Diseases & Conditions


What is mittelschmerz?

Mittelschmerz is the pelvic pain that some women experience during ovulation. Ovulation generally occurs about midway 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 experience nausea, especially if the pain is severe.

Who gets mittelschmerz?

Many women never experience pain at ovulation. Some women, however, have mid-cycle pain every month and can determine 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 unknown, it is believed that the fluid or blood might irritate the lining of the abdominal cavity, causing pain. The pain goes away once the body absorbs the fluid or blood.

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 chart your menstrual cycles, noting any episodes of pain, as well as the location of the pain. 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 blood tests or X-rays to help determine the cause of your pain.

How is mittelschmerz treated?

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

Can mittelschmerz be prevented?

Preventing ovulation, which can be done with 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 experience any of the following symptoms during ovulation:

  • Fever
  • Pain with urination
  • Redness or burning of the skin at the site of the pain
  • Vomiting
  • Mid-cycle pain lasting longer than a day

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


Platt Melissa, Mallory Mary N, "Chapter 36. Obstetric & Gynecologic Emergencies & Rape" (Chapter). Stone CK, Humphries RL: Current Diagnosis & Treatment: Emergency Medicine, 6e: www.accessmedicine.com.

Sass Amy E, Kaplan David W, "Chapter 3. Adolescence" (Chapter). Hay WW, Levin MJ, Sondheimer JM, Deterding RR: Current Diagnosis & Treatment: Pediatrics, 20e: www.accessmedicine.com.

Menstrual disorders in adolescent females: current concepts. Greydanus DE - Dis Mon - 01-FEB-2009; 55(2): 45-113 MEDLINE® is the source for the citation and abstract of this record.

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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: 1/20/2011...#9134