Mittelschmerz Ovulation Pain - Pain in the Middle

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Mittelschmerz is German for "middle" and "pain." It is also known as ‘ovulation pain’ or 'mid-cycle pain.’

Mittelschmerz is a one-sided lower abdominal pain, but can switch to the other side the next month or stay on the same side for several months in a row. Mittelschmerz may occur just before, during, or after ovulation in about 20% of women and can it lasts from a few seconds or minutes to several hours. Rarely does it last 24-48 hours. Longer pain does not usually come from ovulation itself but from bleeding or fluid irritating the peritoneum, the lining of the abdomen or from endometriosis.

Mittelschmerz is due either to swelling and stretching of the surface of the ovary in the area of the follicle, leakage of the follicular fluid or blood, or it comes from enzymes that dissolve the outer wall of the ovary surrounding the follicle to let the egg escape. With ovulation induction the ovaries can swell and pain at that time may be related to post-ovulation ovarian enlargement. This can best be determined by ultrasound.

Does ovulation pain (Mittelschmerz) come before or after ovulation?

Mittelschmerz comes from distention of the ovary either shortly before, during, or after ovulation. Mittelschmerz can last minutes or even days. When you feel Mittelschmerz, it may mean that you are either about to ovulate or you ovulated already. Some women only feel it for minutes, exactly at the time of ovulation, though that is not the rule. Many women who ovulate regularly do not have Mittelschmerz, so it's not necessary for normal ovulation.

Some women with endometriosis can also experience pain well before ovulation. Mittelschmerz is too nonspecific to be a reliable enough indicator of ovulation which can better be assessed with the bbt curve, ultrasound, OPKs, or an elevated postovulatory blood progesterone level.

Review of Symptoms of Mittelschmerz:

  • One-sided lower abdominal pain
  • Pain onset is shortly before, during, or right after ovulation
  • Recurrent or with similar pain in past
  • Duration is typically seconds or minutes to a few hours, but may extend as long as 24 to 48 hours
  • It is usually sharp, cramping, distinctive pain
  • Rarely pain can be severe
  • Pain may switch sides from month to month or from one episode to another

ATTENTION: Pain in your right lower abdominal area can also indicate other more severe problems such as appedicitis (infection of your appendix). If you have this severe pain, especially if it is accompanied by fever, you should immediately call your doctor or go to an emergency room.

Ovulation and Mittelschmerz

Maybe you fell a tiny prink of pain when your ovulation cycle begins or you feel pain that lasts several days after the start of ovulation, both are likely a Mittelschmerz. Typically this type of pain is felt in the lower abdomen or pelvic region.

What are the Symptoms of Mittelschmerz?

Each month I would feel a pain during the first few days of my ovulation cycle only on my left side. This pain might last a few minutes here and a few minutes there or it could last for more than an hour. Often stress level at the time could influence the length and severity of my pain. Apparently women suffer from Mittelschmerz on varying levels – just like me. Some feel just a tiny bit of pain at the beginning of their menstrual cycle and others feel extreme pain for hours and possibly days.

Could the Pain be Associated with a Health Problem?

There are multiple health problems that could cause pelvic or abdominal pain and there is no real way of determining the root cause without some medical testing. If the pain occurs every month during the time you should be ovulating and there are no other symptoms, there is a good chance it is Mittelschmerz.

If there are other symptoms or the pain occurs at a time other than your ovulation cycle, you could be having menstrual cramps or some other problem and you should consult with your physician about the pain and/or other symptoms. 

Mittelschmerz is not a word you’ve likely heard – but it is one that describes the pain you could be feeling every month. When my OB/GYM first told me I was having Mittelschmerz, I giggled just a bit, but there is nothing funny about the pain associated with the condition.