The mechanism involves multiple pathways
Ovulation: Once the follicle is large enough to contain a mature egg, a surge of LH from the anterior pituitary causes ovulation
Central sensitization the nervous system may amplify pain signals over time, so that even mild stimuli produce significant discomfort Sleep disturbance and pain cycle poor sleep increases pain perception and reduces the nervous systems ability to regulate pain Stress and increased nervous system reactivity stress does not cause the pain, but increases sensitivity and helps maintain symptoms Metabolic factors, pro-inflammatory state and low-grade inflammation obesity, insulin resistance, and chronic inflammation increase nerve sensitivity and impair recovery Nutritional deficiencies low levels of vitamin B12, vitamin D, magnesium, or iron may contribute to impaired nerve function and slower healing Vitamin-related factors both deficiency and excess of vitamin B6 may contribute to burning sensations, tingling, or hypersensitivity Medications and previous treatments long-term or inappropriate use of certain medications may alter pain perception without addressing the underlying mechanism Other medical conditions and comorbidities diabetes, immune dysfunction, thyroid disorders, and chronic inflammatory diseases may increase nerve vulnerability and prolong symptoms Physical inactivity and deconditioning reduced activity due to pain may increase overall sensitivity and decrease pain tolerance over time Why this matters in practice In many cases, treatment fails because therapy focuses only on suppressing pain (for example with medications), without addressing the mechanisms that maintain nerve hypersensitivity and central sensitization
doi: 10.1056/NEJM198812153192401
