Endometriosis pain with ovulation (or even ovulation pain in general) is not something that may be commonly talked about, but it is in fact a relatively common occurrence. In fact, it even has its own name: “Mittelschmerz.” This term is a German word translating to “middle pain” due to the fact that it is pain that occurs around mid-cycle.

Ovulation pain is often one-sided from whichever ovary is releasing the egg that month and can range from a twinge to sharp pains. It may last just a few minutes or could go on all day.

Mittelschmerz may be just as common in women with endometriosis as everyone else, but pain can be more extreme just like during your period. 

Why is this? Let’s take a look.

What causes endometriosis pain with ovulation?

Ovulation pain essentially occurs because the ovary expands with the developing egg follicles. In a normal, healthy pelvis the ovaries are free so this causes little to no issue. It is common, however, with endometriosis, for the ovaries to be stuck with adhesions to the pelvic wall, uterus, or other tissues within the pelvis and this can cause some pain or discomfort when the ovary expands.

This in turn can put pressure on sensory nerves in the pelvis, which can also contribute to the pain you feel when you ovulate.

In addition, it is not uncommon for women to have endometriosis lesions, or even endometriomas, directly on the surface of the ovary and this can cause pain and discomfort as well.

How to tell if it is ovulation pain or something else?

Odds are, if you have endometriosis you are no stranger to pain. Women with endo commonly experience not only period pain, but also pain with bowel movements, pain during or after intimacy with their partner, sometimes back pain or leg pain or nerve pain, and of course the ovulation pain that is being discussed today.

So how do you actually know if the current pain you are experiencing is due to ovulation or something else?

The biggest factor, of course, is timing during your cycle! Now, many of us were taught that ovulation occurs on day 14 of your cycle, but that is just not always the case. Many factors can affect ovulation and also many women’s bodies just naturally ovulate a bit earlier or later than that. This is totally normal!

That is why I always recommend cycle charting to my clients, so that you can see where in your cycle you have ovulated. For basic cycle charting, you take your temperature each morning upon waking with a basal body thermometer and mark it on a chart, either a paper one or an app on your phone. 

You can also add symptoms like your cervical fluid, which changes throughout your cycle, to the chart, to help you determine where you are in your cycle and when ovulation occurred.

Once you start to see the pattern and get comfortable with the signs from your body, you may start to notice patterns and when you will be able to see, at least in hindsight, when ovulation has occurred. That will help you to pinpoint if that is associated with the pain you are experiencing.

For resources about cycle charting, see “Resources” below.

What can I do about endometriosis pain with ovulation?

I should start here by saying that if you do have adhesions sticking your ovaries to other organs or any other physical issues, you will likely need surgery to correct this. I highly recommend consulting with a skilled surgeon who specializes in endometriosis excision. See “Resources” below for some places to connect with a surgeon near you.

That being said, pain can also be a sign of inflammation in your body. Endo is a disease rooted in chronic inflammation and, whether you need surgery or not, should be addressed from the inside out.

An excellent starting place here is to work on avoiding inflammatory foods such as vegetable oils, sugar, processed foods, refined carbohydrates, gluten, and possibly dairy.

At the same time, work on including a lot of anti-inflammatory foods such as a wide variety of fruits and vegetables, whole food sources of protein, Omega-3 fats, and staying well hydrated.

Look to your gut health

Any time there is chronic inflammation happening in your body, taking a thorough look at your gut health is always a top priority. I personally love to use the GI-Map, which is a functional stool analysis test, in my practice. This helps to give my clients a good picture of what is going on in their gut, from imbalance in your microbiota to digestive insufficiencies. 

It may not seem directly related, but it absolutely is. Your gut is how all of the nutrients in your body make their way in and it is also how your body works to keep “the bad stuff” out. If any of this is not working properly or if there are bad guys taking over the space, it can wreak havoc in many areas of your body.

What can I do in the moment about my endometriosis pain with ovulation

The strategies I have given you so far are looking more for long-term relief, which is what we all really want at the end of the day.

But what about when I am in the moment, living with a painful flare related to my ovulation?

There are some natural remedies you can use for this as well! Strategies can include taking anti-inflammatory herbs such as ginger and turmeric. These can both be brewed as a tea or taken in capsule form.

Magnesium in the form of magnesium glycinate can also be a good option for pain relief. You can also absorb magnesium through your skin via a hot epsom salt bath. The hot water may also feel soothing to you.

Then of course there is the old trusty heating pad. If you don’t own one of these already, it is probably a good thing to have on hand for pain flares of any kind. The heat can be very soothing to your body.

A word about medical treatments for ovulation pain

At the end of the day, decisions about medications are between you and your doctor. However, I am a big proponent of fully informed consent, so you should know exactly what you are getting yourself into.

For symptoms like ovulation pain, period pain, or just about any other type of pelvic pain, doctors will often prescribe medications like birth control or other hormone-blocking medications. If you are considering this, it is important to know a couple of things.

The first is that these types of medications do not in any way balance your hormones or regulate your cycle. What they do is stop you from ovulating altogether. The synthetic hormones in these medications block your natural hormones from their receptor sites so that you no longer ovulate. This also means that you don’t have a true period. If you bleed while on the medication, it is actually a withdrawal bleed, not a true period.

The second is that these medications come with a lot of side effects and also cause a host of nutrient deficiencies. Before you agree to anything, I highly recommend some time googling possible side effects and nutrient deficiencies that can be caused by the medications you are taking. That way you can make the best and most informed decision for your own body!

A final note on endometriosis pain with ovulation

I like to remind my people regularly that endometriosis is a full body disease. Although we are focused today on pain with ovulation, that is just one symptom to address. If you truly want to heal your body with endometriosis, it is time to start zooming out and looking at the big picture, looking at your body as a whole. 

The systems of our body are all so closely intertwined in ways we may never have thought possible. That is why so often, addressing endo as just a disease of the female reproductive system does women a disservice.

Build a team around you and find practitioners who will also look at you as a person, as a whole body, and work with you as such.

Ready to take your endo health to the next level and get to the root cause of your endo symptoms once and for all? Click here to learn more about my Thrive With Endo program and apply today!


Cycle Charting/Fertility Awareness Based Methods: Taking Charge of Your Fertility by Toni Weschler

Cycle Charting 101

Endo excision surgery info: Nancy’s Nook


A.D.A.M. Medical Encyclopedia [Internet]. Johns Creek (GA): Ebix, Inc., A.D.A.M.; c1997-2023. Mittelschmerz; [reviewed 2021 Apr 14; cited 2023 Feb 14]; [about 4 p.]. Available from: https://medlineplus.gov/ency/article/001503.htm

Romm, Aviva. (2017). Pill: Are the Risks Too Bitter to Swallow? Retrieved from: https://avivaromm.com/the-pill-risks/

Palmery, M., Saraceno, A., Vaiarelli, A., Carlomagno, G. (2013). Oral contraceptives and changes in nutritional requirements. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/23852908/Weschler, Tony. (2015). Taking Charge of Your Fertility. New York, NY: HarperCollins Publishers.

International Association for Functional Hormone Health. (2022). Functional Hormone Specialist Certification Program Module 2.2, 3.1, 3.2 Slides and Transcripts [PDF Documents].

Alyssa Chavez endo belly girl




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