Definition
Mittelschmerz is one-sided, lower abdominal or pelvic pain related to ovulation. Mittelschmerz comes from the German words for ‘middle pain’ and it occurs midway through a menstrual cycle (approximately 14 days before the next menstrual period).
Mittelschmerz may be painful but it is not harmful and it is not a disease. Moreover, it may serve as an indication of the time the egg is released in the menstrual cycle.
Most cases of mittelschmerz do not require medical attention or treatment. However, minor mittelschmerz discomfort can be relieved by over-the-counter pain relievers and home remedies. High discomfort or severe pain can be treated by prescribed oral contraceptives to stop ovulation and prevent midcycle pain.
Symptoms
The pain associated with mittelschmerz usually lasts from a few minutes to a few hours but sometimes it can last for a day or two. Mittelschmerz pain can cause the following symptoms:
- One-sided lower abdominal pain
- Dull and cramp-like pain
- Sharp and sudden pain
- Pain accompanied by mild vaginal bleeding or discharge
- Severe pain (rare)
Mittelschmerz pain occurs on the side of the ovary that is releasing an egg (ovulating). The pain can switch sides every month or remain on the same side for several months.
Causes
Mittelschmerz occurs during ovulation, when the follicle ruptures and releases its egg. Some women experience mittelschmerz every month while others experience it occasionally.
The exact cause of mittelschmerz is unclear, but the possible reasons for the pain include:
- Prior to the egg being released with ovulation, follicle growth stretches the surface of the ovary leading to pain.
- Blood or fluid released from the ruptured follicle can irritate the lining of the abdomen (peritoneum) leading to pain.
- Ovarian wall rupture may be painful as the egg breaks through the ovarian wall.
- Fallopian tube contraction after ovulation may cause pain.
Pain at any other point during the menstrual cycle is not mittelschmerz. It may be menstrual cramping (dysmenorrhea) if it occurs during period or it may indicate other abdominal or pelvic problems.
Treatment
Some treatments for mittelschmerz include:
- Pain relievers to relieve the pain or discomfort from mittelschmerz
- Soaking in a hot bath
- Birth control pills (oral contraceptives) to prevent ovulation and stop the pain associated with mittelschmerz
- Other birth control methods (implant or intrauterine system)
Prevention
Preventing ovulation with birth control pills is the most effective way to prevent mittelschmerz.
