Ovulation pain: Why it hurts more for some and how to cope

It’s not your period, but it hurts like hell. You’re not sick, but you’re bloated, irritable, and spotting. Welcome to ovulation, the mid-cycle moment that’s misunderstood, under-discussed, and sometimes unbearable.

For some women, ovulation passes quietly. For others, it barges in like an uninvited guest, bringing mood swings, pelvic pain, sticky discharge, and a flood of questions even Google struggles to answer. Is it normal? Is it serious? Or is your body just doing its thing?

Dr Wachira Murage, a consultant obstetrician and gynaecologist at Savannah Hospital in Upper Hill, Nairobi, says ovulation typically happens around day 14 of a 28-day cycle, but that’s not universal.

“Cycles can range from 21 to 35 days. If your cycle is 21 days, you might ovulate on day seven. If it's 35, expect it around day 21.”

“It’s all about hormones,” he says. “Follicle-stimulating hormone (FSH), luteinising hormone (LH), oestrogen, and progesterone rise and fall in tune to prepare your body for pregnancy.”

After your period ends, usually between days three to seven, your body begins thickening the uterine lining again.

“The uterus prepares for a potential pregnancy. The body assumes conception is possible.”

Around ovulation, hormone levels peak and the body releases a mature egg. If fertilised, it has about three days to implant in the uterus. If not? “Then it waits for about 14 days. If nothing happens, then the menses come again for ladies with regular cycles.”

But not everyone runs like clockwork. Some women ovulate earlier or later, which can lead to heavier or irregular bleeding.

“You’ll hear some people say, ‘I bleed for long,’ or ‘I don’t have periods.’ It’s because of the variation of those hormones that peak mid-cycle.”

Ovulation signs and symptoms

Most of the time, ovulation doesn’t cause problems. But some women feel it—intensely. Pimples, mood swings, irritability, and emotional turbulence are common. Some have to take painkillers just to get through.

Then there's the ovulation pain. Dr Murage explains it vividly: “The process of ovulation involves an egg carried in a sort of ship. The ship travels, docks, and releases the egg. That docking is like a rupture of a follicle, something cutting the egg loose. and that’s where the bleeding comes from. Blood is a chemical; it’s an irritant. It causes inflammation and pain.”

The pain isn’t always a twinge. Larger follicles bleed more. Sometimes both ovaries release eggs. Pain can radiate down your legs. “The nerves are passing through there, so they’re irritated by that blood,” he says.

Hormones can also cause bloating, water retention, or a feeling of weight gain. “Some get diarrhoea, others vomit, because the hormonal upsurge affects the gastrointestinal tract, hence nausea or even loss of appetite.

Discharge is another clue. “A good, healthy ovulation discharge is clear and tenacious,” says Dr Murage. “You may have a streak of blood, but it doesn’t smell.” Brownish discharge can occur due to spotting. “But if it’s continuous, you need to get checked. It could be an early sign of cervical cancer. Make sure that within two years you’ve done your Pap smear.”

When ovulation is more painful

Women with endometriosis usually experience worse ovulation pain. Misplaced uterine cells respond to hormonal surges just like normal uterine lining—causing inflammation.

Pelvic inflammatory disease (PID) or active infections also worsen ovulation discomfort. “There’s a lot of activity happening around there during ovulation,” Dr Murage says.

Even the position of your uterus matters. Ideally, it’s tipped forward. But if it tilts sideways or backwards, it can press on the spine, causing backaches, especially mid-cycle.

“Severe ovulation pain is a diagnosis of exclusion,” he explains. “First, rule out infections. You can do a blood test. But start with listening to the patient. Before you rush to any test, do a thorough history. Understand the pain trend—when does it come? When does it stop?”

A pelvic exam helps too. “We can insert fingers into the vaginal region and feel where the pain is, from below and above. Sometimes there may be swelling, cysts, fibroids, or adenomyosis, where the uterus swells.”

Managing the pain

Ovulation pain is normal, to a point. “If you can cope, you don’t need to do anything. Rest, take a warm shower, and some painkillers.”

But if pain becomes severe or persistent, further investigation is necessary. “If Pap smear and ultrasound are normal, and it’s not endometriosis, then try extra analgesics.”

Hormone suppression may help. “If the pain doesn’t go away, you can stop the periods for a few months using family planning pills. You’re trying to alleviate symptoms and see if the body resets.”

There’s also a surprising approach: pregnancy. “If she is married and waiting for a baby, we encourage them to get pregnant,” Dr Murage says. “Because during those nine months, the body adjusts to a new norm after delivery.”

It’s not your period, but it hurts just as much. You’re not ill, but you feel bloated, irritable, and you’re spotting. What you may be experiencing is ovulation—an often misunderstood, under-discussed part of the menstrual cycle that can be surprisingly painful.

For some women, ovulation comes and goes quietly. For others, it barges in like an uninvited guest, bringing mood swings, pelvic discomfort, sticky discharge, and questions that even a thorough internet search can’t easily answer. Is this normal? Is it something to worry about? Or is the body simply doing what it’s meant to do?

Dr Wachira Murage, a consultant obstetrician and gynaecologist at Savannah Hospital in Upper Hill, Nairobi, explains that ovulation typically takes place around day 14 of a 28-day cycle. However, since menstrual cycles can range from 21 to 35 days, ovulation doesn’t occur at the same time for everyone.

“If your cycle is 21 days, you might ovulate on day seven. If it’s 35, expect it around day 21,” he says.

Ovulation is governed by a finely tuned hormonal rhythm.

“It’s all about hormones,” Dr Murage says. “Follicle-stimulating hormone (FSH), luteinising hormone (LH), estrogen, and progesterone are rising and falling in tune to prepare your body for pregnancy.”

Once menstruation ends, typically between days three and seven, the uterine lining begins to rebuild. “During this time, the uterus begins to rebuild the lining that was shed, preparing for the next potential pregnancy. The body assumes that conception is possible,” he adds.

Around the time of ovulation, hormone levels peak and the body releases a mature egg. If it is fertilised, the egg travels through the fallopian tube and attempts to implant in the uterus. If it isn’t fertilised, the body waits about 14 days before the next period begins—assuming the woman has a regular cycle.

But not every woman has a textbook cycle. Some ovulate earlier or later, and that can lead to heavier bleeding or irregular periods.

“You hear some people saying, ‘I have irregular periods,’ or, ‘I bleed for a long time,’ or even, ‘I don’t have periods.’ It’s because of the variation of those hormones that we have spoken about that peak at mid-cycle during ovulation,” Dr Murage explains.

While many women go through ovulation without any issues, others can feel it strongly. In fact, some women need painkillers to cope with the discomfort.

Acne breakouts, mood swings, irritability, or feeling emotionally off-balance are also common. Ovulation pain can range from a mild twinge to something more intense.

Dr Murage uses a vivid analogy to describe what’s happening internally: “The process of ovulation involves that an egg is carried in a sort of a ship. The ship travels and docks and then releases the egg. So that docking is like a rupture of a follicle, something cutting the egg, and that is where the bleeding comes from. Remember, blood is a chemical; it is an irritant, and it causes inflammation and pain.”

In some cases, the pain is more than just a twinge. Larger follicles can bleed more, and both ovaries might even release eggs, leading to more discomfort. Pain can shoot down into the legs because of nerve irritation. Hormonal fluctuations can also lead to bloating, water retention, or the sensation of temporary weight gain.

“Some have diarrhoea, others will vomit because there is an upsurge during that process of ovulation that affects the gastrointestinal tract, hence the nausea or even loss of appetite,” says Dr Murage.

Discharge can also change during this time. Estrogen can trigger a clear, stretchy, mucus-like discharge that signals fertile days. “A good, healthy ovulation discharge is clear and tenacious,” Dr Murage notes. “You may have spotting, a streak of blood, but it doesn’t smell.”

If, however, you notice a continuous brownish discharge, that could be a warning sign. “It is possible because of spotting, but remember if it is continuous, you need to get checked,” he says, adding that persistent brown discharge may be an early symptom of cervical cancer. “
Make sure that within two years you have done your Pap smear,” he advises.

For women with endometriosis, ovulation pain can be particularly severe. This is because endometrial tissue, meant to grow inside the uterus, can grow elsewhere in the body and still respond to hormonal signals. This causes inflammation and pain.

Similarly, conditions like Pelvic Inflammatory Disease (PID) or other infections can heighten the discomfort. “They become more and more painful because there is a lot of activity happening around here during ovulation,” Dr Murage explains.

The physical position of the uterus itself can also be a factor. A uterus that tilts backwards or sideways may rest against the spine, causing lower back pain, especially during ovulation. In cases of severe ovulation pain, a doctor must first rule out other possible conditions.

“Severe ovulation pain is a diagnosis of exclusion. So, you want to know if there are any infections. If so, you can do a blood test,” Dr Murage says.

But even before lab work, he emphasises the importance of patient history. “Before you rush to any test, do a thorough history. You want to understand the trend of this pain. How does it come? When does it stop?”

A physical exam can also help. “We can put our fingers into the vaginal region, and we want to feel where the pain is—from below and above. Sometimes there can be swelling, cysts, fibroids, or adenomyosis, where the uterus kind of swells,” he says.

As for treatment, it depends on the severity. Mild ovulation pain can be managed at home. “If you can cope, you don’t need to do anything. Just take a rest, a warm shower, and some painkillers,” says Dr Murage.

If symptoms persist or become more severe, more extensive treatment may be needed. “If you find nothing from the Pap smear and ultrasound, and it is not endometriosis, then you can have extra painkillers,” he says.

In some cases, hormone suppression may be used. “If the pain doesn’t go away with that, then you discuss with the client whether she can stop her periods for, like, three months by putting her on family planning pills. In a way you are trying to alleviate that and see whether the body will forget.”

And finally, there’s a less conventional route: pregnancy. “If she is married and waiting for a baby, we encourage them to get pregnant,” Dr Murage adds. “Because during those nine months, again, the body adjusts to a new norm after they deliver.”

→ [email protected]