Ovulation pain is a debilitating symptom of endometriosis – accurate diagnosis and effective treatment of the underlying cause can provide long term relief.
Symptoms of ovulation pain and why it occurs
Ovulation pain is most often described as “midcycle” pain, when the ovaries are primed to release a developed oocyte (egg) for fertilisation.
While it is normal to be aware of the moment when an egg is released from a dominant follicle (egg cyst) on the ovary it is not normal to experience crippling, debilitating pain that prevents most normal activity; such pain occurs in patients with severe ovarian adhesions usually caused by endometriosis.
What ovulation pain feels like and how long it lasts
Ovulation pain gives a referred pain to the lower abdomen on either side, below the umbilicus, and above the level of the groin.
The pain from a fixed ovary attempting to release it’s egg is constant, unrelenting, and may last 12-48 hours.
Causes of ovulation pain
Ovulation pain is essentially due to an expanding ovary (with developing egg follicles) that causes pressure on adjacent sensory nerves in the pelvis.
In the normal pelvis, ovaries are mobile and free. In the pelvis of the patient with known severe endometriosis, the ovaries are often fixed to the pelvic wall, ureter, vessels derived from the internal iliac artery, and in most severe cases, to major pelvic nerves (obturator; presacral nerves) giving the patient back, hip or buttock pain, or worsening bladder function in the short term.
Surgical correction of deeply infiltrating endometriosis (DIE) beneath the ovaries remains one of the most challenging yet rewarding surgeries for the gynaecologist specialising in advanced pelvic surgery.
In the vast majority of patients, surgery to preserve ovarian function and mobility can be safely effected, particularly if there has been complete removal of any ovarian cyst pathology, a primary ovarian repair effected, and a temporary hitch of the ovary to avoid local adhesion formation (oophoropexy).