warm bath or applying a heating pad to your belly or back provides relief, too.

Medical options

There are lots of treatment options your doctor might recommend, such as prescription pain relief, birth control, or hormonal therapy that puts a pause on your cycle. “I have endometriosis patients who do not have pain when they’re on birth control or medicines that shut down their cycle completely,” says Dr. Jones. But only your health care provider can tell you what might be suitable for you, so schedule an appointment to discuss your options. 

Medications can be really helpful for endometriosis. But in more severe cases, your doctor might recommend surgery for endometriosis. If this is suggested for you, you’ll be given plenty of space to learn more about what the procedure would involve so you can make a decision on whether it’s the right route for you. 

When to see a doctor 

The bottom line is that pain that gets in the way of your life isn’t normal. Although ovulation pain is quite common, it’s always worth telling your doctor about it if:

• The pain is severe or lasts more than a couple of days
• Ovulation pain is getting in the way of your normal day-to-day activities
• You have pain during sex or when you pee or poop

Even if you don’t think you’re experiencing problems with periods and ovulation, Dr. Jones recommends scheduling an annual check-up with your obstetrician and gynecologist. They’ll be able to tell you if what you’re experiencing is typical or not and whether you have any signs of a health condition that might need treating.

“The conversation should always be open to any concerns that you have,” she says. “Some people experience painful periods and think that’s how it’s supposed to be and never say anything because they have an internal barometer that this is normal. But it’s not.”