Dear Doctor,

Unlike most women, my menstrual period is not painful. Besides having to change my pad, my period comes and goes without me even noticing. I wish that I could say the same for my ovulation period. I literally fall sick. I have painful cramps and my mood is that of an extremely irritated person. While I know how to get relief should I have a painful period, I don’t know what to do when ovulation is painful. What causes this and how can I deal with it?

Jennifer

Dear Jennifer,

Pain during ovulation or mittlesmerz is a common concer for many women. As  ovulatory cycles of a woman start few years after beginning of menstruation, this pain also starts few years after menarche(start of menstrual cycles). The pain may occur on either side of lower abdomen, depending on the left or right ovary releasing eggs.

Since birth in a female, due to hormonal influence, eggs are formed in ovary. They start getting released from a short time after menarche and this process continues till menopause. As ovulation occurs from 14th-21st day of menstrual cycle(counted from the first day of bleeding of a menstrual cycle), ovulatory pain also occurs in the same duration. It may last from 3-5 days. The exact cause of the pain is not known, It is said to be due to release of fluid and blood from ovary, while releasing an egg. The distension of the ovarian wall causes some discomfort. The fluid and blood released may cause irritation of the surrounding tissues, causing release of prostaglandins and pro inflammatory cytokines, resulting in pain.

 The pain occurs regularly   in middle of each menstrual cycle. Some women experience no pain at all, whereas some have mild pain which is best ignored. But the pain may be severe and disabling for some women, mimicking other causes of acute abdomen like appendicitis, severe colitis, etc There may be accompanying nausea and vomiting. 

In case of mild pain, nothing needs to be done. But for moderate and severe pain, one can take non steroidal anti inflammatory drugs(NSAIDS) like Ibuprofen. But if there is some condition like peptic ulcer disease, chronic dyspepsia, kidney failure, these drugs should be avoided as these conditions can be aggravated. Bed rest is also useful in reducing the pain. However if the pain is not controlled by pain relieving drugs, birth control pills that block ovulation are used. However a young woman desiring to start a family, should discuss with a doctor, before starting these pills, Ovulation can be suppressed  for some time, even after stopping the birth control pills. The pills used to stimulate ovulation like clomiphene citrate may be effective in first instance in some women, but in some it has to be repeated. They are also known to cause multiple births like twins, triplets, etc., many couples not being comfortable with it. A word of caution here. A woman who did not have painful ovulation before, if suddenly starts having pain and has well crossed puberty, should consult to exclude any other cause for  the pain on one side of lower abdomen.

Dr. Rachna Pande 

Internist

E-mail- rachna212002@yahoo.co.uk