What’s the Deal with Ovulation Pain?

Do you have heating pads and pain pills on standby for period and ovulation pain?  If so, rest assured that you are not alone.  An overwhelming number of women suffer from painful ovulation.  Pain during ovulation is normal; however, there are a few layers to what can contribute to painful ovulation as usual.  Let’s start by defining ovulation:

Ovulation occurs about midway through our menstrual cycle, in between periods.  It is the process of releasing an egg from one of the ovaries.  Ovulation is the highlight of our cycle since it’s how we make progesterone.  Without ovulation, progesterone can’t balance out the estrogen.  Here’s what it looks like during our menstrual cycle–after menstruation, our follicle is built up and getting ready to release an egg.  Estrogen is increasing during this time and then peaks–this peak stimulates the release of luteinizing hormone or LH, which tells our ovary to release an egg.  Some women get pain in one of their ovaries when it occurs–it shows up as pain on one side of their lower abdomen.  This is also known as “Mittelschmerz.”

This is the most common type of ovulation pain discussed, but I also consider symptoms like migraines, headaches, low back pain, muscle aches, etc., to count as pain around ovulation.  I also count these toward period pains during that time.  What do all these types of pain have in common?  They are all driven by estrogen.  Why does estrogen cause pain?  Estrogen increases inflammation, which leads to more prostaglandins and more pain.  Estrogen also increases vascular spasms in our muscles, leading to cramping during ovulation or right before our period. 

Estrogen is supposed to be increasing leading up to ovulation–it’s how we ovulate, and we need enough, but when we have too much, it can lead to inflammation and pain. 

What Contributes to Excess Estrogen?

I’ve talked about estrogen A LOT and have many blogs and posts on this, but let’s do a quick breakdown of areas that can lead to estrogen imbalances and issues like ovulation pain (whether it be muscle or migraine/headache). 

  • Poor Liver Function: Our liver processes our estrogen.  If the liver is inundated with toxins and hormones and not supported, you can struggle with estrogen detox.  This can lead to high estrogen symptoms even if your estrogen is low because your body isn’t processing it well.  Learn more about estrogen detox here.
  • Nutrient Deficiencies: Lack of B vitamins, magnesium, vitamin C, amino acids, vitamin E, and more can lead to poor liver function, blood sugar management, and a sluggish metabolism, all leading to a buildup of estrogen. 
  • Excess Stress/Cortisol: As cortisol goes up, estrogen goes up.  Estrogen and cortisol both are harmful to thyroid function and can lead to hormone imbalances. 
  • Inadequate Digestion: To break down and absorb the nutrients from our food, we need adequate stomach acid, digestive enzymes, and bile production.  Stress, high estrogen, and sluggish thyroid slow this entire process down.  This can lead to inadequate removal of estrogen from the gut, constipation, and overgrowth. 
  • Imbalanced Blood Sugar: Poor blood sugar control leads to high blood sugar, which means more insulin and low blood sugar levels, which mean more cortisol.  This is a recipe for excess estrogen and stress within the body. 

Is Any Amount of Pain Normal During Ovulation?

It is normal to have some mild cramping during ovulation.  This is common after getting off of hormonal birth control as well as after you’ve had children or if you’re recovering a regular cycle after having PCOS.  If you have some mild cramping that is tolerable and just tells you you’re ovulating, that’s not a concern.  If you’re in extreme pain and it’s impacting your life, that IS a concern.  After the pill, postpartum, and after recovering your cycle with PCOS, the pain should reduce within three cycles.  If this does not happen, talk with your doctor or healthcare practitioner about the next best steps. 

I Also Struggle with Anxiety & Mood Changes Around Ovulation–Is That Normal?

Along with the pain that can come from excess estrogen, mood changes and anxiety can also present themselves during this time.  When we have a surge in estrogen, and our levels are high, we then have an even more significant drop, leading to anxiety. 

Tips to Reduce Ovulation Pain

  1. Balance Your Blood Sugar: Balance your meals with protein, carb, and fat and eat regularly throughout the day.  Don’t skip meals (especially breakfast)!
  2. Reduce Your Stress: This is a loaded one, but even taking one small step to reduce the amount of stress in your day to day or shift your mindset toward it is helpful. 
  3. Support Your Liver
    1. Eat enough animal protein to provide amino acids and B vitamins.
    2. Include beef liver in your diet 1-2x per week or supplement form. 
    3. Eat vitamin C-rich foods. 
    4. Prioritize sleep. 
  4. Chill Out At Meals: Digestion is dependent on our parasympathetic nervous system.  When we are in a stressed state or distracted, we don’t digest our food as well.  This can lead to poor digestion and gut issues that contribute to excess estrogen. 
  5. Reduce Estrogens In Your Environment: Start looking at your beauty products, skincare routine, menstrual products, and more to start reducing estrogens in your environment.  The Environmental Working Group or EWG is an amazing resource for this. 

All of this helps to support regular ovulation and progesterone production.  Having adequate progesterone is truly the key to overall health for women and pleasant ovulation and periods. 

For lots of women, mildly painful ovulation accompanies our menstrual cycles.  Your ovulation pain may be triggered by estrogen imbalances caused by a host of reasons that include poor liver function, nutrient deficiencies, cortisol, inadequate digestion, and imbalanced blood sugar.  I hope you’ll find relief by implementing my tips for reducing your ovulation pain. If you’d like to dive even deeper and find the root cause of your pain, check out my Master Your Minerals course! In it, we teach you how to interpret your own HTMA and build a hormone-healing protocol based on your unique results.

Amanda Montalvo

Amanda Montalvo is a women's health dietitian who helps women find the root cause of hormone imbalances and regain healthy menstrual cycles.

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