Mittelschmerz – what should you know

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Have you ever experienced severe midcycle pain? Does pain and cramping seem to occur during ovulation? What you are experiencing may be Mittelschmerz (German: “middle pain”) which is a medical term for “ovulation pain” or “midcycle pain”.  About 20% of women experience mittelschmerz, some every cycle, some intermittently.

Mittelschmerz is characterized by lower abdominal and pelvic pain that occurs roughly midway through a woman’s menstrual cycle. The pain can appear suddenly and usually subsides within hours, although it may sometimes last two or three days. In some cases it can last up to the following cycle. In some women, the mittelschmerz is localized enough so that they can tell which of their two ovaries provided the egg in a given month. Because ovulation occurs on a random ovary each cycle, the pain may switch sides or stay on the same side from one cycle to another.

Mittelschmerz is believed to have a variety of causes:

Follicular swelling: The swelling of follicles in the ovaries prior to ovulation. While only one or two eggs mature to the point of being released, a number of follicles grows during the follicular phase of the menstrual cycle (non-dominant follicles atrophy prior to ovulation). Because follicles develop on both sides, this theory explains mittelschmerz that occurs simultaneously on both sides of the abdomen.

Ovarian wall rupture: The ovaries have no openings; at ovulation the egg breaks through the ovary’s wall. This may make ovulation itself painful for some women.

Fallopian tube contraction: After ovulation, the fallopian tubes contract (similar to peristalsis of the esophagus), which may cause pain in some women.

Smooth muscle cell contraction: At ovulation, this pain may be related to smooth muscle cell contraction in the ovary as well as in its ligaments. These contractions occur in response to an increased level of prostaglandin F2-alpha, itself mediated by the surge of luteinizing hormone (LH).

Irritation: At the time of ovulation, blood or other fluid is released from the ruptured egg follicle. This fluid may cause irritation of the abdominal lining.

Diagnosis of mittelschmerz is generally made if a woman is mid-cycle and a pelvic examination shows no abnormalities. If the pain is prolonged and/or severe, other diagnostic procedures such as an abdominal ultrasound may be performed to rule out other causes of abdominal pain.

Self treatment is often the best way to alleviate cramps that you experience mid-cycle. Here are some tried and tested ways of getting rid of those aches and pains.

Drink Water: Try to drink between six and eight glasses of water every day. Water will help to keep you hydrated, which will alleviate cramps.

Use a Heating Pad: Heat helps to soothe cramps. Get an electric heating pad and keep it on your abdomen for 15 minutes or so.

Take a Warm Bath: Fill your tub up with warm water and just relax. The heat of the water will help to relieve any pain.

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15 Comments

  1. I am 37 years old all my periods have been normal. Two days ago I started feeling what I can only discribe as discomfort in my right ovary. Almost like an intermittent buzzing?? If that makes sense. My period tracker on my phone says I’m supposed to ovulate in 6 days. The feeling would come and go nothing painful just strange. The next day nothing then the next day it started on my left side. The right side has completely stoped. I’m going on my second day with this strange sensation on my right. Has anyone ever experienced this? I know I’m not pregnant my husband has had a vesectomy. Any thoughts would be appreciated

  2. Can this cause heavier bleeding like a mild period?? My dr diagnosed me with mittleschmeitz or whatever but I’ve just never had this happen and the dark bleeding is making me nervous.

  3. Hello, I am 21 and have always experienced regular once a month periods. I have taken birth control in the past, but it has never affected my cycle. My doctor gave me a new birth control that controls progesterone only. I took one pill after my last period then stopped because I’m just not ready to commit to it yet. Two weeks later (which is the present time) I began cramping and spotting. I have never had this happen before so it scared me and sent me to the ER. I was told everything looks fine and that it’s more than likely Mittelschmerz. I’m now on day 5, I repeat, day 5! of whatever this is of light, brown spotting. The cramps have subsided…but I’m still spotting and I’m getting quite worried. I’m debating on making an appointment with my doctor since I literally had a pelvic exam last month with my doctor and everything was fine. I’ve never experienced mittelschmerz in my life though! Is this what’s happening? Why is this just starting now?? Help ease my worried mind!

    1. It’s probably the pill. Try to not taking it for a few months, use other means of birth control, and see if it still happens. It may take a few months to return to normal but it likely will.

  4. okay, so here is where I am at… I got my period at 14. Two weeks before that I was sitting in health class ironically learning about ovulation and had severe pain in my abdomen. It lasted a few hours, then went away. Off and on for the next few years it would flare up mid cycle. About three years ago, however, I started getting cramps every mid cycle, and occasional dark brown spotting with the pain. It would switch sides and flare up both on ovulation and one day before my period-two days in, then go away again. About two years ago the pain became really bad, and stopped switching sides. It is only on my right side now and is EVERY two weeks or so. The pain on my right side is in my lower pelvis, and is so bad at times I can’t put pressure at all on the right leg, or I feel like I’m getting my ovaries pulled through a needle-sized hole on my abdomen. When I have my period, I am getting blood clots, but the biggest one I’ve ever had was about the size of a pea. I went to my OB doctor, and since I’m not sexually active there is not much she is willing to do. I’ve attempted birth control, but my blood pressure shot to a dangerously high level, so I had to stop taking them. I have a family hx of PCOS and endometriosis, but my doctor quickly shrugged them off saying “We aren’t going to test for either until at least after your first pap” which is 4 months away.. Then even longer after that due to readiness of the procedures. I want to opt to stop my periods all together but I’m scared to gain weight. I’m at a loss of what to do. My pain hurts really bad, and up til about a year ago, I thought it was normal to feel what I felt. Not being able to walk without limping is complete torture, especially being in the armed forces and having to go to work regardless of ability. Someone please try to make sense of all this?

    1. Hi Leah, this might not be helpful at all, but I would suggest finding a different doctor. This one seems very dismissive and is not willing to listen to you as you try to advocate for yourself.

      Continue to research via internet and books. Eat as wholesomely as you can. Marks Daily Apple is a great place for food and nutrition info. Kelly Brogan’s book also has a lot of good info that might help. She definitely discourages birth control pills and advocates for healthy eating/living. You can find her online and amazon. You don’t say how old you are, but I’m wondering if you’re experiencing a hormonal imbalance…find a dr who is willing to investigate this. Both pcos and endometriosis can have a connection w/ low progesterone.

      Good luck

      1. I had these symptoms earlier in my life, and was diagnosed with MIttelschmertz at about age 16. Later on in life (my thirties), it was determined that I have ovarian cysts and that I had PCOS. Perhaps ultrasound could be an option for further diagnosis? Other symptoms of PCOS that I had/have are slight facial hair (chin mostly), and difficulty losing weight/insulin resistance. I had five pregnancies during my life; I lost one of a set of twins and I lost an early pregnancy in between my first and second live child. I did find that birth control pills made the pain worse, as well as the weight gain. So, again, maybe a pelvic ultrasound, CAT or MRI might give more definitive diagnosis. I’d hate to see someone suffer as many years as I did. I am 52 now, and had a hysterectomy in 2010. The pain of a burst cyst is excruciating; it’s right up there with labor. It starts out as a little twinge, and normally after a difficult bowel movement. When standing from sitting, it feels like a “groin pull”. That’s when I grab 2 ibuprofen and a heating pad. It takes about 20 minutes to go away, and comes in waves. Just horrible. So, again, I’d pursue further testing, perhaps with a new medical provider, especially a gynecologist or a reproductive endocrinologist.

    2. Hey Leah, I have been going through the same thing as u since the past 9years. My pain is on the left side. When the attack happens all I can do is take a pain killer, writhe in pain till it goes away. I went to a trusted doctor and she advised contraceptive pills but I am too scared to take them. I don’t wanna play with hormones is what I say. And being a working woman doesn’t help at all. You don’t get sympathetic colleagues. Some think you’re overdoing it while some say it’s just not possible that it’s happening every month. I wake up in the middle of the night cos of the pain. It starts without warning when I’m​ talking to my colleagues. Life has been difficult. Going through this pain every month.

      1. I completely understand. It is not imagined. The pain is so intense and I too have endured this for several years. Doubled over in pain. For me it lasts about 3 days and then I feel better. Extra strength advil takes the edge off a bit and massage. I’m not sure why some women experience it so severely. I’ve been for several ultrasounds and they note swelling and irritation during the attack and if the ultrasound is done post-period, everything is back to normal. Weirdly, I find when my bladder is full the pain increases – I think because it pushes on the abdomen cavity or something. A noticeable decrease in pain after I go pee. Ok, maybe TMI HA HA. I think stretching exercises like ballet or pilates helps a little too. Also find that I feel more constipated because the muscles are all held so tight and tense … so I sometimes take Senokot tablet. Magnesium is suppose to relax muscles as well. After years of suffering, this is about all the advice I have. My left side is the worst. Every few months I have no pain and I guess its because the right side has fired. But the doctor says that it is completely random which ovary will release – for some weird reason it is the left that is a killer.

  5. I’ve been experiencing abdominal tenderness midcycle since coming of the pill two months ago. Last month it lasted 5 days, and felt like pressure and tenderness in my lower abdomen. I thought it was related to my bladder. This month it’s less pressure but more tenderness in my lower abdomen. I’m on day 5 (16th day of cycle) and it has not yet gone away. Last month I stuck to drinking only water, but this month I have also been drinking decaf coffee and sparkling water which may be irrigating my bladder if it is related to that. I have been to two Ob/gyn’s which say it is fine and just related to ovulation but I’m not convinced. Suggestions or advice? Thank you.

    1. Hi Sarah, Yvonne is no longer with us. Check out some of the sites related to coming off the pill. There are a number of symptoms associated with withdrawal from hormonal contraceptives and this may be related. Depending upon how long you were using hormonal contraceptives, it can takes many months for your system to come back online fully. Additionally, look at the information we have on endometriosis, adenomyosis and interstitial cystitis.

  6. You know fibroids are a common cause of pain and menstrual discomfort, perhaps even ovulation discomfort. Some recent research is suggesting vitamin D reduces fibroids in rats, perhaps vitamin D and other nutritional deficiencies are linked to painful ovulation and painful menstrual cycles. It would be a worthy blog topic.

    1. PMS is known for triggering mood swings and food cravings. It can also cause abdominal cramps, low back pain, headaches, tender breasts, and acne. Hormonal changes may be to blame. Stress, lack of exercise, and some vitamin deficiencies may make the symptoms worse.

      Menstrual cramps can occur when the uterus contracts to help push out blood. The cramps are usually felt in the lower belly or back and last one to three days. A heating pad and over-the-counter pain relievers may help.

      One of the most serious complications of STDs is pelvic inflammatory disease or PID. This infection can cause permanent damage to the uterus, ovaries, and fallopian tubes (seen here, swollen and red). In fact, it’s the leading preventable cause of infertility in women. Symptoms include belly pain, fever, abnormal vaginal discharge, and pain during sex or urination. PID is treated with antibiotics, and in severe cases, surgery.

      A follicle houses the maturing egg during the menstrual cycle and releases the egg when you ovulate. Occasionally, a follicle doesn’t open to release the egg or recloses after releasing the egg and swells with fluid, forming an ovarian cyst. This is usually harmless and goes away on its own. But large cysts may cause pelvic pain, weight gain, and frequent urination. Ovarian cysts can be identified with a pelvic exam or ultrasound.

      Fibroids grow in the wall of the uterus and are sometimes called fibroid tumors, but they are not cancerous. Fibroids are common in women in their 30s and 40s and usually cause no problems. However, some women may experience pressure in the belly, low back pain, heavy periods, painful sex, or trouble getting pregnant.

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