Understanding Endometriosis and Ovulation Pain
Nearly 1 out of every 5 women experience ovulation pain. Most of the time this isn’t something to worry about, but sometimes ovulation pain can be a sign of an underlying medical condition. Endometriosis is a medical condition that can cause ovulation pain. Endometriosis ovulation pain can spread to the leg or thigh, and may be more severe than “ordinary” pain. In this post we’ll cover why endometriosis causes ovulation pain, how it differs from “regular” ovulation pain, and some ways you can cope with endometriosis pain.
What Is Endometriosis?
Endometriosis is a condition that causes tissue similar to the lining of the uterus (the endometrium) to grow on other organs and anatomic structures. Most commonly, the endometrial tissue grows in the pelvic region, but it has been found on every organ and anatomic structure in the body except the spleen. The tissue responds to estrogen and just like your endometrial lining, it thickens every month and breaks down when you have your period. This can lead to pain, inflammation, scarring, and adhesions (organs sticking together).
As many as 1 in 10 women of reproductive age have the condition. Diagnosis can take time and symptoms vary widely from person to person. Many experience no endometriosis symptoms at all, while others experience debilitating endometriosis pain. Endometriosis is commonly classified in stages (1 being minimal with 4 being most severe) but endometriosis stages are not necessarily indicative of the level of pain or symptoms one experiences. Endometriosis stages reflect the spreading of the condition and associated growths, cysts, or scarring.
What Is Ovulation Pain?
Ovulation pain is commonly felt midway through your cycle, when an egg is released from one of the ovaries. Often referred to as “mittelschmerz” (German for “middle” and “pain”), they differ from menstrual cramps, and it’s estimated that nearly 20% of those who get their period experience cramping during ovulation.
The pain felt is usually minor to moderate and shouldn’t last longer than a couple of days. It occurs as a result of the process of ovulation and may be accompanied by bleeding or spotting. Pain in the abdomen region can often be attributed to normal reproductive functions like ovulation, and should only be mild to moderate. Endometriosis can also cause pain in the pelvic region but is usually more severe.
How Does Endometriosis Cause Ovulation Pain?
Ovulation isn’t inherently painful, but the process itself can cause pain for some people. Since endometriosis commonly affects the ovaries, which are responsible for controlling ovulation, it can cause ovulation pain.
Your ovaries are normally mobile and free, allowing for some movement and growth. But in those with endometriosis, tissue often implants on the ovaries and fallopian tubes (among other areas) and causes them to be fixed to the pelvic wall or attached in some other way. Just like it does inside the uterus, endometrial tissue outside the uterus responds to hormonal changes and can bleed or become inflamed. In more serious cases, it can lead to scar tissue or endometriosis adhesions, leading to more pain.
Sometimes endometrial tissue attaches to your ovary and can be filled with a brown chocolate-like fluid. This is known as an endometrioma or “chocolate cyst” and may be another reason for ovulation pain or endometriosis pain. Similarly, when the fallopian tubes become blocked or damaged by endometriosis, it can cause pain during ovulation.
Symptoms of Endometriosis-Related Ovulation Pain
When Is Ovulation Pain Abnormal?
Some discomfort or soreness is an unfortunate reality of ovulation, even though not everyone experiences ovulation pain. If your pain becomes severe, or is accompanied by other symptoms, it may be more than ovulation and could warrant investigation.
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“Normal” ovulation pain |
Endometriosis-related ovulation pain |
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Other Symptoms of Endometriosis That May Appear During Ovulation
Aside from ovulation pain, other endometriosis symptoms may appear.
Other common symptoms of endometriosis include:
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Chronic pelvic pain
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Fatigue and bloating
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Heavy or irregular bleeding
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Painful sex (dyspareunia)
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Urinary and bowel pain
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Pain in pelvic region, lower back, or legs
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Infertility
It can be difficult to pinpoint exactly how many people who have the condition experience these symptoms. Up to 30% of those with endometriosis don’t experience symptoms, but for those that do, they can range from mild to severe. And an estimated 30-50% of cases of infertility involve endometriosis.
Causes of Endometriosis-Related Ovulation Pain
What Happens in the Body to Cause Pain?
Endometrial tissue responds to hormones and goes through a cycle of thickening, breaking down, and bleeding with each menstrual cycle. Regardless of whether this tissue is on the inside or the outside of the uterus, it still goes through this cycle. When it grows outside the uterus, it doesn’t have a chance to leave the body like it would with a normal period, and the surrounding tissue can become irritated and form lesions or scar tissue. When these tissues band together, they can form adhesions that cause pelvic organs and tissues to stick to one another.
Why Do Some Women Experience More Pain Than Others?
The signs and symptoms of endometriosis vary with each person who has the condition. Not everyone experiences pain with the condition, although it is a common symptom for many, and the level of pain you experience doesn’t necessarily correlate with the severity of your condition.
Recent research has investigated the genetic factors of endometriosis pain and found that many of the same genes implicated in endometriosis also play a role in pain perception. One possible explanation for this involves chronic pain and sensitization of the central nervous system. In other words, when you experience chronic pain, the nervous system undergoes fundamental changes that can make you more sensitive to pain. Studies have even shown that when compared to women without endometriosis, those with the condition have higher levels of certain biomarkers that indicate inflammation. Inflammation plays a critical role in the development of endometriosis and chronic inflammation contributes to that pain.
How Endometriosis-Related Ovulation Pain Affects Fertility
How Does Endometriosis Impact the Ovaries and Fallopian Tubes?
Since endometriosis can impact the ovaries and fallopian tubes, you may have trouble getting pregnant if you have an endometriosis diagnosis. In fact, 30-50% of women with endometriosis might find it hard to get pregnant and up to 50% of those with infertility have endometriosis.
Damage in the pelvic region from endometriosis may make it more difficult to get pregnant in a variety of ways. Scar tissue and adhesions can affect the fallopian tubes, leaving them blocked or damaged. Damaged fallopian tubes can make it difficult to conceive naturally and even increase the risk of an ectopic pregnancy (where the egg implants outside the uterus).
The combination of endometriosis and changes to the pelvic region may even change the “environment” of the womb, making it more difficult for an egg to be fertilized and ultimately implant in the womb lining. Endometriosis also affects egg quality. We don’t know for sure how endometriosis causes infertility, but we do know that the physical changes associated with endometriosis symptoms can certainly impact your fertility.
What Fertility Treatments Are Available for Women With Endometriosis?
An endometriosis diagnosis doesn’t spell the end of your fertility and there are a number of options available for women with endometriosis. Although endometriosis medication has not been shown to improve fertility, surgery is an option with generally good outcomes. For those with mild endometriosis, surgery to remove or destroy the endometriosis has been shown to improve fertility but other options include medication, IVF, and egg freezing.
Hormonal therapies and medications can be used to reduce endometrial implants. Assisted reproductive technology like in vitro fertilization (IVF) and intrauterine insemination (IUI) are also popular fertility treatments for less severe cases of endometriosis. If you aren’t ready to be pregnant, but still want to preserve your fertility, then egg freezing may be an option for you. Endometriosis is known to affect ovarian reserve (the number of eggs you have), and this minimally invasive procedure has no effect on future ovarian reserve. Statistics are mixed and the stage and severity of your endometriosis can affect your success rate.
Diagnosing Endometriosis-Related Ovulation Pain
Medical Tests for Identifying Endometriosis
Along with a description of your symptoms, a physical exam is necessary to diagnose endometriosis. You may undergo the following tests:
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Pelvic Exam - Physically examining your pelvic region to check for growths, unusual changes, painful spots, or cysts.
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Ultrasound - Medical images of the reproductive organs to find endometriomas.
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MRI - Detailed medical images of the organs and tissues to see the location and size of growths.
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Laparoscopy - Surgical procedure to check your abdomen for endometriosis tissue.
Laparoscopy is the gold standard for an endometriosis diagnosis. Your diagnosis can be both confirmed and treated during this minimally invasive surgical procedure. A small sample of tissue is removed and examined under a microscope to confirm the diagnosis.
Common Misdiagnoses and How to Advocate for Proper Diagnosis
An endometriosis diagnosis can be a complicated process and general physicians are not experts in the signs and symptoms of endometriosis so misdiagnosis is common. Endometriosis symptoms may mimic other conditions, especially when they involve the pelvic region. Irritable bowel syndrome (IBS), leaky gut syndrome, and small intestinal bacterial overgrowth (SIBO) all share symptoms like bloating, diarrhea, and fatigue that can also be signs of endometriosis. Of the 20 symptoms of endometriosis, ovarian cysts can share a number of them and may also be a cause for misdiagnosis.
It can take years to receive a proper diagnosis and unfortunately many clinicians lack awareness and understanding of the condition. It can be difficult to speak up, especially to those you consider an authority (like doctors), but if you have endometriosis (or suspect you do) it is crucial to advocate for yourself. Arm yourself with knowledge about the condition, keep track of your symptoms and ask questions. If you feel like you aren’t being heard or your concerns are dismissed, get a second opinion and find someone who is willing to listen so your health concerns are taken seriously.
Treatment Options for Endometriosis-Related Ovulation Pain
Medications for Pain Management
There are a number of different options for endometriosis treatments for pain management. Simple pain relievers like over-the-counter medications and non-steroidal anti-inflammatories (NSAIDs) may offer some relief.
Hormonal medications offer endometriosis treatments through suppressing the normal menstrual cycle. Endometrial tissue responds to hormones and treatments like the birth control pill essentially stop or slow endometrial growth to reduce pain associated with them. Gonadotropin-releasing hormone (GnRH) antagonists or agonists take it up a notch and stop the hormones that cause your menstrual cycle associated with pain. Non-hormonal endometriosis medications are currently being researched for pain relief and to reduce the size of endometrial lesions.
Surgical Options for Severe Cases
In the most severe cases, medications may not be enough for your endometriosis pain. Endometriosis surgery is usually a last resort and the options depend on your personal circumstances, goals, and endometriosis stage.
Laparoscopy (keyhole surgery) is a type of surgery where a small telescope is inserted into the abdomen for both identification and treatment. The endometrial tissue is either removed through cutting (excision) or diathermy (ablation) or a combination of both techniques.
In extreme cases, and often when other conditions are involved, a hysterectomy is performed. This type of surgery involves removal of the uterus, cervix, and fallopian tubes. The ovaries may or may not be removed as well, and recovery is much longer than it would be for a laparoscopic surgery.
At-Home and Holistic Management Strategies
Lifestyle Changes That Can Help Reduce Pain
Lifestyle changes to reduce inflammation and support hormone regulation can help you manage your endometriosis symptoms. Maintaining a healthy weight, getting enough exercise, and prioritizing sleep are important pillars of a healthy lifestyle. An anti-inflammatory diet can have a direct impact on your hormonal balance and there’s even some research to suggest following a gluten-free diet can reduce endometriosis symptoms.
Stress management is also key when you have a chronic condition like endometriosis. While it may not have a direct impact on your condition, stress in and of itself can have negative impacts on your overall system. Heightened stress hormone levels contribute to inflammation and other negative outcomes like an upset tummy or appetite changes.
For more information on the science of stress and our hormones, see our article on Stress and Fertility.
Using Tracking Tools Like Mira to Monitor Symptoms
The signs and symptoms of endometriosis can be hard to keep straight. It can be helpful to track your cycle, along with other signs and symptoms that may be related. A low-tech option like a notebook or the notes app in your phone can be a great place to start noticing patterns and help you monitor your symptoms over time. You can also use a free period tracking app, like the Mira App, to keep everything in one place.
When it comes to a condition like endometriosis, it can be helpful to know exactly what’s happening with your body through hormone testing. Testing your fertility hormone levels with Mira’s digital fertility analyzer can help you predict your fertile window, date of ovulation, and give you personalized fertility insights based on your unique hormone data. With our Mira Max Wands to measure the numeric levels of 4 key fertility hormones, you’ll be able to track your hormones continuously, with over 99% accuracy. You can track symptoms, notice patterns, and even share personalized reports with your healthcare team to monitor your condition and assess treatment options.
Hormone testing is the gold standard if you want to get pregnant faster, or have irregular cycles or hormonal issues like endometriosis. Mira is a non-invasive way to monitor your fertility and understand your full fertile window. It takes the guesswork out of fertility, even if your cycle is irregular.
Natural Remedies and Alternative Therapies
There are a number of popular natural remedies and alternative therapies that you might want to try for endometriosis supportive therapy. Research has shown that acupuncture is an effective strategy for pain management and can help regulate conditions like endometriosis. And since endometriosis can affect the pelvic floor, specific therapy for that region can be a valuable part of endometriosis treatment and management. Pelvic floor therapy combines a variety of physical techniques and exercises to address the pain associated with endometriosis for each patient.
One area of natural remedies for endometriosis that’s becoming popular is herbs and supplements. While research is ongoing, many herbs or supplements target hormonal regulation to improve symptoms. Curcumin, pine bark, chamomile, peppermint, vitex, and ashwagandha are all being investigated for their ability to offer relief. Mira’s Fertility Tea is designed to provide you with a mix of antioxidants, vitamins, and minerals to support both your overall health and your reproductive health. It won’t cure your endometriosis but it can provide you with a relaxing ritual and help you destress while promoting vitamins and minerals in your body to support your overall health.
Frequently Asked Questions
How to get rid of cramps?
Cramps may be relieved through over the counter pain medications that reduce inflammation (NSAIDS), applying heat, or rest.
Is endometriosis genetic?
Yes. There are strong genetic factors to the disease that may play a role in its development. Endometriosis can also be influenced by environmental factors but several genetic components have been linked to endometriosis causes and it often runs in families.
What are the urgent signs of endometriosis?
If you have sudden or severe pain, severe nausea/vomiting, heavy bleeding, fever, or fainting are urgent signs of endometriosis and you should seek immediate medical advice.
How often is the experience of pain due to endometriosis?
Symptoms and experiences vary, but approximately 50-80% of those with pelvic pain have endometriosis.
What are some common symptoms of endometriosis that women may overlook or not take seriously?
There are many signs and symptoms of endometriosis since it affects the entire pelvic region, but some can get overlooked. These include fatigue, bloating, lower back or abdomen pain, and painful bowel movements or urinary disorders.
Is it possible to have endometriosis without any symptoms?
Yes. Not everyone who has endometriosis will experience endometriosis symptoms. Up to 30% of those with the condition will not experience the signs and symptoms of endometriosis.
