It is not your period, but it hurts like hell. You are not sick, but you are bloated, irritable, and spotting. Welcome to ovulation—the mid-cycle moment that is misunderstood, under-discussed, and sometimes unbearable.
For some women, ovulation passes like a whisper. For others, it barges in like an uninvited guest—bringing mood swings, pelvic pain, sticky discharge, and a flood of questions even Google struggles to answer. Is it normal? Is it serious? Or is your body just doing its thing?
Dr Wachira Murage, a consultant obstetrician and gynaecologist at Savannah Hospital in Upper Hill, Nairobi, says ovulation typically happens around day 14 if your cycle is 28 days long. But cycles can range from 21 to 35 days—and so can ovulation. If your cycle is 21 days, you might ovulate on day seven. If it's 35, expect it around day 21.
"It's all about hormones," Dr Murage explains. "Follicle-stimulating hormone (FSH), luteinising hormone (LH), estrogen, and progesterone are rising and falling in tune to prep your body for pregnancy."
Ovulation isn't one-size-fits-all
After your period ends (typically between days three to seven), your body starts thickening the uterine lining again.
"During this time, the uterus begins to rebuild the lining that was shed, preparing for the next potential pregnancy," says Dr Murage. "The body assumes that conception is possible."
Around ovulation, hormone levels peak, and the body releases a mature egg. The fertilised egg—if one comes along—has about three days to travel to the uterus and implant. If it doesn't? "Then it waits for about 14 days, and then if there is nothing, then the menses come again for ladies with regular menses."
Not everyone has clockwork periods. Some women ovulate early or late, leading to heavier or irregular bleeding. "So, you hear some people saying I have irregular periods, I bleed for a long period, I don't have periods. It's because of the variation of those hormones that we have spoken about that peak at mid-cycle during the ovulation time."
How your body might tip you off
Most of the time, ovulation doesn’t cause problems. But some women feel it—and strongly. Some have to take painkillers.
"If I start with the normal things that you may feel as a woman, and you know that you are ovulating, is number one, you may get some pimples on the face," says Dr Murage.
Mood swings, irritability, or feeling emotionally off are also common. Then there's the ovulation pain. Dr Murage paints a vivid picture: "The process of ovulation involves that an egg is carried in a sort of a ship... The ship travels and docks and then releases the egg. So that docking is like a rupture of a follicle, something cutting the egg, and that is where the bleeding comes from. Remember, blood is a chemical; it is an irritant, and it causes inflammation and pain."
Discharge that speaks volumes
Sometimes, the pain is more than a twinge. Larger follicles bleed more. Both ovaries might release eggs. That pain might even shoot down your legs. "The nerves are passing through there, so they are irritated by that blood," Dr Murage explains.
Hormones can also make you feel bloated, swollen, or like you've gained weight.
"Some have diarrhoea, others will vomit because there is an upsurge during that process of ovulation that affects the gastrointestinal tract, hence the nausea or even loss of appetite."
Estrogen can trigger a clear, stretchy discharge. Dr Murage says, "A good, healthy ovulation discharge is clear and tenacious." You may have a spotting, a streak of blood, but it doesn't smell."
But brownish discharge? "It is possible because of spotting, but remember if it is continuous, you need to get checked."
That could be an early sign of cervical cancer.
Dr Murage adds, "Make sure that within two years you have done your pap smear."
Even the uterus has a 'bad' angle
Got endometriosis? Ovulation will likely be more painful. Misplaced uterine cells respond to hormonal surges just like the ones in your uterus—and that means inflammation.
Dr Wachira Murage.
Pelvic Inflammatory Disease (PID) and other active infections can add layers of pain.
"They become more and more painful because there is a lot of activity happening around here during ovulation."
Ideally, your uterus is tipped forward. But if it tilts sideways or backwards, it can rest on your spine and cause backaches—especially during ovulation.
Dr Murage is clear: "Severe ovulation pain is a diagnosis of exclusion. So, you want to know if are there any infections? If so, you can do a blood test."
But it starts with listening to the patient. "Before you rush to any test, do a thorough history. Do you want to understand what the trend of this pain is? How does it come? When does it stop?"
A pelvic exam can help too. "We can put our fingers into the vaginal region, and we want to feel where the pain is and feel from below and above. Sometimes there can be swelling, cysts, fibroids, adenomyosis—where the uterus kind of swells."
How to ease the pain
Ovulation pain, according to Dr Murage, is normal to a certain extent. "So, if you can cope, you don't need to do anything. Just take a rest, a warm shower, and some painkillers."
Dr Wachira Murage is an obstetrician/gynaecologist and Director of the Savannah Hospital in UpperHill, Nairobi.
But if it gets worse, he recommends investigating further. "If you find nothing from the Pap smear and ultrasound, and it is not endometriosis, then you can have, like, extra painkillers (analgesics)."
Sometimes, hormone suppression is considered. "If the pain doesn't go away with that, then you discuss with a client whether she can stop her periods for, like, three months by putting her on family planning pills. In a way you are trying to alleviate that and see whether the body will forget."
There's also a more surprising approach: pregnancy. "If she is married and waiting for a baby, we encourage them to get pregnant,” Dr Murage says. "Because during those nine months, again, the body adjusts to a new norm after they deliver."
