If you have endometriosis, you may be suffering from ovulation pain. For me, it was my worst pain from this annoying disease. While ovulation pain (with a fun name mittelschmerz) is common for many people, endo can turn it into a full-blown event. For me, it was like someone saran-wrapped my ovary and microwaved it for 10 minutes at ovulation (ka-boom!), followed by days—yes plural—of lower belly tenderness, pain, and even swelling. This was head-scratching for me because I didn’t have endo on my ovaries.

It turns out while ovulation pain can be due to endometriosis on the ovaries (endometriomas, anyone?), other times, the pain shows up with no lesion, scar tissue, or adhesion involvement at all. This was me, and it may be you too.

But here’s the hopeful part: with the right tools, you can tackle that ovulation pain head-on. You may even be able to get rid of it, like me. This is especially important if you’re trying to conceive since sex at ovulation + ovulation pain = no bueno.

First, let’s address the why. Ovulation pain with endometriosis can happen for several reasons:

1. Endo on the Ovaries: When endometriosis lesions or endometriomas (ovarian cysts caused by endo) are involved, ovulation can trigger inflammation and irritation in surrounding tissue. This is the trigger I see most often listed as the culprit behind severe ovulation pain. But it’s not the only one!

2. Pelvic Nerve Sensitization: Endometriosis can make pelvic nerves more sensitive overall, so the stretching and hormonal shifts accompanying ovulation can pack a painful punch.

3. Inflammatory Overload [this is the big one for this blog] Even without endo on the ovaries, there is often a lot of inflammation in the body, as well as localized around the reproductive organs. Inflammation involves free-radicals, which require anti-oxidants to subdue it. So, if you are using up all your antioxidants for the existing inflammation and suddenly introduce ovulation—a naturally inflammatory process as the egg bursts out of the ovary— your body won’t be able to properly address the inflammation.

   Think about it like this: you only have so many firemen to put out fires (antioxidants). They’re all on other jobs dealing with other inflammatory issUes. And suddenly, YOU HAVE AN EXPLOSION (I.E., ovulation) that needs a LOT of firemen! But there are no firemen available…

   Here is an image from my book to help us better understand. See the fire below? That’s natural levels of inflamation. Totally normal. The “antioxidant” firehose puts it out under normal circumstances. But when there’s too much inflammation, we need a TON of antioxidants to quell it.

Why not take Ibuprofin and Call it a day?

In my book, I have a whole chapter called “Med-ucation.” It's a word I use so we can make educated decisions about which pharmaceuticals we take. In the case of using anti-inflammatory painkillers like NSAIDs (such as aspirin or ibuprofen) consistently, we see that they damage the gut lining and contribute to leaky gut with even minimal use (so using them once a month for a few days consistently isn’t the best recommendation long-term).

Moreover, if you’re trying to get pregnant (which you do at ovulation, right?), they significantly increase the risk of miscarriage! How much? It depends on when it's taken, but we see that the risk rises SIGNIFICANTLY if it's taken around the time of conception [1]

- 5.6x more likely to miscarry if taken around conception (when you ovulate)

- 8x (!!) more likely if used for over a week around conception (think, if your ovulation pain is lasting or you have other side effects like headaches or pelvic pain).

It’s why we need doctors to be aware of this terrible side effect and educate women like us (often taking NSAIDs) about the repercussions.

My Antioxidant Approach: An Ovulation Game Changer

Now, let’s talk solutions. For years, I wrestled with ovulation pain that made me dread the middle of my cycle. Seriously, it was like five straight days of my life lost to this process. Then, I stumbled onto an approach that changed everything: antioxidant therapy.

It all started when I was researching my best-selling book, Heal Endo. When researching antioxidants I saw how high levels of vitamin C and E reduced endometriosis pain significantly because it ADDED THE NECESSARY FIREMEN (so to speak).

The study supplemented endo patients for two months with a lot of firemen: 1000 mg Vitamin C and 1200 iu Vitamin E (16 and 54 times the RDI, respectively). When they did this, inflammation in their peritoneal fluid decreased significantly. Moreover, the study highlighted their pain-banishing superpowers: 43% of participants saw a reduction in chronic everyday pain; 37% reported a reduction in menstrual pain, and 24% noted a reduction in painful sex. The authors conclude that Vitamins E and C “are a highly efficient alternative therapy to relieve chronic pelvic pain in women with endometriosis.” [2]

I was intrigued and added this exact amount to my daily regimen. Three months later … are you ready … I had a painless ovulation. I was blown away.

The issue with continuing this approach is that research isn’t sure how well the body reacts long-term to high-dose supplementation of antioxidants. Not to mention it’s expensive to down that high of a dose of quality supplements every month. So here’s where I started experimenting with a different approach. Now, for 5 days before ovulation plus 2 days after (so 1 week a month rather than all 4 weeks), I take a high-dose anti-oxidant blend. This is way more affordable, and it works well.

My Antioxidant Arsenal for ovulation pain

HEADSUP! This is my personal protocol, not a doctor-recommended protocol or a pub-med recommendation. It’s based on the research I did for the book combined with my own body’s response. And I publish this “unscientific” info because there’s no helpful information out there for women like you and me: we just suffer painful ovulation.

Also, when I’ve sent this protocol to women with the same issue who have reached out on social, I get responses like this:

“IT WORKS!!!!!! I AM BLOWN AWAY!!!!” and,

“Why didn’t you publish this in your book? It seriously works.”

Plus, with anti-oxidant therapy, there’s not a lot of room for harmful side effects. It’s usually more like, “It works, or it doesn’t.” So, in that way, there’s often no harm trying it out. Of course, please check with your doctor before making any changes to your medications or supplements! That being said, here is what you could consider:

Starting 5 days before ovulation and continuing 1-2 days after (7 days total) take

• Vitamin C: 1000mg/day liposomal C such as by Designs for Health. Liposomal vitamin C is much easier on the digestive system, especially when taking a high dose like this! 1 tsp a day, divided into 2.

• Vitamin E: 1200 iu that includes a mix of tocopherols and tocotrienols. For this I like Dr. Mercola’s Vitamin E. 6 pills, divided into 3 doses/day (i.e. 2 per meal)

• Resveratrol: A superstar anti-inflammatory compound, resveratrol helped me immensely with pelvic pain, but only when I took high doses. I have heard some women who said they didn’t feel a difference with this one, but it’s possible they weren’t taking enough. My favorite (and I’ve tried a lot of varieties) is Designs for Health Resveratrol Supreme, which also has Quercitin in it. 1 pill, 3 times a day. If pain is really bad, up the dose to 2 pills/meal for the 2 days before ovulation.

• Zinc: 30 mg/day. I like Thorne Zinc Bisglynate. 2 pills/day.

If you want to get the plan above with recommended brands and dosages (with a 15% discount)—delivered to your door in mere days—check out my Heal Endo Fullscript (button below). If not, please make sure to purchase high quality, third party certified brands! I can’t tell you how poorly regulated the supplement industry.

Also, just as a reminder some people do better with other anti-oxidants. You may feel way less pain with NAC, curcumin, maritime pine bark, or green tea extract. I tried all of these and whittled down my own pain banishing super mix based on what worked for my body. So if you’re not feeling much changed, consider swapping around the options, but maintaining a high dose of each, to see if that’s helpful.

Of course, you could also try the around-the-month anti-oxidant arsenal as well. Remember, it’s your body and your story, so play around with timing and ingredients to see what helps best.

Just remember: Timing is Key

Remember, you take high doses of anti-oxidants before the big bang (i.e. ovulation) because you want to have the “firemen” take care of current inflammation needs while having enough overflow to be circulating at the time of the explosion (i.e., ovulation). That’s why anti-oxidant therapy won’t be as helpful if you only take it after the inflammatory response has started…and cascaded. So, for this to work, you need to have a general idea of when you will ovulate. If you don’t know, you better start cycle tracking!

What About food-based anti-oxidants?

I mean, yes! They are important! But remember, your inflammation levels may be sky-high, meaning you need a considerable amount of antioxidants to take care of them. Consuming that many anti-oxidants via food alone may be impossible for some of us (me included!), or at the very least, could cause serious digestive issues as you down cup after cup of fresh fruit, veggies, beef, and oysters.

So, while I would never negate diet (duh, my life is spent talking about the importance of this stuff), severe inflammatory pain cases like this may be helped by anti-oxidant therapy.

Let me highlight the word THERAPY. It’s a pain intervention in addition to, rather than instead of, proper food choices.

What About Birth Control?

Truth, oral contraceptives will totally stop ovulation pain because it stops ovulation. However, I’m a fan of natural ovulation if you can. Why?

1) Ovulation is the main progesterone-producing event in the body!!!! And this is so important for endometriosis. If you’ve read my book Heal Endo, you may remember me talking about progesterone being the soother, the cooler, and the immune modulator—why we want copious amounts of progesterone to balance the estrogen. Truly, progesterone is a lovely natural anti-inflammatory that works hard to fight against endometriosis. So, if you can tolerate ovulation (and the periods that follow), then it’s important to ovulate.

The Bottom Line: endo ovulation pain be gone

Ovulation pain with endometriosis can feel …. awful. However, the pain may be surmountable with some extra antioxidants, especially if that pain is due to inflammation. Whether your pain is tied to endo on the ovaries or something else entirely, embracing antioxidant-therapy might offer the relief you’ve been looking for.

Your body deserves care, and you deserve to feel good—yes, even in the middle of your cycle. If you’re struggling with ovulation pain, this is your sign to dig deeper, try new tools, and find what works for you!

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1] Li DK, Liu L, Odouli R. Exposure to non-steroidal anti-inflammatory drugs during pregnancy and risk of miscarriage: population based cohort study. BMJ. 2003 Aug 16;327(7411):368. doi: 10.1136/bmj.327.7411.368. PMID: 12919986; PMCID: PMC175811.

2] Santanam, N., Kavtaradze, N., Murphy, A., Dominguez, C., & Parthasarathy, S. (2013). Antioxidant supplementation reduces endometriosis-related pelvic pain in humans. Translational research : the journal of laboratory and clinical medicine, 161(3), 189–195. https://doi.org/10.1016/j.trsl.2012.05.001