Mid-Menstrual Cycle Pain (Mittelschmerz)

What Is It?

Some women feel pain in the abdomen or pelvis during ovulation, when an egg is released from the ovary. This usually happens midway between menstrual cycles. The medical term for this is mittelschmerz, which comes from the German words for "middle" and "pain." Some women don't feel anything when an egg is being released from an ovary. Other women may feel intermittent or constant discomfort or pain during ovulation.

Symptoms

Ovulation usually occurs two weeks before the first day of each menstrual period, give or take a couple of days. During this time, you may feel pain in the pelvis that can range from a sense of discomfort or a mild twinge to severe pain that mimics appendicitis. It usually lasts a short period of time, from a few minutes to hours. It often is felt in the lower abdomen or pelvis, either in the middle or on one side. If the pain is severe, it may be accompanied by some mild nausea.

Diagnosis

Pain during ovulation usually is easy to recognize because its timing is so characteristic. Your doctor will be able to determine that you are experiencing pain from ovulation based on your menstrual cycle, the location and description of your pain, and the results of an abdominal and pelvic exam. It is important to let your doctor know about any other symptoms you have, such as fever, vomiting, changes in urination or changes in your bowel movements or appetite.

Additional blood tests, X-rays, a pelvic ultrasound or a computed tomography (CT) scan may be necessary if your pain is severe or if your doctor notices any unusual findings on your physical examination, such as a very tender abdomen or pelvis or an enlarged ovary.

Expected Duration

Ovulatory pain usually lasts from a few moments to several hours. The longer episodes of pain may be due to lingering irritation from a small amount of bleeding, which sometimes happens when the egg is released.

Prevention

It usually is not necessary to prevent this mild, short-lived pain syndrome. Birth control pills prevent ovulation and can be used to prevent mid-cycle pain.

Treatment

Painful ovulation is generally brief, so using medication for pain relief usually is not necessary. Over-the-counter pain medicines, such as ibuprofen (Advil, Motrin and others), can be used as needed and are very effective at relieving mid-menstrual cycle pain.

When To Call a Professional

Call your doctor if you have fever, pain with urination, abnormal bleeding or vomiting, even if your pain happens exactly at time of ovulation. Let your doctor know if mid-cycle pain lasts longer than a day. You also should contact your doctor if you missed your last menstrual period.

Prognosis

Pain during ovulation does not have any dangerous consequences.

Additional Info

American College of Obstetricians and Gynecologists
http://www.acog.org/