Question: Is lower ovulation back pain normal?
If you are experiencing back pain during ovulation on the right or left side, it’s normal that you will be concerned.
Here’s an email I received from Ashley (one of my readers)
Hi Doctor Dunn,
I am 22 years old and have a regular 27 days menstrual cycle. Recently, I had sex with my boyfriend after the end of my period, and now a week later, I feel mild cramps on the right side of my abdomen and back.
I experienced the same pain on the left side last month and I’m worried if this is normal. Should I take a pregnancy test?
Just like Ashley, it’s normal that after unprotected sexual intercourse, abdominal cramps and back pain may cause you to wonder if you are pregnant. The truth is your mild back pain around ovulation is usually not abnormal. However, if you experience severe or sudden back or abdominal pain, pain that keeps getting worse, or pain with fever, heavy bleeding, dizziness, fainting, or unusual vaginal discharge, you should see a doctor urgently, as it may be something more serious than ovulation pain.
At the age of 14, a lot of young girls will have already started having menstrual period that comes with abdominal cramps. These cramps are usually located in your lower abdomen, though could spread to other parts of your body, including your back.
After the end of your menstrual period, your body’s estrogen and follicle stimulating hormone help in the development of follicles that are released during ovulation.
Ovulation is the monthly release of an egg from your ovary; and in fact, if you’ve started having regular period, it often means you are ovulating. However, some women can have regular bleeding and still not ovulate every month (for example, with polycystic ovarian syndrome or during perimenopause).
Just like period cramps, it’s not abnormal that you will feel cramps during ovulation. For some women, these cramps are usually mild and can occur before, during and after ovulation.
Ovulation pain, also called Mittelschmerz pain, is common in about 1 in 5 women, and it can also be felt at your lower back.
While it’s possible your right or left side back pain may be due to ovulation, a severe and long-lasting back pain with abdominal cramps may indicate something more serious.
Endometriosis, ovarian cysts, polycystic ovarian syndrome, adhesions from previous surgeries, pelvic inflammatory disease from sexually transmitted infections, peptic ulcer disease, acute appendicitis, indigestion and urinary tract infections may cause you to feel back and abdominal pain.
This article explains what lower back pain around ovulation means, when it’s abnormal, when to worry, and when to see a doctor.
What causes lower ovulation back pain?
First of all, most women will not have any form of back or abdominal pain while ovulating. So, if you feel pain in your left or right side of your back, it may or may not be due to ovulation.
Having said that, about 1 in 5 women will feel ovulation pain, and for some women this discomfort can be felt in the lower back. In most cases, ovulation back pain is not serious and settles quickly. Ovulation back pain occurs because of changes in your ovaries around the time of ovulation.
Like most women with a 28-day menstrual cycle, ovulation will occur about a week after the end of your menstrual period – usually around day 14 of your cycle (about two weeks before your next period).
Before this time, and just after the end of your period, follicle stimulating hormones and estrogen cause the growth of 16 to 20 ovarian follicles in your ovary.
These follicles will increase in size until only one follicle gets “bigger than others” and contains the egg that will be expelled during ovulation.
Abdominal and back pain before ovulation occurs because of expansion and stretching of your ovaries and follicles.
During and after ovulation, some women may also feel a sudden sharp pain in the back. This pain occurs because fluid and a small amount of blood released from the follicle can irritate the lower abdomen and surrounding areas.
How to tell your lower back pain is due to ovulation?
There are many reasons women could develop lower or upper back pain. It’s important you know how ovulation back pain feels like, the timing and other symptoms of ovulation.
1. Nature of pain
Ovulation pain is usually a sudden sharp or crampy pain that occurs in your lower abdomen and sometimes your lower back. This pain is short-lived and for most women will settle within a few minutes to 1–2 days. Many women feel better with rest, a warm bath or simple pain relief like paracetamol or ibuprofen (if these medicines are safe for you).
Rarely, it’s possible that some women will experience a very severe back or pelvic pain during the middle of the cycle. In that case, it’s important you check it out with your doctor to rule out a ruptured ovarian cyst, ovarian torsion, ectopic pregnancy or appendicitis.
2. Ovulation back pain timing
Ovulation back pain occurs before, during and shortly after ovulation has occurred. So, if you experience a mild or sharp pain around mid-cycle that fits the time you usually ovulate and it settles within 1–2 days, it’s usually nothing you should worry about.
Lower back pain before ovulation occurs because of stretching of your ovaries. It’s also possible for women to experience a lower back pain after ovulation. This occurs due to irritation of your abdomen due to bloody fluid released during ovulation.
Depending on your menstrual cycle, your ovulation period will vary. If you have a 28 days menstrual cycle, on day 14, ovulation will occur.
However, if you are not sure of your menstrual cycle length, these are some easy ways to tell you are in your ovulation period:
From the start of your menstrual cycle to the end, your vaginal discharge texture, color, volume, and thickness will vary.
During the early parts of your menstrual cycle and after the end of your period, it’s normal your vagina feels dry with occasional milky or creamy vaginal discharge that is thick, non-smelly and whitish.
During ovulation, your vaginal discharge becomes watery, clear, egg-like, stretchy and jelly-like. If you experience a clear watery discharge in the middle of your menstrual cycle and back pain, it’s likely because of ovulation. ACOG also explains these changes in their FAQ on fertility awareness-based methods of family planning.
Bloating and nausea
During ovulation, transient abdominal swelling and tightness are common in some women. You may also have mild nausea. If you have severe nausea or vomiting with strong pain, you should see a doctor.
Other signs of ovulation are mid-cycle spotting, increased sexual drive, brown vaginal discharge, breast pain and swelling.
If your mid-cycle pain lasts longer than 2–3 days, keeps getting worse, or comes with fever, chills, very heavy bleeding, pain when you urinate, shoulder pain, dizziness or fainting, please see a doctor or go to the emergency room.
Ovulation back pain for days: When to worry?
Ovulation back pain usually lasts for a few hours up to 1 or 2 days, and then you will feel okay again, sometimes even without treatment or with simple home remedies like rest and a warm compress.
If you experience back pain for days to weeks, it’s likely not because of ovulation and you should talk to your doctor for more evaluation.
Here are other reasons your back pain is lasting longer than usual.
1. Endometriosis
About 1 in 10 women of reproductive age will have endometriosis worldwide. Endometriosis happens when tissue similar to the lining of the uterus grows outside the uterus, in places like the ovaries, fallopian tubes, and the pelvic cavity. The World Health Organization explains that it is a chronic condition that commonly causes pelvic pain and can affect fertility.
In most women, abdominal pain is the most common symptom. Though, you could develop pain in your back that last for days.
Other symptoms of endometriosis are painful sexual activity, excruciating cramps during menstruation, pain during bowel movement, painful urination, heavy menstrual periods, infertility, and body weakness.
If you experience any of these symptoms, see your doctor for more evaluation and advice.
2. Ovarian cyst
Ovarian cysts are fluid-filled sacs that happen when an ovarian follicle fails to break open and release its content during ovulation.
If this occurs, and the cyst grows very big within your abdomen, you will feel back and abdominal discomfort.
Worst still, if an ovarian cyst ruptures or twists (ovarian torsion) and releases blood into your abdomen, you will feel a sudden severe abdominal and back pain. This is an emergency and needs urgent medical attention.
3. Peptic ulcer disease
A peptic ulcer is an injury to the lining covering your stomach and upper parts of your small intestine. If you have a stomach ulcer, a sharp, burning and biting upper abdominal pain is common and may sometimes spread to the back.
4. Pelvic inflammatory disease..see here
5. Uterine fibroids..see here
6. Urinary tract infections
Can lower back pain during ovulation be due to pregnancy?
During ovulation, abdominal and back pain may occur and resolve on its own. Should you have unprotected sexual intercourse during this time, it’s unlikely your back pain at that moment is due to pregnancy.
It takes at least 7–12 days after ovulation for implantation of an embryo to occur. Implantation occurs when your fertilized egg is attached to your womb.
Around the time of implantation, some women may notice mild cramping, back pain, or light vaginal spotting. However, these symptoms are not specific to pregnancy and can easily be confused with your normal premenstrual symptoms. Many pregnant women feel no symptoms at all this early.
If you think you might be pregnant, the most reliable time to do a home pregnancy test is from the first day of your missed period or about 12–15 days after ovulation. MedlinePlus has a helpful patient page on pregnancy tests that explains when these tests are most accurate.
If your test is positive, see your doctor or clinic for confirmation and antenatal care. If you have a positive pregnancy test and one-sided pelvic or back pain, shoulder pain, dizziness, or fainting, get emergency care to rule out an ectopic pregnancy.
Dr Akatakpo Dunn is a Nigerian medical doctor, sonologist and Medical Director of Verah Clinic & Maternity in Warri, Nigeria. He holds an MBBS from the University of Nigeria, Nsukka, a Postgraduate Diploma in Diagnostic Ultrasound (India) and a Professional Diploma in Obstetrics & Gynaecology (RCPI). Through Medplux, he explains women’s health, pregnancy, fertility and ultrasound in clear, practical language so readers can make informed decisions with their own doctors.
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