Mittelschmerz

Overview

By Tina Shahian, PhD

Mittelschmerz is a lower abdominal pain that one in five women will experience during ovulation – the monthly process of releasing an egg from the ovaries. The pain is one-sided and occurs in the middle of the cycle, hence the German word mittelschmerz (or “middle pain”). Mittelschmerz is different than menstrual cramping or abdominal discomfort that is linked with other stages of the menstrual cycle. This condition is not considered harmful and generally does not require medical intervention. Over-the-counter pain medication can help alleviate the pain, which can be severe at times.

Causes and Risk Factors

picture of ovary and fallopian tubeMittelschmerz occurs about 14 days before the next expected period, which is when an egg is released from a follicle inside the ovary. Although the exact cause of the pain is not known, there are two possible explanations:

  • Stretching of the ovary due to follicle growth just prior to releasing an egg can cause pain.
  • Abdominal irritation may result from blood or fluid released by the ruptured follicle.

Symptoms

The main symptom of mittelschmerz is a one-sided pain that occurs on the side the egg is released. The pain can last from a few minutes to a few days and can switch sides each month, depending on which ovary releases an egg. Some months, there may be little to no pain. The symptoms of mittelschmerz include:

  • One-sided abdominal pain
  • Pain that lasts from minutes to hours
  • Sharp cramps
  • Mild vaginal bleeding
  • Pain that is severe (rarely).

Diagnosis and Treatment

Mittelschmerz is generally managed at home and does not require medical intervention. Doctors look for other causes when severe pain persists and other symptoms (e.g., fever, nausea) develop. Conditions other than mittelschmerz that can cause abdominal pain include appendicitis, pelvic inflammatory disease and ectopic pregnancy. The most common way of examining the female reproductive system for physical abnormalities is with an abdominal or transvaginal ultrasound, which uses sound waves to produce a picture of internal organs.

The abdominal pain associated with mittelschmerz can be managed at home with the help of over-the-counter pain relief drugs. Mittelschmerz is not associated with any underlying health disorders or serious complications.

Prevention

There is no way to prevent mittelschmerz, but women can anticipate and plan for the pain symptoms by tracking their ovulation cycle on a calendar. Contraceptive pills that stop ovulation may help lessen the pain from mittelschmerz.

Sources

  • “Mittelschmerz”. MedlinePlus, NIH. Retrieved Aug 27, 2015. https://www.nlm.nih.gov/medlineplus/ency/article/001503.htm.
  • "Mittelschmerz". Mayo Clinic. Mayo Foundation for Medical Education and Research. Retrieved Aug 27, 2015. http://www.mayoclinic.org/diseases-conditions/mittelschmerz/basics/definition/con-20025507.