Ovulation is a critical part of reproduction. Not every person who menstruates will feel ovulation when it occurs, but it can be very painful for others.

Though the sensation isn’t necessarily cause for alarm, you shouldn’t ignore ovulation pain — it can be a sign of something more serious.

Here’s what you need to know:

In most cases, ovulation discomfort is brief and harmless. You may notice one-sided pain for a few minutes or even a couple hours on your day of suspected ovulation.

Ovulation involves a follicular cyst swelling and then rupturing to release the egg after a surge in luteinizing hormone (LH) goes through your body.

After the egg is released, the fallopian tube contracts to help it reach awaiting sperm for fertilization. Blood and other fluid from the ruptured follicle may also enter the abdominal cavity and pelvis during this process and cause irritation.

The sensation can range from a dull ache to sharp twinges. It may be accompanied by spotting or other discharge. If your pain becomes severe or happens at other points in your cycle, check in with your doctor.

There are several other reasons why you might be experiencing pain during your cycle.

Try keeping track of when and where you feel the discomfort, how long it lasts, and any other associated symptoms. Keeping a record can help you and your doctor figure out the underlying cause.

If your midcycle pain persists, your doctor can perform different tests to identify the source and offer treatment to help.

Cysts

An ovarian cyst can cause a number of symptoms, from cramping and nausea, to bloating. Some cysts may cause no symptoms at all.

Dermoid cysts, cystadenomas, and endometriomas are other, less common types of cysts that might cause pain.

Another condition called polycystic ovary syndrome (PCOS) is marked by many small cysts on the ovaries. Untreated PCOS can cause infertility.

Your doctor may order a CT scan, MRI, or ultrasound to help determine if you have a cyst and what type it is. Many cysts resolve on their own without medical intervention.

If they grow or are abnormal, though, cysts can lead to complications and may need to be removed.

Endometriosis or adhesions

Endometriosis is a painful condition where tissue similar to the inner lining of the uterus grows outside the uterine cavity.

Areas affected become irritated when the lining tissue responds to hormones during your cycle, causing bleeding and inflammation outside of the uterus. You may develop scar tissue or endometriosis adhesions that are particularly painful during your period.

Likewise, intrauterine adhesions, also known as Asherman syndrome, can develop if you’ve had previous surgery. This includes a dilation and curettage (D & C) or cesarean delivery.

A prior infection in the uterus can also cause these adhesions. You can also develop Asherman syndrome with no known cause.

Since doctors can’t see these conditions during a routine ultrasound, your doctor may order a hysteroscopy or laparoscopy. These are surgical procedures that let doctors see directly inside your uterus or pelvis.

Infection or sexually transmitted infections (STIs)

Is your pain accompanied by unusual or foul-smelling discharge? Do you have a fever? Do you feel burning when you urinate?

These symptoms might indicate a bacterial infection or a sexually transmitted infections (STI) that needs urgent medical attention.

Medical procedures — or even childbirth — can cause infections. Sometimes a urinary tract infection (UTI) might even cause general pelvic pain.

STIs like chlamydia, gonorrhea, and human papillomavirus (HPV) are contracted from condomless sex.

Ectopic pregnancy

One-sided pelvic pain could be a sign of an ectopic pregnancy.

This occurs when an embryo implants in the fallopian tubes or other location outside of the uterus. An ectopic pregnancy is potentially life-threatening and is usually discovered by the eighth week.

If you think you might be pregnant, see your doctor immediately. If you have an ectopic pregnancy, you’ll require immediate treatment with medication or surgery to prevent your fallopian tube from rupturing.

If you’ve visited your doctor and ruled out any issues, you’re likely experiencing normal ovulation discomfort. Continue to pay attention to any changes in your symptoms.

Here are some things you can do to ease the discomfort of midcycle pain:

The American College of Obstetricians and Gynecologists (ACOG) recommends women from ages 21 to 29 have a Pap smear to screen for cervical cancer every 3 years.

ACOG also recommends women ages 30 to 65 have either a Pap smear every 3 years, or a Pap smear with an HPV test every 5 years.

Women over 65, according to ACOG, don’t need to have cervical screening unless they have a history of:

  • abnormal cervical cells
  • a number of abnormal Pap test results in the past
  • cervical cancer

All people who menstruate should also have a yearly wellness visit with their gynecologist for a full pelvic exam and to discuss any other concerns about their gynecological health.

Yearly exams are recommended, even though you might not need a Pap smear each time. If you’re overdue for your visit or are having pain and other symptoms, call your doctor today.

For many people who menstruate, midcycle pain is simply a sign of ovulation. There are several other conditions that can cause pelvic pain, some of which are serious if left untreated.

It’s always a good idea to pay attention to your body and report anything new or different to your healthcare provider.

Read this article in Spanish.