Ovulatory syndrome is a complex of disorders that occur during ovulation and are associated with it. Develops on average two weeks before the next menstruation, lasts from several hours to two days. It is manifested by pain in the lower abdomen, bloody discharge from the vagina, in some cases — an increase in temperature to subfebrile figures, nausea, vomiting, emotional disorders. To confirm the diagnosis, the method of basal temperature control, folliculometry, assessment of the level of luteinizing hormone and estrogens are used. Specific therapy is not required, with severe pain, the appointment of analgesics and antispasmodics is indicated.
According to most specialists in the field of gynecology, ovulatory syndrome is not an independent disease. According to statistics, its signs were noted at least once in every second woman’s life, at least 20% of patients experience disorders of varying severity with all ovulatory cycles. In 85% of cases, pain and discharge during ovulation are caused by physiological processes, in 14% — diseases of the reproductive organs, in 1% — the development of pathology in the middle of the menstrual cycle, which is not associated with the release of an egg. The disorder occurs more often in patients aged 25 to 42 years and completely stops with the onset of menopause.
Causes of ovulatory syndrome
Normally, a woman does not feel the egg coming out of the follicle. However, there are a number of physiological reasons that, in the presence of predisposing factors, contribute to the occurrence of pathological manifestations during ovulation and within 48 hours after it. These include:
- Follicle growth. The increase of the dominant maturing follicle to the required size is accompanied by stretching of the ovarian capsule. In this case, pain syndrome may develop.
- Rupture of the follicle. The ovarian membrane contains nerve endings. When the follicle wall is damaged, they are excited and transmit the corresponding signals to the cerebral cortex, which is perceived by a woman as ovulatory pain.
- Contractions of the fallopian tubes. The movement of the egg into the uterine cavity occurs under the action of contractions of the fallopian tube wall. According to some researchers, peristalsis can be accompanied by painful sensations.
- Irritation of the peritoneum. When the follicle ruptures, not only the egg enters the abdominal cavity, but also the surrounding fluid, as well as a small amount of blood. Due to irritation of the peritoneum, pain occurs.
The key factors that increase the likelihood of a pathological course of the ovulatory period are diseases of the female genital sphere. The risk of pain syndrome increases in women with ovarian cyst, chronic oophoritis, salpingitis, adnexitis, adhesions in the pelvic cavity. In addition, a decrease in the pain threshold is noted in patients with dysmenorrhea.
The pathogenesis of ovulatory syndrome is caused by a combination of two key links. The first of them is the sealing of the ovarian capsule and the wall of the fallopian tubes due to inflammatory and adhesive processes. The rupture of dense and inflamed tissues is perceived by pain receptors, and then by the cerebral cortex, as a more serious injury. In the presence of adhesions and synechiae in the pelvic cavity, the peristalsis of the fallopian tubes becomes painful. The second link of pathogenesis is a decrease in the threshold of pain sensitivity. In extremely rare cases, it is congenital.
Usually, sensitization to pain is caused by local volumetric and inflammatory processes in the pelvis. At the same time, due to the cessation of estrogen secretion by the follicle, relative hypoestrogenemia occurs. As a result, the functional layer of the endometrium partially peels off, spotting secretions appear. After 1-3 days, the temporary estrogen deficiency is compensated by the yellow body, the endometrial detachment stops.
Symptoms of ovulatory syndrome
The pathognomonic manifestation of the pathological condition is unilateral pain in the lower abdomen. With a 28-day ovulatory cycle, painful sensations occur approximately in the middle of it. With a cycle of shorter or longer duration — 13-15 days before menstruation. The pain syndrome has different intensity, from mild to acute. Often, the pain gives to the groin, sacrum, lower back, increases during walking, sexual intercourse, a sharp change in body position, lifting weights, and other physical exertion. A woman may notice the appearance of vaginal discharge. Usually they are sparse bloody or serous.
In some patients, during ovulation, the body temperature rises to 37.5-37.7 ° C, subfebrility persists for no more than 24 hours. Extremely rarely, ovulatory syndrome is accompanied by nausea and vomiting. Sometimes, with the pathological course of ovulation, weakness, irritability and tearfulness are observed on such days. The duration of painful manifestations usually does not exceed 2 days. If pain and fever persist for a longer period of time, a thorough diagnostic search is necessary to exclude acute surgical pathology.
The pathological course of the ovulatory period, as a rule, does not pose a risk to a woman’s health. Its consequences mainly affect the emotional state and quality of life. In some patients, in the middle of the monthly cycle, daily activity is disrupted, sexual desire decreases, and emotional disorders reach the level of depression. Life—threatening complications occur only in cases when other diseases are hidden under the mask of ovulatory syndrome – acute appendicitis, ectopic pregnancy, rupture of an ovarian cyst or twisting of its legs.
The main task of the diagnostic stage is to exclude more serious diseases that could occur during ovulation, but are not associated with it. The survey plan usually includes:
- Measurement of basal temperature. The temperature measured in the rectum or vagina increases by almost 1 ° C during ovulation, reaching 37.7-37.8 ° C. The coincidence of the time of temperature rise with characteristic clinical manifestations indirectly indicates the presence of ovulatory syndrome.
- Ultrasound folliculometry. With dynamic ultrasound of the ovaries, the growing follicle is monitored, which by the time it reaches the size of 18.0-24.0 mm. After ovulation, a yellow body is found in the ovary, and a small amount of fluid is found in the pelvic cavity.
- Determination of the level of sex hormones. During the release of a mature egg, the content of luteinizing hormone (LH) in the blood increases and the level of estrogens decreases somewhat.
Disorders that occur during ovulation must be differentiated from both chronic gynecological diseases (inflammatory processes, volumetric neoplasms, endometriosis) and urological pathology, as well as from acute abdominal syndrome. In addition to the examination on the chair, transvaginal and transabdominal ultrasound of the pelvic organs, CT, diagnostic laparoscopy, puncture of the posterior vaginal arch, smear and seeding for flora, PCR diagnostics, pregnancy test can be additionally prescribed to patients. If necessary, the gynecologist engages a surgeon and a urologist to examine the patient.
Treatment of ovulatory syndrome
There are no specific therapies for ovulation-related disorders. Treatment is symptomatic, mainly aimed at eliminating the pain syndrome. Given the pathogenesis, such patients are prescribed analgesic and antispasmodic drugs. The intensity of pain is significantly reduced when applying thermal compresses or a heating pad to the lower abdomen. During this period, sexual rest is recommended (except in cases when a woman is planning a pregnancy), significant physical loads are excluded. With frequent ovulatory syndrome, oral contraceptives can be used at the request of the patient and taking into account her reproductive plans, against the background of which painful manifestations do not occur. The appointment of vitamin and mineral complexes and other restorative agents has a positive effect.
Prognosis and prevention
The prognosis is favorable. For prevention during the period of expected ovulation, it is recommended to exclude significant physical activity and limit sexual activity (taking into account pregnancy planning). The severity of painful manifestations is significantly reduced or they completely stop with the normalization of diet, sleep and rest, reduction of stress and other loads. Timely and adequate treatment of gynecological diseases is especially effective, reducing the risk of their occurrence by refusing abortions and unjustified invasive procedures, preventing unwanted pregnancy and infection with sexual infections.