Endometriosis and Ovulation Pain: Causes, Symptoms, and Treatments

by Nov 19, 2020

1 out of every 5 women experiences ovulation pain. Most of the time, ovulation pain isn’t something to worry about — but sometimes, ovulation pain can be a sign of an underlying medical condition. 

One medical condition that can cause ovulation pain is endometriosis. Endometriosis ovulation pain can spread to the leg or thigh and may be more severe than “ordinary” pain.

woman experience pain in a belly

Today, we’ll be talking about endometriosis ovulation pain in depth, including:

  • How it differs from “regular” ovulation pain
  • Why endometriosis causes ovulation pain
  • How to cope with endometriosis ovulation pain

This article will help you if you are suffering from ovulation pain due to endometriosis or if you’re looking for more insight into pain you’re currently experiencing.

Endometriosis Overview

Endometriosis is a disease that causes tissue similar to the lining of the uterus (the endometrium) to grow on other organs and anatomic structures. It most commonly affects the reproductive organs like the ovaries and fallopian tubes but has been found on every organ and anatomic structure in the body except the spleen. 

As many as 1 in 10 women of reproductive age suffer from endometriosis. Many women with endometriosis have no symptoms, while others have debilitating pain. This pain is often worse during menstruation, though it can occur at any time of the month. It may also be accompanied by symptoms like constipation, diarrhea, nausea, and vomiting, and is a frequent cause of infertility in females.

Can endometriosis cause ovulation pain?

Yes, endometriosis can cause ovulation pain. Endometriosis commonly affects the ovaries, which are responsible for controlling ovulation. It can also impact the fallopian tubes, which are also involved in ovulation. 

Ovulation pain due to endometriosis may be caused by endometrial implants on the ovaries or fallopian tubes, by scar tissue (a.ka. “adhesions”) on or around these organs, or by painful endometriomas (a.k.a. “chocolate cysts”) on the ovaries that are filled with menstrual blood.

Many women experience ovulation pain each month, but ovulation pain due to endometriosis is often prolonged and more severe than “normal” ovulation pain. 

How to know if your ovulation pain is due to endometriosis

Many women experience ovulation pain as a normal sign of ovulation. However, sometimes pain occurring during ovulation is due to endometriosis.

Symptoms

Signs that your ovulation pain may not be normal and may actually be endometriosis ovulation pain include:

  • Intense or prolonged pelvic pain lasting longer than 48 hours
  • Pain that is so severe it causes vomiting or diarrhea
  • Ovulation pain due to ovarian cysts called endometriomas or “chocolate cysts”
  • Abnormal bleeding during ovulation

Other signs of endometriosis that may occur alongside ovulation pain include:

  • Pelvic pain ranging from mild to disabling throughout the menstrual cycle
  • Pain during sexual intercourse
  • Urinary urgency and/or pain during urination
  • Chronic fatigue
  • Constipation and/or shooting rectal pain

Causes

Ovulation pain can occur in women with or without endometriosis — so why do women with endometriosis commonly experience ovulation pain?

Most of the pain due to endometriosis, including ovulation pain, occurs due to uterine tissue growing outside the uterus. This tissue may bind to the pelvic cavity, creating scars or adhesions between organs that frequently lead to pain during ovulation, sexual intercourse, urination, and/or bowel movements.

Endometrial tissue can infiltrate deep into surrounding organs and may also remain confined to the peritoneal lining of your abdomen. However, the depth of your endometriosis does not predict the severity of the pain you experience. Women with early stages of endometriosis can still experience severe ovulation pain — and women with late-stage endometriosis may have no symptoms at all! The only way to know for sure if you have endometriosis is to visit your doctor for testing and treatment.

Causes of endometriosis-related ovulation pain include:

  • Endometriosis implants on or around the ovaries and/or fallopian tubes
  • Adhesions, or scar tissue, on or around the ovaries
    • In severe cases, the ovaries may be stuck together by adhesions, known as the “kissing ovaries” sign
  • Narrowing or blockage of the fallopian tubes due to endometriosis implants or adhesions
  • Endometriomas, or “chocolate cysts,” on the ovaries, which are filled with menstrual blood
    • Sometimes, large endometriomas may burst, releasing menstrual blood into the abdominal cavity and causing severe pain and inflammation

Treatments

If you suspect your ovulation pain may be due to endometriosis, you should make an appointment with your OB/GYN. Your doctor will be able to evaluate your symptoms to tell you if you could have endometriosis. They may also order imaging, such as an ultrasound or MRI. 

However, the only definitive way to diagnose endometriosis is through laparoscopic surgery. This surgery is minimally invasive and offers physicians the opportunity to treat endometriosis at the same time that they diagnose the condition.

In this minimally invasive surgery, a lighted tube with a camera on it is inserted into the abdomen through small incisions and used to locate endometriosis implants. The surgeon then uses special tools to remove the endometriosis through the incisions. Excision surgery is currently considered the gold standard of endometriosis treatment.

Endometriosis cannot be cured, but your symptoms can be treated in a number of ways. One way to manage endometriosis pain is by using birth control pills. The hormones in the pills can stop you from ovulating to prevent endometriosis ovulation pain. They may also make your periods shorter, lighter, and less painful. 

There are also things you can do at home to help you cope better with endometriosis ovulation pain. For example, you might try:

  • Using a microwaveable heating pad, hot water bottle, or self-heating patches purchased from a drugstore
  • Taking warm baths with soothing Epsom salts or essential oils to help you relax
  • Trying a TENS machine, which uses electrical impulses to block the nerves from sending pain signals to your brain
  • Taking over-the-counter pain medication such as Advil, Aleve, or Tylenol for endometriosis ovulation pain

Could my pain be from normal ovulation and not endometriosis?

Not all ovulation pain is considered abnormal. For some women, mild ovulation pain, also known as Mittelschmerz, is a normal sign that their ovulation has occurred. 

Normal ovulation pain can be identified according to the following criteria:

  • Ovulation pain causes lower abdominal pain, just above the hip bone
  • Pain typically occurs on one side (the side releasing the egg)
  • Pain occurs about two weeks before your next cycle is supposed to start
  • The pain lasts from a few minutes up to 48 hours
  • The pain is mild to moderate and does not cause nausea, diarrhea, or vomiting

When to seek professional help

Ovulation pain does not usually require medical attention. However, you should seek help for ovulation pain if:

  • The pain is new or worsening
  • The pain lasts longer than 48 hours
  • The pain is severe or interferes with daily functioning
  • The pain also occurs at other times of the month (besides ovulation)
  • The pain is accompanied by nausea, vomiting, or diarrhea
  • You have other symptoms of endometriosis, such as painful, heavy periods

Your first call should be to your primary care doctor or OB/GYN. They can perform an exam and let you know if they suspect something more serious than normal ovulation pain. If your doctor suspects endometriosis or another health problem, they may refer you to a specialist.

✔️ Medically Reviewed by Banafsheh Kashani, MD, FACOG

Banafsheh Kashani, MD, FACOGBanafsheh Kashani, M.D., FACOG is a board-certified OB/GYN and specialist in reproductive endocrinology and infertility at Eden Fertility Centers, and has been treating couples and individuals with infertility since 2014. Prior to joining Eden Centers for Advanced Fertility, she was practicing as a top fertility specialist at Kaiser Permanente in Orange County and Reproductive Fertility Center. Dr. Kashani has received numerous awards throughout her years of study and medical training. 

Dr. Kashani has conducted extensive research in female reproduction, with a specific focus on the endometrium and implantation. Additionally, Dr. Kashani has authored papers in the areas of fertility preservation, and fertility in women with PCOS and Turners syndrome. She also was part of a large SART-CORS study evaluating the trend in frozen embryo transfers and success rates.

Dr. Kashani is a fellow of the American Congress of Obstetricians and Gynecologists. In addition, she is a diplomat of the American Board of Obstetrics and Gynecology and an active member of the American Society of Reproductive Medicine (ASRM) and Pacific Coast Reproductive Society (PCRS). She is also a member of the Society of Reproductive Endocrinology and Infertility (SREI).

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