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Painful Ovulation (Mittelschmerz)

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What Is Painful Ovulation (Mittelschmerz)?

  • Mittelschmerz (pronounced MITT-ul-shmurz) is a German word that means middle pain.
  • Mittelschmerz is also referred to as painful ovulation.
  • This pelvic pain occurs during ovulation -- the midpoint of a woman's menstrual cycle, about two weeks before a period may begin.
  • The discomfort can appear on either side of the lower abdomen depending on which ovary is producing the ovum (egg).
  • Pain can be on one side of the abdomen one month and switch to the opposite side during the following cycle.
  • About 20% of women experience this type of midcycle pain.
  • Most of the time, it is a mild annoyance. In rare instances, it can be unbearable.

What Causes Painful Ovulation (Mittelschmerz)?

Just before the follicle ruptures and an egg is released by the ovary, it stretches the membrane covering the ovary. This follicular stretching results in symptoms like pelvic pressure and pain. The fluid from the follicle and blood released when the egg is released from the ovary may cause discomfort. Blood may be very irritating to the tissues lining the abdominal cavity and could be responsible for the mid-cycle pain. The amount of pain varies tremendously from person to person. Many women do not have any discomfort. Others feel symptoms such as mild pressure or twinge lasting a few minutes to a few hours. For a rare few, the pain is intense and can last for days. In severe cases, the pain may be mistaken for that of appendicitis.

What Are the Symptoms of Painful Ovulation (Mittelschmerz)?

Pain associated with ovulation may take on various forms:

  • Pain occurs on one side of the lower abdomen (can be either side).
  • Pain occurs midway between menstrual periods (during ovulation).
  • Pain can occur every month.
  • Pain lasts anywhere from a few hours to 2-3 days.

When Should I Call the Doctor about Painful Ovulation (Mittelschmerz)?

Women with ovulation pain rarely need to go to a hospital's emergency department, but some serious medical conditions such as appendicitis and ectopic pregnancy can mimic the pain of ovulation. A woman should go to the emergency department if it is possible one of these conditions is causing the pain.

A woman should call her doctor if midcycle pain lasts longer than 3 days.


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How Do Health Care Providers Diagnose Painful Ovulation (Mittelschmerz)?

No specific test can determine if a woman has mittelschmerz pain. It is a diagnosis of exclusion - meaning the doctor will order tests to make sure no other medical problems exist. The diagnosis of mittelschmerz is confirmed if the test results are normal and the pain is typical for premenstrual pain. The doctor may ask the woman to keep a diary of her menstrual cycles to determine if the pain actually occurs at midcycle.

Are There Home Remedies for Painful Ovulation (Mittelschmerz)?

The best way to relieve midcycle pain is to take a non-steroidal anti-inflammatory medication. Ibuprofen (Advil is a familiar brand name), naproxen (Aleve, Naprosyn), and ketoprofen (Orudis) are available without a prescription and are effective at blocking the effects of prostaglandins.

  • These medications can be continued as long as needed. If one type does not relieve the pain, try another, because these medications vary among individuals in their effectiveness.
  • Anti-inflammatory medicine can be harsh on the stomach. If there is a history of kidney or stomach problems (such as ulcers or reflux), consult with a health care professional before taking this type of medication. Taking the pills with meals may help prevent upset stomach.

If anti-inflammatory medicine is not an option or if additional relief is needed, a heating pad applied to the pelvic area may relieve some pain.

What Are Treatment Options and Medications for Painful Ovulation (Mittelschmerz)?

If a woman with ovulation pain is not already taking an anti-inflammatory medicine, the health care professional may advise her to take one of the over-the-counter pain relievers or prescribe an anti-inflammatory drug.

If mittelschmerz is severe and occurs every month, some forms of birth control may help. Birth control such as oral contraceptive pills (OCPs) that prevent ovulation from taking place can stop the pain from occurring. These are prescription medications and are prescribed by a doctor.

What Is the Prognosis for Painful Ovulation (Mittelschmerz)?

Anti-inflammatory medications and birth control pills are effective at controlling painful ovulation.

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Reviewed on 10/26/2018
Medically reviewed by Wayne Blocker, MD; Board Certified Obstetrics and Gynecology

REFERENCES: MedscapeReference.com. Gynecologic Pain.

Reiter, Robert C. "Evidence-Based Management of Chronic Pelvic Pain." Clinical Obstetrics and Gynecology 41.2 June 1998: 422-435.

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