What is mittelschmerz?

Mittelschmerz is pain in the pelvis that some women have during ovulation. Ovulation usually occurs about halfway between menstrual cycles; hence the term mittelschmerz, which comes from the German words for "middle" and "pain."

The pain of mittelschmerz usually occurs in the lower abdomen and pelvis, either in the middle or to one side. The pain can range from a mild twinge to severe discomfort and usually lasts from minutes to hours. In some cases, a small amount of vaginal bleeding or discharge might occur. Some women have nausea, especially if the pain is very strong.

Who gets mittelschmerz?

Many women never have pain at ovulation. Some women, however, have mid-cycle pain every month, and can tell by the pain that they are ovulating.

What causes mittelschmerz?

As an egg develops in the ovary, it is surrounded by follicular fluid. During ovulation, the egg and the fluid, as well as some blood, are released from the ovary. While the exact cause of mittelschmerz is not known, it is believed to be caused by the normal enlargement of the egg in the ovary just before ovulation. Also, the pain could be caused by the normal bleeding that comes with ovulation.

How is mittelschmerz diagnosed?

Ovulation usually occurs about two weeks after the first day of each menstrual cycle, so the timing of the pain makes mittelschmerz easy to recognize. To help determine if your pain is related to ovulation, your doctor might ask you to keep a record of your menstrual cycles, noting whenever you have pain, as well as where the pain is located.

Your doctor also might perform an abdominal and pelvic examination to help rule out other possible causes of pain, such as endometriosis or a cyst on your ovary. If your pain is severe or if the doctor notices any irregularities on the exam, he or she might order further testing to help determine the cause of your pain.

How is mittelschmerz treated?

The pain usually goes away within 24 hours, so treatment is usually not needed. Over-the-counter pain medicines—such as ibuprofen—are usually effective in relieving mittelschmerz. Women with very painful ovulation might find relief by taking birth control pills, which prevent ovulation.

Can mittelschmerz be prevented?

Preventing ovulation, which can be done with a variety of hormonal contraceptives (including birth control pills), is the only way to effectively prevent mittelschmerz.

When to call your health care professional

Call your health care provider if you have any of the following symptoms during ovulation:

  • Fever
  • Pain while urinating
  • Redness or burning of the skin at the site of the pain
  • Vomiting
  • Pain in the middle of your menstrual cycle that lasts longer than a day

You also should call your health care provider if you missed your last menstrual period.


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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 9/29/2015...#9134