Signs of Ovulation

Today, I’m going to answer a common reproductive health question: 

“How do I know if I’m ovulating?”

My patients trying to get pregnant often wonder if they’re releasing eggs. In this blog post, I will teach you the multiple ways to figure out whether you are (or are not) ovulating. 

Let’s get started.

Your menstrual cycle

You are most likely ovulating if you have regular, predictable monthly menstrual cycles. If you can time intercourse around the time of ovulation, you will improve your odds of getting pregnant on your own.

For the first (about) two weeks of your menstrual cycle, the ovary selects an egg, matures the egg, and then in the middle of your cycle (around day 14), the egg ovulates. After ovulation, your ovaries make progesterone to stabilize the uterine lining. 

If you are not pregnant, your ovaries will decrease the amount of progesterone or estrogen (or stop making progesterone) that causes your uterine lining to build up. This decrease signals the release of the uterine lining, which is your period. 

A little variation in cycle length by a few days is common, but monthly cycles approximately every 21-35 days are reassuring. The menstrual cycle is naturally regular. So, when my patients say they bleed multiple times per month or go six months without a period, they are most likely not ovulating, and we’ll want to investigate further. 

Physical signs of ovulations

There are several signs of ovulation, but I want to focus on three: 

1. Change in cervical mucus 

Your cervical mucus responds to estrogen levels throughout your cycle by changing in amount and consistency. 

Around the time of ovulation, your estrogen level is the highest, and the cervical mucus will be the thinnest. You’ll experience more discharge during ovulation than at other times in the cycle. There will also be more production of cervical mucus, which is described to have the consistency of egg whites (thin and stretchy). 

When you're in the second half of your menstrual cycle, you're in a progesterone-dominant state. The cervical mucus will be pretty thick and won't be as stretchy. 

2. Mittelschmerz 

The second physical sign of ovulation is something called mittelschmerz. It’s a German word that means “middle pain.” It represents pain, discomfort, or physical awareness in the middle of your menstrual cycle. 

An egg is released from the ovary during ovulation, and the follicular fluid surrounding the egg can come into the abdomen and pelvis. Some people feel this typically one-sided sensation (mittelschmerz). 

I’ve personally never experienced mittelschmerz, but my patients have described it to me. Some patients experience mittelschmerz each month and can even tell which ovary they are ovulating from. (So cool!) 

3. Increased interest in intimacy

As estrogen levels rise and peak, we become more interested in trying to have a baby. I think that's just absolutely fascinating. Not everyone will have this experience, but it’s interesting to exercise awareness about it. 

At-home ovulation tests

People use two main at-home tests to determine if they're ovulating: basal body temperature taking and ovulation predictor kits. 

1. Basal body temperature taking

Basal body temperature taking has been around for a very long time. It involves taking your temperature daily and seeing a rise in your basal body temperature AFTER ovulation. The temperature changes all come back to the hormones. After ovulation, progesterone secretes from the ovaries, which causes your basal body temperature to go up by half a degree Fahrenheit (or 0.3 degrees Celsius). 

Basal body temperature monitoring is excellent because it’s straightforward. The most important thing to remember is to take your temperature every morning before leaving the bed. (Your temperature will change right when you start moving around, so it has to be the first thing you do.) 

Keep a digital thermometer next to your nightstand. You’ll need to do this for several months to learn about your cycle. For tracking, many people will use a paper chart, and there are also some apps to track. 

The main mistake I see in people using this method is the assumption that they need to wait to have intercourse until they see a temperature spike. Once you see that increase, it’s too late because you’ve already peaked and ovulated. 

The fertile window is about six days before ovulation. The egg is viable for about 12 to 24 hours, and the sperm live in the reproductive tract for up to five days. With these considerations, I recommend having intercourse about two to three times in the fertile window. 

Basal body temperature can help determine your fertile window based on your ovulation history. If you can see that you typically ovulate on day 14, you’ll want to start having intercourse six days before that. 

Basal body temperature charting can also help see early signs of pregnancy. If you are pregnant, your ovaries are stimulated to keep making progesterone, which causes a steady basal body temperature. If the temperature does not start when you expect your period to start, you might be pregnant. 

2. Ovulation predictor kits

Ovulation predictor kits look similar to pregnancy tests in the drugstore. They’re simple to use. You pee on the tests, and if they appear favorable, you’re close to ovulation. 

The tests measure the presence of a luteinizing hormone (or LH). This hormone comes from the pituitary gland to signal ovulation. 

Before ovulation, your estrogen levels rise while your egg matures. Once estrogen hits a peak threshold, the pituitary gland releases LH, which tells your ovary it’s time to ovulate.  

When the ovulation predictor kit is positive (due to the presence of LH), your body is getting ready to ovulate. If you are trying to time intercourse, you’ll want to do these tests daily for about a week before you expect to ovulate. You’ll have a few negative tests before seeing a positive. When you see a positive, you’ll know it’s time for intercourse because you’ll ovulate 24 to 36 hours later. 

If you could only choose one day in your whole cycle to have intercourse, it would be on the day that you see your first positive ovulation predictor kit. 

Work with your fertility clinic

The last way to determine if you're ovulating is to do some tests with your fertility clinic. This can include an ultrasound or a blood test for progesterone. I recommend finding a clinic you trust, and this video can help you prepare for your first appointment.

The ultrasound is not perfect, but it can give clues about ovulation. When an egg matures, it develops in a follicle, a collection of fluid in the ovary. After an egg is released, the fluid collection collapses and becomes a corpus luteum. We sometimes see the collapsed structure (corpus luteum) in the ultrasound. 

A blood test is another definitive way to determine ovulation. Your ovaries will not make progesterone before ovulation, but they should make progesterone after ovulation. If we check your progesterone level in the second half of your cycle, we’ll generally be able to tell if you’ve ovulated. 

I hope this was helpful. If you learned something or have questions, comment in my YouTube video. Stick around for more learning.