"Mittelschmerz": Ovulation Pain

If you experience cramping pains in your lower abdomen around the midpoint of your menstrual cycle, you may be having "Mittelschmerz". The word is German, meaning "middle pain".

Although about 20% of women experience this pain on a regular basis¹, it does not seem to be a widely discussed subject. Having such an obvious indicator of ovulation would seem to be a useful thing, either for family planning or for accurate dating of pregnancies, but there is not much out there beyond basic health information about this subject.

What causes "mittelschmerz"?

There are two probably contributors, though the cause is not known for sure. The stretching of the ovary just before ovulation may cause this pain. Another possibility is that with the ovary release and rupture of the follicle, blood and fluid may be released and irritate the lining of the abdomen. ²

How much pain is normal, and is medical care required?

The level of pain experienced varies from woman to women. Some describe it as a "twinge", while others may have cramping for several days. In rare cases, the pain is severe enough to warrant seeking medical attention. Both ectopic pregnancies and appendicitis can cause similar pain as mid cycle cramping, in the same general area. If there are symptoms along with the pain that could be caused by either condition, medical attention should be sought immediately. If general mittelschmerz pain continues for more than three days, or is accompanied by vaginal bleeding, medical attention should be sought.³

Is there treatment for mittelschmerz?

There is no specific treatment for mid-cycle ovulation pain. Ovulation is a normal function of the body, and isn't treated as a disease. However, the pain may be lessened by the use of anti-inflammatory medications such as Ibuprofen or Aleve, as well as prescription medications for more severe pain. Ask your doctor what is safe for you to take. The birth control pill may also have a secondary effect of ending this type of pain, since it is designed to prevent ovulation and would thus prevent the cause of mittelschmerz altogether.⁴ Medications aside, many of the same non-medical methods for treating menstrual cramps can alleviate mid-cycle pain. A heating pad applied to the affected area is a simple and common method. A hot bath or shower may do the trick too.

Is there any cause for concern?

Aside from the possibility that the pain is not from "mittelschmerz" but from a more serious condition, there is generally nothing to worry about with mid-cycle ovulation pain. From the information that is currently available, it seems that this is an occasional (1 woman in 5) response to a natural, healthy physical process, and not disordered or dangerous. The main concern is if an individual woman's pain response is elevated to the point of severe discomfort or it interferes with her ability to function.

¹Mittelschmerz, staff, MedlinePlus
²Mittelschmerz: Causes, staff, Mayo Clinic
³Mittelschmerz, staff, eMedicineHealth
⁴Mittelschmerz: treatment, staff, eMedicineHealth