What is mittelschmerz?
Mid-cycle ovulation is pain on one side of the lower abdomen. Women experience the pain around the time of ovulation—when an egg is released from the ovary. It is also known as mittelschmerz, which is German for "middle" and "pain."
The pain is usually felt about 2 weeks before menstruation ("period") begins. It is generally the midpoint of the menstrual cycle. That is when ovulation occurs.
The abdominal pain may last a few minutes to a few hours. It varies from a sharp cramp to a dull ache. Mittelschmerz is common and usually treated with home care.
Most common symptoms
Symptoms I listen for when diagnosing this illness: Transient, short-lasting, and mild. If the pain is severe and lasts longer, or persists during the menstrual cycle, I would want to evaluate it further. —Dr. Huma Farid
Mid-cycle ovulation pain occurs when one of the two ovaries releases an egg. (The ovaries alternate the release of an egg month to month.) The pain is typically mild to moderate and may feel similar to menstrual cramps.
Though for some it can be an extremely sharp pain. It may last a few minutes or as long as a few hours.
- Lower abdominal or pelvic pain.
- Pain may be dull and achy or sharp and crampy.
- Pain lasts a few seconds to minutes. Occasionally, a few hours.
- On the left, right, or middle of the abdominal or pelvic region.
- Usually, 2 weeks before your period starts.
- Pain may alternate sides month to month.
Nausea. Intense pain may make you feel sick to your stomach.
Mid-cycle ovulation pain causes
The exact cause is unknown, though there are a few possible triggers.
The ovaries store and release eggs. Usually, every month, an egg from one of the ovaries grows until it is ready to be released.
The pain can be felt before, during, or even a bit after ovulation. It may be related to some of the physical changes happening.
As the maturing egg grows, it may stretch the surface of the ovary. You may feel the pain from the egg breaking through the wall of the ovary. A small amount of fluid or blood is also released, which can irritate the lining of the belly and cause pain.
I have had patients who think they aren't ovulating because they do not feel mid-cycle pain. That is not true. Some women never have any pain with ovulation, but they are still ovulating. —Dr. Farid
Next steps for mittelschmerz
Usually, there's no reason to be concerned.
But when it is severe and not relieved by pain relievers like acetaminophen (Tylenol) or ibuprofen (Advil or Motrin), or you also have vaginal bleeding that is not your period, contact your doctor.
Keep track of symptoms and chart them to see when they occur. What are you doing when you have this pain? What are you feeling? Asking yourself these can help confirm the diagnosis. —Dr. Farid
How can I ease ovulation pain?
Typically, you do not need to treat mid-cycle ovulation pain. But if the pain is bothering you, there are home care and medication options.
- Home care. Hot water bottles, heating pads, or hot baths. Warmth helps relax muscles.
- Pain relievers. Over-the-counter pain relievers like acetaminophen (Tylenol) and ibuprofen (Advil or Motrin), naproxen (Aleve), or aspirin.
Sometimes your doctor will recommend treatment with hormone-based methods. Birth control pills, the birth control patch, and the vaginal ring stop pain by stopping ovulation.
Dr. Maina graduated from Princeton University (BA, 2013) with a degree in psychology and received her medical degree from the University of Pennsylvania Perelman School of Medicine. She is currently a resident physician in Otolaryngology at the University of Pennsylvania affiliated hospitals. After graduating from Princeton, she spent a year researching embryonic gene expression with the Center for Research on Reproduction and Women's Health at UPenn. She also received a grant from the National Institutes of Health to study abnormal innate immune responses and taste-related genes in chronic sinus infections. In her free time, she enjoys cooking, reading, listening to podcasts, and finding new DIY décor projects.