Mittelschmerz

Mittelschmerz (pronounced MITT-ul-shmurz) is a German word that means middle pain. This pain occurs during ovulation—the midpoint between menstrual periods, about 2 weeks before a period may begin. The discomfort can appear on either side of the lower abdomen depending on which ovary is producing the ovum (egg). Pain can be on one side of the abdomen one month and switch to the opposite side during the following cycle. About 20% of women experience this type of midcycle pain. Most of the time, it is a mild annoyance. In rare instances, it can be unbearable.

Just before the egg is released by the ovary, it stretches the membrane covering the ovary. This stretching results in pressure and pain. The fluid and blood released when the egg is released from the ovary may cause discomfort. Blood is very irritating to the tissues lining the abdominal cavity and could be responsible for the midcycle pain. The amount of pain varies tremendously from person to person. Most women do not have any discomfort. Others feel a mild pressure or twinge lasting a few hours. For a rare few, the pain is intense and can last for days. In severe cases, the pain may be mistaken for appendicitis.

Pain associated with mittelschmerz may take on various forms:

• Pain occurs on one side of the lower abdomen (can be either side).
  
  
• Pain occurs midway between menstrual periods (during ovulation).
  
  
• Pain can occur every month.
  
  
• Pain lasts anywhere from a few hours to 2-3 days.
  
  

Women with mittelschmerz rarely need to go to a hospital's emergency department, but some serious medical conditions such as appendicitis and ectopic pregnancy can mimic the pain of ovulation. A woman should go to the emergency department if it is possible one of these conditions is causing the pain.

• Appendicitis causes pain in the lower right side of the abdomen along with loss of appetite, nausea, or vomiting.
  
  
• An ectopic pregnancy is a pregnancy that develops in the fallopian tube instead of the uterus. This might be the cause of the pain if the woman thinks she might be pregnant or if her last menstrual period was irregular.

A woman should call her doctor if the following occur:

• Midcycle pain lasts longer than 3 days
  
  
• Vaginal bleeding occurs during midcycle pain

No specific test can determine if a woman has mittelschmerz. It is a diagnosis of exclusion—meaning the doctor will do tests to make sure no other medical problems exist. The diagnosis is confirmed if the test results are normal and the pain is typical for midcycle pain. The doctor may ask the woman to keep a diary of her menstrual cycles to determine if the pain occurs at midcycle.

|Self-Care at Home|

The best way to relieve midcycle pain is to take an anti-inflammatory medication. Ibuprofen (Advil is a familiar brand name), naproxen (Aleve, Naprosyn), and ketoprofen (Orudis) are available without a prescription and are effective at blocking the effects of prostaglandins.

• These medications can be continued as long as needed. If one type does not relieve the pain, try another, because these medications do not work the same in everyone.
  
  
• Anti-inflammatory medicine like this can be harsh on the stomach. If there is a history of kidney problems or stomach problems (such as ulcers or reflux), consult with the health care provider before starting this type of medication. Taking the pills with meals may help prevent upset stomach.

If anti-inflammatory medicine is not an option or if additional relief is needed, a heating pad applied to the pelvic area may relieve some pain.

|Medications|

If a woman with midcycle pain is not already taking an anti-inflammatory medicine, the health care provider may advise her to take one of the over-the-counter pain relievers or prescribe an anti-inflammatory drug.

If mittelschmerz is severe and occurs every month, some forms of birth control may help. Birth control that prevents ovulation from taking place can stop the pain from occurring. These are prescription medications and can only be obtained after a visit to the doctor.

|Outlook|

Anti-inflammatory medications and birth control pills are effective at controlling mittelschmerz.

American College of Obstetricians and Gynecologists
409 12th St, SW
PO Box 96920
Washington, DC 20090-6920
(202) 638-5577

|Web Links|

MedlinePlus, Mittelschmerz

MayoClinic.com, Mittelschmerz

mittelschmerz, middle pain, midcycle pain, pain during ovulation, lower abdominal pain, appendicitis, ectopic pregnancy, cramps, abdominal cramps

Author: Frederick B Gaupp, MD, Consulting Staff, Department of Family Practice, Assumption Community Hospital.

Coauthor(s): Laszlo Sogor, MD, PhD, Chief, Division of Gynecology, Acting Chairman, Department of Obstetrics and Gynecology, University MacDonald Women's Hospital; Associate Professor, Department of Reproductive Biology, Case Western Reserve University.

Editors: Bryan D Cowan, MD, Director, Division of Reproductive Endocrinology, Professor, Department of Obstetrics and Gynecology, University of Mississippi College of Medicine; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, ; Lee P Shulman, MD, Professor of Obstetrics and Gynecology, Head, Section of Reproductive Genetics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.