- ATHENS OFFICE MED4WOMAN ATHENS
- VOLOS OFFICE MED4WOMAN VOLOS
Obstetrician-Gynecologist
PhD, University of Athens Medical School
Obstetrician-gynecologist Panagiotis Polyzos practices at the Institute of Life, the IVF Unit of IASO Maternity Hospital.
Every woman is born with hundreds of thousands of immature eggs stored in her ovaries, which later in life will start to be released each month for the purpose of fertilization. The process during which a mature egg is released from the woman’s ovaries is called ovulation. Although the term “ovulation” is widely used, the more accurate term is follicular rupture, since what actually ruptures is not the egg itself, but the follicle, the “sac” in which the egg matures.
Each month, approximately 15 to 20 eggs in each ovary begin to mature inside their follicles. Ovulation occurs when one of the ovaries releases one (or sometimes more, though less frequently) mature egg from the dominant follicle. The egg then travels into the fallopian tube, where it becomes available for fertilization.
At the same time, the endometrium (uterine lining) thickens to host the fertilized egg. If fertilization does not occur, the unfertilized egg is transported into the uterus and expelled from the body together with the endometrial lining through bleeding, known as menstruation or period. However, if fertilization does occur, the fertilized egg will continue its journey toward the uterus over the next 5 to 6 days, where it will implant into the endometrium.
Some women know very well when they are ovulating. Other women do not notice any change. If you are thinking of getting pregnant, observe yourself for a few months and you will soon be able to work out your fertile days. Some small signs of ovulation are the following:
Learn when eggs are most likely to be released and increase your chances of conception.
First, you need to understand when ovulation will occur (the release of an egg from the ovary). There are several different methods you can try to help you identify when you are ovulating.
In one study, couples who timed intercourse around ovulation got pregnant significantly faster than is typically observed among couples trying to conceive:
In most cases, a woman does not experience any clear symptoms before ovulation. However, in some women, symptoms may appear more noticeably and become easily recognized by the woman herself. The most common signs of ovulation may include abdominal discomfort or mild pain, as well as a very small amount of bleeding or spotting from the vagina.
In rare cases, the symptoms may be more intense or bothersome, and it is advisable to consult a gynecologist who can provide guidance and management options. What is certain is that during this time, the fertile days have arrived and the chances of achieving a pregnancy are increased.
If you notice a very small amount of blood, this is generally considered a normal symptom and should not worry you. However, if the bleeding is heavier than usual or more than just spotting, it is advisable to contact your doctor for proper guidance.
The LH hormone, or luteinizing hormone, is produced by the cells of the pituitary gland and is responsible for the proper functioning of the ovaries in women. Ovulation typically occurs about 2.5 days after the increase in LH levels. Immediately afterward, the egg enters the fallopian tubes, where fertilization can take place.
Yes, pain during ovulation is considered normal and is one of the common symptoms indicating that ovulation is beginning. For many women, however, pain may not be present at all. If the pain becomes persistent or bothersome, it is best to contact your doctor and explain your symptoms, so they can provide appropriate guidance.
Ovulation symptoms do not appear with the same intensity in every woman. The most reliable are:
The fertile days are the five days before ovulation and the day of ovulation itself. The symptoms of the fertile days are essentially the symptoms of ovulation: more and clearer mucus, increased desire and, close to ovulation, a positive LH test. To calculate them with a calendar, see the guide on fertile days and the tips on how to get pregnant.
Ovulation pain (mittelschmerz) is a cramp or twinge low on one side that lasts from a few minutes to one or two days. It is caused by the rupture of the follicle and a small amount of fluid that irritates the peritoneum. It shows that you are in the most fertile hours of your cycle, so intercourse on that day and the day before has the best chance of conception. The pain on its own does not mean that conception has happened. If it is severe, lasts longer or comes with period pains that are getting worse, discuss it with your doctor, because it may be a sign of endometriosis or an ovarian cyst.
The cycle is divided into two phases, with ovulation between them. Each phase is controlled by different hormones.
This sequence explains why temperature rises after ovulation, why mucus changes before it, and why the length of the cycle is determined mainly by the first phase.
Body signs and home tests give indications. When certainty is needed, for example when there is difficulty conceiving, the doctor uses:
A cycle without ovulation can happen to any woman occasionally. When it keeps happening, however, it is one of the most common causes of difficulty conceiving. Ovulation disorders are grouped into three main categories:
Signs of anovulation are very infrequent or unpredictable cycles, absent periods, no temperature rise on the chart and LH tests that never turn positive. Treatment depends on the category. That’s why a correct diagnosis comes before any medication.
Combined birth control pills, the ring and the patch work mainly by suppressing ovulation. As long as you use them correctly, there is no ovulation, and the bleeding during the break is not a real period. After stopping, ovulation usually returns quickly.
The morning-after pill works mainly by delaying ovulation. That’s why it is more effective the sooner it is taken, and it does not protect you if ovulation has already happened. It does not end a pregnancy that has already implanted.
Mild ovulation pain is harmless. Rarely, however, a follicle or corpus luteum can bleed into the abdomen, or the ovary can twist (ovarian torsion). Seek medical help right away if you have:
If there is a chance of pregnancy, the same pain may be due to an ectopic pregnancy. That’s why a pregnancy test is the first step at the hospital.
Yes. Light mid-cycle bleeding, pink or brown, occurs in a small percentage of women and is due to the temporary drop in estrogen. If it is heavy, happens often or comes with pain, a gynecological checkup is needed.
Usually from a few hours to two days, and it is just a few drops. Bleeding that lasts longer or looks like a period is not considered ovulation bleeding.
The five days before ovulation and the day of ovulation. In a 28-day cycle, this corresponds roughly to days 10 to 15. In a longer or shorter cycle, ovulation happens about 14 days before the next period.
Mild pain low in the abdomen, usually on one side and sometimes radiating to the lower back, is common. Dizziness is not a typical symptom. If it is intense or keeps recurring, discuss it with your doctor.
Yes. Anovulatory cycles are common in adolescence, in perimenopause and in polycystic ovary syndrome (PCOS). If your cycle is very irregular, it is worth having your ovulation checked.
Clear, stretchy cervical mucus, mild pain on one side of the abdomen, breast tenderness, increased libido and a small rise in basal body temperature after ovulation.
Usually from a few minutes to 24 to 48 hours. If it lasts longer or is very severe, a gynecological checkup is needed.
Not necessarily. The pain shows that you are in your fertile hours, not that conception has happened. The chance is higher when intercourse takes place the day before and the day of ovulation.
Rarely, two eggs may be released within the same time window, usually within 24 hours, and this explains fraternal twins. Two separate ovulations weeks apart in the same cycle do not happen under normal conditions.
With correct use of combined birth control pills, ovulation is suppressed. Missed pills, vomiting or interactions with certain medicines may allow ovulation.
Signs are very infrequent or unpredictable cycles, absent periods and ovulation tests that never turn positive. Confirmation is done by measuring progesterone in the second phase of the cycle or with ultrasound follicle tracking.
Exclusive breastfeeding often delays the return of ovulation, but does not rule it out. The first ovulation happens before the first period, so you need contraception if you are not planning another pregnancy.
