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Mittelschmerz - "middle pain"

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  • Dysmenorrhea

  • Menorrhagia

  • Mittelschmerz

  • Premenstrual syndrome

  • A German word that means "middle pain" - mittelschmerz is simply pain during ovulation. If you're a woman who sometimes experience a pain on one side of your lower abdomen and you don't know what it is, keep track of its timing. Chances are it occurs midway through your menstrual cycle, about 14 days before your next menstrual period. If so, you're most likely having mittelschmerz.

    An estimated 20 percent to 50 percent of women experience ovulation pain at some time during their reproductive years. Some have it every month; some have it only occasionally.

    Most of the time, mittelschmerz doesn't require medical attention. Treatment may involve taking over-the-counter pain relievers and following other self-care strategies. If your pain continues to be troublesome, your doctor may prescribe an oral contraceptive.

    Signs and symptoms

    The main symptom of mittelschmerz is a distinctive, one-sided lower abdominal pain. Chances are you've experienced a similar pain in the past, possibly switching to the other side of your abdomen every other month or every other time you feel it. It's also possible to feel it on the same side for several months in a row. The pain occurs on the side you're ovulating.

    The pain usually lasts a few minutes to a few hours, but it may continue for as long as a day or two. It may be sharp, or it may be a dull ache that feels like a cramp. Rarely is the pain severe. It may be associated with a small amount of vaginal bleeding, possibly caused by the rapid drop in estrogen that occurs at the time of ovulation.

  • Abdominal pain

  • Causes

    During your menstrual cycle, the female sex hormone estrogen causes your uterine lining (endometrium) to thicken every month to create a nourishing environment for a fertilized egg. Soon afterwards, a follicle — a tiny sac in your ovary that contains a single egg (ova) — ruptures and releases its egg (ovulation). If the egg becomes fertilized by contact with a sperm on its way to your uterus, the egg implants in the lining of the uterus. However, most often the unfertilized egg passes through your uterus and out of your body. Shortly thereafter, your uterus releases this lining, and your menstrual flow begins.

    Mittelschmerz occurs during ovulation, when the follicle ruptures and releases its egg. No one knows for sure what causes mittelschmerz, but it's possible that just before you ovulate, follicle growth stretches the surface of your ovary, causing pain. You feel it on the side of your abdomen that contains the ovary that's releasing an egg that month. It's also possible that blood or fluid released from the ruptured follicle irritates the lining of your abdomen (peritoneum), leading to pain.

    Pain at any other point in your menstrual cycle isn't mittelschmerz. It may be normal menstrual cramping (dysmenorrhea), but if your pain is severe, during ovulation or at any time during your cycle, see your doctor.

    When to seek medical advice

    In the vast majority of cases, mittelschmerz is a normal occurrence and requires no medical intervention. However, contact your doctor if the pain becomes severe, if it's accompanied by nausea or fever, or if it lasts longer than a day — any of which could indicate you have a condition more serious than mittelschmerz, such as appendicitis.

    The location and the timing of the pain usually serve to identify mittelschmerz, especially if you have a history of it. For several months, keep track of your menstrual cycle and when you experience the pain. If the pain occurs midcycle and goes away without treatment, it's most likely mittelschmerz.


    If you need relief from the discomfort of mittelschmerz, try an over-the-counter pain reliever, such as acetaminophen (Tylenol, others), aspirin, ibuprofen (Advil, Motrin, others) or naproxen (Aleve, Anaprox).

    If you feel mittelschmerz most months and it causes you quite a bit of discomfort, talk to your doctor about the option of taking a birth control pill (oral contraceptive). Birth control pills prevent ovulation, which prevents mittelschmerz because the condition occurs when one of your ovaries releases an egg.


    If the discomfort from mittelschmerz lasts more than a few minutes, try some self-care strategies to gain relief. Heat increases blood flow, relaxes tense muscles and eases cramping, so soaking in a hot bath or using a heating pad on your abdomen on the side where the pain occurs may provide some relief.


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    This information is provided for general medical education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient's medical condition.
    In no event will The Integrated Medical Clinic be liable for any decision made or action taken in reliance upon the information provided through this web site.

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