Mid-Cycle pain lasts 2 weeks.

by Chesley
(Brooklyn, NY)

Dear Wray,

I am hoping you may have some insight! I feel at a loss. It started about 2 years ago. Summer '11, thought I was pregnant, had the classic symptoms, cramps and no period...well, the cramps got pretty severe and it actually ended up being a UTI. Went on Cipro, and continued cramping, thought I still had the UTI, but I didn't. Tests came back negative. I had an ultrasound and there was a lot of fluid but everything looked normal, no cysts, no fibroids. Ever since then, I experience horrible mid-cycle pain, lasts for 2 weeks, on and off. When i get my period, that is really when i experience relief. No cramps at all. But the two weeks prior to my period, are filled with horrible cramps, bloating, I feel lots of pressure in my pelvis (hard to explain) headaches, lower back aches....for 2 weeks, and for some reason emptying my bladder (during these 2 weeks) can bring on the cramps as well. Then my period, which is pain free. My OB suggested at the time to get on birth control pills, since this seemed to be linked to ovulation. But at the time, we were trying to get pregnant. I did end up getting pregnant, and during my pregnancy, I didn't have any of these pains, I had a healthy baby boy in Nov '12 -- he is 6 months old. And just now, I am starting to have these ovulation pains. that last, I wouldn't describe it as Middleschmertz, because it lasts for 2 weeks. I am exclusively breastfeeding. And want to continue. And the last 6 months have been pain free, but it just started up again! So frustrating! And really took a toll on my mental health. Do you think the mini-pill (POP) could help? I am 35. Both my mom and grandmother went through Menopause very early. 38, and 40. Any insight into this would be soooo wonderful and so appreciated. Thanks so much,
Chesley Thomas

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May 25, 2013
Mid-Cycle pain lasts 2 weeks.
by: Wray

Hi Chesley It certainly can't be Mittelschmerz, as that only lasts a max of two days. Besides you had tests which showed no cysts etc. Although to test for Mittelschmerz they would have to do a scan just prior to ovulation to see if the follicle could be causing so much pain. But I think it's being caused by oestrogen, the symptoms and timing fit. It's always been believed, and still is by everyone including the medical profession, that progesterone is only produced by the corpus luteum after ovulation. But as far back as 1930 it was thought there must be another source. This was confirmed in the 1960's, and re-confirmed in the 1980's, that there is an exponential rise of progesterone about 50 hours prior to ovulation. This surge comes from the brain, see here, here, here and here. Oestrogen also rises exponentially about 50 hours prior to ovulation. Unless there is the progesterone surge too, there is nothing to counter the oestrogen effect. This explains why many women get migraines, seizures, palpitations, panic attacks and asthma attacks around ovulation. And now you've added another symptom to my growing list! Oestrogen is an inflammatory hormone, it increases free radicals, and stimulates prostaglandins, cytokines and chemokines which cause cramping, and contractions in labour too. In fact the ratio of oestrogen to progesterone rises prior to labour. Things always go awry when oestrogen is higher than progesterone. Oestrogen also causes water retention, hence the bloating. It seems you are not getting the progesterone surge prior to ovulation, and that once you have ovulated, the corpus luteum is not producing sufficient progesterone to counter the oestrogen. Round about age 35 anovulatory cycles usually begin, it appears with you it occurred slightly earlier as you say the cramping started 2 years ago. This would fit with the earlier menopause your family has. If ovulation doesn't occur, no progesterone is produced which would only make matters worse. Continued below

May 25, 2013
Mid-Cycle pain lasts 2 weeks Part 2
by: Wray

Hi Chesley Something we tend to forget, is that although progesterone rises mid-luteal phase, so too does oestrogen. So with the surge prior to ovulation, no progesterone to oppose it, then a further surge about 7 days later, would mean oestrogen is high for two weeks. To my mind your problem has nothing to do with ovulation per se, but with excess oestrogen. I'm very against any drug based Contraceptive, and feel you would do better with progesterone. But of course the decision is yours. If it helps you decide, you had no cramps while Pregnant. This is due to progesterone, one of it's many roles is keeping the uterus quiet by suppressing inflammatory cytokines. And in part by suppressing the action of oestrogen, see here. In case you do opt for progesterone, you might like to see our page on How to use progesterone cream. Take care Wray

Oct 25, 2014
Thank you
by: Anonymous

Hi - I found this page on a desperate Internet search. My situation parallels the original authors exactly only I am 43. My Gyn put me back on the pill too with the same lack of results. I'll go back with this insight and hope to discuss further with my Dr. I really need some relief. Best. Jenny

Oct 27, 2014
I know how you feel
by: Anonymous

I was browsing for people who is having similar symptoms too.. Mine is almost similar to yours. I had ultrasound and doctor told me that my womb looks fine. No cyst nor fibroid. I have this annoying cramps every mid cycle for every month almost 2 years. Backaches, cramps, pain during bowel movements & sometimes the urge to pee is quite frequent. It is so frustrating to experience cramps and pain for almost 2 weeks in every month. Pain will disappear once my period started. (T_T) sigh.. I'm just in my 20s. Getting married soon.

Oct 28, 2014
an update....
by: Chesley Thomas

Hello Wray & Ladies...

Wish i was updating you with good news but I am still having all these symptoms and it's been a little over 3 years now. I did see a Urologist recently, and what I have really concluded myself and the urologist also confirmed is, it's Interstitial Cystitis. Now, I didn't have a cystosopy, but based on my symptoms it very much sounded to the doctor like IC (interstitial Cystitis). It's been going on like I said for 3 years now. And it is mainly around ovulation time and couple days before my period. But, I had really noticed that once I emptied my bladder I always had cramping, discomfort. I will have lots of pelvic pressure. Like, a bowling ball pressing on my bladder. (it's hard to explain) headaches, fatigue....cramping after bowel movements (IBS??)...some frequency/urgency but not a lot. Maninly a burning sensation, and pressure, and cramping. Mainly at night and in the morning.
SO, the urologist suggested going on the birth control pill to see if that helps at all. I've been on it a month now, and haven't noticed much of a change, but it's only been a month. I've also started Acupuncture.
Curious, to know your thoughts Wray on IC. I feel like it's completely hormonal related. At least for me. It seems that way. I am going to do the 3 months of BC pills and see if there is any change in my symptoms. If not, maybe progesterone cream is what i need?? I just don't know at this point. I am at a loss. I know that IC is chronic, but it can also go into remission. I am ready to do whatever I can to feel better. I would love your insight on IC!
Take Care,

Oct 30, 2014
an update....
by: Wray

Hi Chelsey I take it you didn't try using the progesterone? I still feel what I said previously is correct. So many women get adverse symptoms prior to bleeding. Many experiencing them for the two full weeks after ovulation, suggesting ovulation didn't take place, or insufficient progesterone was secreted if it did, i.e. asthma, epilepsy, migraines all these can worsen during this time. You said you did not have any pain while pregnant, to my mind this points out the excess oestrogen link. I have looked into IC and UTI's as so many women get them. UTI's (urinary tract infections) are generally considered distinct from IC (interstitial cystitis or bladder infections). Suggesting bacteria, viruses or fungi are responsible for the UTI, whereas the aetiology of IC is unknown. As the bladder is connected to the urethra, I find it difficult to conceive of two separate problems. Antibiotics are given for UTI's, often unsuccessfully, or repeatedly in the belief it's killing the pathogen. In 1911 Bernard Shaw wrote "… the characteristic microbe of a disease might be a symptom instead of a cause." I tend to believe this. Pathogens are opportunists, if a cell or tissue is damaged they will take advantage of this fact. More and more studies are finding that inflammation is behind our diseases and disorders. Inflammation results from a disturbance in the immune system, often due to a lack of antioxidants. Which is usually a result of the pollution, processed food and drink, stress and of course drugs to which we are now subject. Inflammation seems to fit the bill for both UTI's and IC, but as the urethra is more easily accessible to bacteria etc, it doesn't surprise me they are found there. Several studies have found IC is due to inflammation, and a subsequent damage to the lining. Why not the UTI's too? D-mannose is sometimes effective. It's believed that the bacteria, if present, will adhere to the D-mannose and be excreted. A more likely explanation is the lining of the urinary tract, including the bladder, has become damaged by inflammation. The lining is a thin layer of glycoproteins, these are a combination of a sugar molecule and a protein. The D-mannose can be used for glycoprotein biosynthesis, see here. This would strengthen the lining preventing possible attack from bacteria or inflammation. Continued below

Oct 30, 2014
an update.... Part 2
by: Wray

Hi Chelsey The amino acid arginine can help too, see here. Mast cells are implicated, see here. Progesterone inhibits mast cell secretions, see here. Excess oestrogen and a lack of progesterone appear to be a reasonable cause, see here and here. Oestrogen is an excitatory, inflammatory hormone, it's involvement is hardly surprising. Particularly when looking at the statistics, far more women get UTI's and IC than men. Interestingly oestradiol increases mast cell histamine secretion, which is initiated by substance P. This is a pro-inflammatory, nociceptive neuropeptide. Even more interesting, progesterone and it's metabolites are suppressed by substance P, see here, unless sufficient is used, see here and here. Take care Wray

Jan 19, 2015
I concur
by: Anonymous

This sounds like me. I had terrible acne growing up and was on the pill for nearly 15 years to treat it. When I came off it - when I wanted to get pregnant - not only did the irregular periods continue but also the acne, with a vengence. It took us nearly a year to conceive, and that was after I was diagnosed with pcos (the lean version) and went to see a naturopath. She put me on a low gi diet and some supplements.
When I did get pregnant, my son was born premature (he's fine and healthy now, but it was an eventful start.) They couldn't really tell me why. It may have been a resistant uti I had for a few weeks. I've been prone to uti's since my 20s. I'm 35 now.
With my second son, again, I was prone to uti's (asymtomatic bateriuria) and was put on a low dose antibiotic for the duration of the pregnancy. I also suffer from ridiculously irritable uterus when pregnant which only made my high anxiety of preterm labour worse. Yay! However, he was born 20 mins shy of 37 weeks and is healthy.
Now, I'm dealing with mittelschmerz which lasts a good week and a half mid-cycle - bloating, low back pain, fatigue, and general abdominal pain.
Seems as if all this crap is related. Could I have a progesterone shortage? What could I do to make this better?

Feb 02, 2015
by: y28

oh god, i'm so glad i have found people with the same pain. My peroid returned when my daughter was 15 months, shes 21 months now, i'm happily still breastfeeding. The pains began a month before my period returned and each month after that and lasting 2 weeks each time, pain is all in my lower back. For two months in a row the pain only lasted a day so i assumed it had settled. This month it has returned and so far lasting 2 weeks. I used to suffer from cystitis a lot and a few months before i got pregnant i took antibiotics for it after which i felt my bladder was 'bruised'. i had tests done for uti and they showed nothing. This went away when i got pregnant but has returned recently. I have booked an appointment to see the doctor but im afraid it will be dismissed as being normal. there is a long history of ovarian ncancer in my family so im terrified.

Feb 15, 2015
@ Y28
by: Anonymous

Natural progesterone protects against ovarian cancer. Check out the cancer page on this site. I think you will find the information reassuring and show you ways you can be proactive in protecting yourself from ovarian cancer.

Mar 26, 2015
Washington State
by: K~

So glad I found this - I ended up in the ER last night after having deep sharp pain in my lower right abdomen (low) and ignored it. The pain ended up so bad that I found myself in the ER after vomiting because of the pain (9/10 pain) and thought I was having apendicitis. After Ultrasounds, urine test and blood tests, everything looked normal except cyst on ovary and possible twisted ovary. They dx me with middleschwertz. But I thought how is that possible if I am on birth control pill. Since the pill stops ovulation. After researching I am wondering if it is Endometriosis. I have had a laproscopy for cysts 15 years ago - I am 41 now. I have had one child - 20 - I am so shocked about how painful this is. After having intravenous pain meds and hydrocodone and anti-inflammatories the pain is better but still there - waiting for my GYN to call me back. Reading your posts - wondering about endimitriosis. Have a lot to find out about

Feb 24, 2016
I really think this is progesterone related!
by: Anonymous

So relieved to read these comments!! Diagnosed with endometriosis decades ago and PCOS 10 years ago after coming off birth control pills for the endo. Coming off the pill was awful. The worst. Took two years to stop the hair loss and the cystic acne.

My husband and I have a darling 3yo daughter now (a miracle!) but I've experieced horrible mid-month pain on either and both side of abdomen for almost 2 years now. Chocked it up to PCOS and got on Metformin, which helps a little. Menstual cramps/bloating is nothing compared to mid-month pain that last for at least 2 weeks! So ...

Had my fourth laparoscopy this morning. No kidding. I expected gyno to see ovaries full of cysts or something else. Aside from one moderate cyst on an ovary, everything looked pretty good. Ugh!! On one hand, great that the endo isn't growing even without being on BC! And the Metformin is working because no cysts really. But the pain?

Feb 26, 2016
I really think this is progesterone related
by: Joy

All drug based BCP have a potential to cause harm as you have found out. It can take years before the body adjusts. PCOS, endo and fibroids are all caused from oxidative stress and unless the stress is dealt with you will battle. You are very much a candidate for progesterone therapy which should be used every day with no breaks for 2-6 months, possibly longer. You also need the nutrients mentioned on these pages. Progesterone is an excellent anti-inflammatory, should you decide to use it, rub it on the painful area as often as needed.

Cysts are usually caused by excess estrogen which you will have because of the BCP which makes it worse. Please read the Estrogen Dominance and How to use Progesterone Cream pages as they explain how to use it correctly and what is needed. I also feel that your iodine level is low, have you been tested? Did your doctor tell you that Metformin causes a vitmain B12 deficiency? He should have informed you.

What is your vitamin D3 level? A deficiency reduces the benefits of progesterone and is vital for PCOS, endo and fibroids.

Please read the following pages:

Estrogen Dominance
How to use Progesterone Cream
Progesterone Cream
Vitamin D3

Sep 26, 2018
Same pain
by: Anonymous

Hi Chesley

It's me who undergoes through the same pain which you are going through. And its been 4 years. It starts 2 weeks before menses. At the time of menses I'm pain free. And then again the same story. I do get cramps after emptying the bladder and that goes in my back too. Each and every gynae told me that pregnancy will help but i'm unable to conceive also.

Really do not know how many years to go with this which even stopped me from working as the pain is for almost 15 days.

Sep 27, 2018
response to Anonymous...
by: Chesley

Hello! so it's been 3 years! But, wanted to update you...things are better. Not perfect but way better.

The things that have helped me have been pelvic floor physical therapy twice a week, acupuncture once a week, gave up caffeine, do yoga, and take BC Pills (I am on a low estrogen one) -- those are the things that have really helped me. LOTS of water too. I try to avoid sugar.

Just wanted to share a little of what has helped, I am so sorry anonymous! I know your pain and frustration. Just hang in there, try anything and everything. That's what I did, you feel desperate and want to fix it. Something will work. Some days I have mild discomfort but nothing like it was. Feel for anyone that has to go thru this...


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