Ovulation Pain on Both Sides: Causes, Treatment (Danger Signs)

Question: What causes ovulation pain on both sides? Is it possible to have twins if both right and left ovary release an egg at the same time?

Ovulation is the release of an egg from either the right or left ovary, and the process is controlled by the rise and fall of hormones such as estrogen, progesterone and brain hormones FSH and LH.

During ovulation, most women will have only one of their ovaries release an egg. So, it’s not unusual if you are experiencing pain on one side of your abdomen.

However, if you are experiencing ovary pain on both sides of the abdomen, its normal you will be scared something is wrong. Here’s an email I received from Theresa (One of my readers)

Hi Doc,

I have a 28 days menstrual cycle, and sometimes I do experience pain while ovulating. In fact, a short-lived and sharp pain in my belly and back is how I know I’m ovulating.

Surprisingly, this month, after the end of my period, I get this severe pain on both sides of my abdomen. I feel like vomiting, and I’m wondering if its pregnancy.

Three weeks ago, I had sexual intercourse with my husband (protected with a condom), and I do not have any other signs of pregnancy.

What causes cramps on both sides during ovulation?

Just like Theresa, you will be wondering what’s wrong when you suddenly start having stabbing pain on both sides of your tummy while expecting ovulation.

The truth is, it can be normal in some women and may sometimes occur because of the release of eggs from both your ovaries. This is sometimes called multiple or bilateral ovulation. However, ovulation pain on both sides does not always mean both ovaries have released an egg.

Having said that, it’s important you know a very severe and long-lasting pain could be due to something else. Endometriosis, adenomyosis, pelvic inflammatory disease, ovarian cysts, fibroids, kidney infections, and acute appendicitis may cause you to feel this way.

This article explains why you have abdominal cramps on both sides during ovulation, what ovulation pain feels like, and when you should see your doctor.

What causes ovulation pain on both sides of the abdomen?

Within your abdomen, your body houses different structure that makes it possible for you to have a regular menstrual period.

Your ovaries (right and left) are located on the sides of the uterus, and after the release of an egg during ovulation, the fallopian tube (which is a 10cm muscular tube) picks up the “released egg” and slowly convey your egg to the body of the uterus.

At each month, during your ovulation period, you are likely to release an egg from one of your ovaries. Your body spontaneously directs an ovary, that is, your right or left ovary, to release an egg.

During bilateral ovulation, your both ovaries will work to release an egg at the same menstrual cycle, meaning, instead of one egg released, you will have 2 or more eggs released into your fallopian tube. Doctors sometimes call this multiple ovulation or hyperovulation.

Usually, there are many signs you will expect while ovulating. One of those signs is pain in your abdomen and affects 1 in 5 women during ovulation. So, if ovulation occurs on both ovaries, you will experience cramps on both sides at the same time.

How do cramps on both sides of the abdomen occur during ovulation?

More than 80 percent of women will not have abdominal cramps during ovulation. This pain, also referred as Mittelschmerz pain, will be noticed by 20 percent of women, and it may feel like a mild ache, pressure, or a sharp stabbing pain that only lasts for about 48 hours.

Before ovulation occurs, estrogen hormone plays a vital role. At your ovaries, it causes many follicles to grow, and this result in the expansion of ovarian follicles and your ovaries. This stretch in the outer covering of your ovary can cause “ovulation pain”.

Another reason you will feel pain during ovulation is the release of follicular content (blood and fluid) into your abdomen. This can cause inflammation and pain.

Finally, after the release of an egg into the fallopian tube, muscular contractions will push your “released egg” to the uterus. This may also cause you to feel pain.

Experts are not completely sure which of these mechanisms is the main cause in each woman, but all of them can contribute to Mittelschmerz.

Ovulation pain is not abnormal, and for most women it is a short-lived pain that may last from a few minutes to one or two days. See your doctor if pain continues with other symptoms.

Can ovulation pain on both side mean twins?

If you are ovulating, mostly, your body spontaneously picks an ovary to release an egg. However, if you are experiencing pains on both sides during ovulation, it could be due to both ovaries preparing for ovulation, but it is not a guarantee that you will have twins.

After the release of an egg from your ovaries, if there is a waiting sperm (released from the man after sex), you can get pregnant.

If two eggs are released and both are fertilized, you can have a twin pregnancy. Twins will not be identical, but fraternal because your ovaries release two eggs at the same time. These fraternal twins come from two separate eggs and are no more alike than other brothers and sisters.

If only a single egg is released, fertilized and then divides into 2, you can expect an identical twin.

Ovulation pain on both sides on Clomid

If you are currently taking medications to boost fertility, you can experience cramps on both sides during ovulation. Clomiphene citrate (Sold as Clomid) is an important drug that helps improve fertility in women.

It works by boosting hormones that control ovulation with a resultant development of multiple follicles in your right and left ovaries.

The truth is because multiple follicles develop while on Clomid, you can expect more than one egg released into your fallopian tube.

If this occurs a sharp short-lived pain can occur, and you can get pregnant if you also had sexual intercourse.

Because multiple eggs may be released, your chance of twins is higher than normal (studies suggest around 5–10% with Clomid), and triplets or higher-order multiples are much less common but can still happen with fertility drugs.

Bilateral ovulation pain: When to worry?

While abdominal pain on both sides days apart could be due to ovulation, it’s important you know that there are other causes of severe pain in your abdomen.

Usually, cramps during ovulation will only last one or two days, and in a 28-day menstrual cycle, pain occurs on day 14 – 16. Also, Ovulation cramps usually require no treatment, because it stops on its own.

If cramps are occurring at other times in your menstrual cycle and lasting longer than usual, it’s essential you inform your doctor.

Danger signs that signify serious health issues are vomiting, excruciating abdominal pain, painful menstruation, smelly discharge, body weakness, fever, burning sexual intercourse, and dizziness. If you have a positive pregnancy test with sudden severe pain or heavy bleeding, treat it as an emergency and go to the hospital because of the risk of ectopic pregnancy.

See your doctor for evaluation.

Helpful resources for further reading on ovulation pain and twins:
– Mayo Clinic – Mittelschmerz (ovulation pain): https://www.mayoclinic.org/diseases-conditions/mittelschmerz/symptoms-causes/syc-20375122
– Cleveland Clinic – Ovulation pain (Mittelschmerz): https://my.clevelandclinic.org/health/diseases/9134-ovulation-pain-mittelschmerz
– MedlinePlus – Mittelschmerz: https://medlineplus.gov/ency/article/001503.htm
– Better Health Channel – Twins: identical and fraternal: https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/twins-identical-and-fraternal
– ASRM / ReproductiveFacts – Fertility drugs and the risk of multiple births: https://www.reproductivefacts.org/news-and-publications/fact-sheets-and-infographics/fertility-drugs-and-the-risk-of-multiple-births/