Mittelschmerz, German for “middle pain”, is also known as painful ovulation. It is a medical condition characterized by lower abdominal pain during ovulation that occurs midway through the menstrual cycle, about two weeks prior to the menstrual period.¹ Ovulation is the process in which an ovary releases an egg, or ovum, to be fertilized by sperm. Ovulation pain varies from female to female, and some females may never experience mittelschmerz, while others have it every month. Pain can last anywhere from a few minutes to as long as two days.² Mittelschmerz is not a serious medical condition and usually does not require medical intervention, but if pain becomes too discomforting a doctor can provide treatment options.

Symptoms

Due to the nature of mittelschmerz, there is a wide range of symptoms. Mittelschmerz is experienced in the lower abdomen, usually on one side of the body, depending on which ovary is releasing an egg for that cycle.¹ Some females may experience mittelschmerz only on one side, and for some, the pain switches sides each month. The following is a list of possible symptoms of mittelschmerz.

• Dull or cramp-like pain in lower abdomen
• Sharp and sudden pain in lower abdomen
• Mild vaginal bleeding or discharge¹

In order for lower abdominal pain to be considered mittelschmerz, these symptoms must occur during the mid-cycle. By tracking the  menstrual cycle each month, it can be determined whether the pain that is occurring is attributed to mittelschmerz.¹

Causes

The exact cause of this condition is unknown, but here are a few theories as to why females experience ovulation pain.

• Follicle growth: An ovarian follicle is a fluid filled sac that holds the egg until maturation. As a follicle grows to release an egg, it stretches the surface of the ovary, causing pain.
• Irritation: Follicular fluid and blood are released from the ruptured follicle after it has released an egg and this can irritate the lining of the abdomen and cause pain.¹

Other ideas that have been considered include smooth muscle contractions of the uterus and contraction of the fallopian tubes. No further research has been conducted on the causes of mittelschmerz and the question still remains as to why some females experience ovulation pain and others do not.

Diagnosis and Treatment

In most cases, mittelschmerz does not need to be diagnosed by a physician. If mittelschmerz symptoms become too uncomfortable, a doctor can make a mittelschmerz diagnosis and provide treatment options. There are multiple tests that a physician can perform to determine a diagnosis, including a full medical history, a pelvic exam, blood tests, cervical cultures, and abdominal and/or vaginal ultrasounds.³ If you have the corresponding symptoms within the appropriate time frame, and a pelvic exam rules out any other causes, your physician may be able to make a diagnosis.

Although mittelschmerz is not an indicator of a more serious underlying condition, if lower abdominal pain becomes severe and lasts for an extended period of time, or is accompanied by other symptoms (e.g. fever, nausea) we recommend telling your physician. Listening to your body and how it feels is critical in distinguishing between a minor condition like mittelschmerz and a more serious health concern. If you have any of the previously mentioned symptoms, you should seek medical attention immediately.

Ovulation pain usually goes away on its own without treatment but, if needed, it can be managed with remedies that are available over the counter.² An anti inflammatory medication, such as ibuprofen, is an effective pain reliever for mittelschmerz. Applying warmth to the lower abdomen with a hot compress or warm bath can also be helpful. In some cases, a doctor can prescribe a hormonal contraceptive to stop the ovulation process, which in turn would prevent ovulation pain from occurring.¹ Hormonal contraceptives are used to prevent pregnancy in this manner as well.

Mittelschmerz as a Fertility Sign

Mittelschmerz may be a midcycle nuisance, but many females utilize the symptoms as a fertility sign. Mittelschmerz can occur right before, during, or after ovulation. Ovulation is the time a female is most likely to become pregnant, so mittelschmerz can indicate when a female is at highest chance of pregnancy. It is important to note that if you are trying to avoid pregnancy, you should not rely solely on ovulation pain as an indicator of when you are ovulating because it may not be the most accurate indicator. If you are trying to avoid pregnancy, you can learn more about different birth control options here.

Concluding Remarks

Mittelschmerz is not a serious medical condition and there are many females who experience it. With the help of both over-the-counter and prescription treatments, females affected by mittelschmerz can find ways to manage their pain and lead happy and healthy lives.

References

1. “Mittelschmerz.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 9 May 2018.
2. “What Is Mittelschmerz (Painful Ovulation)?” Cleveland Clinic.
3. Department of Health & Human Services. “Ovulation Pain.” Better Health Channel, Department of Health & Human Services, 13 Mar. 2018.

Last Updated: 18 October 2018.