What is Mittelschmerz?
Mittelschmerz is German for "middle" and "pain," and is known as ovulation 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.
This pain might last a few minutes here and a few minutes there or it could last for more than an hour. Often stress levels can influence the length and severity of the pain. Women suffer from Mittelschmerz on varying levels. 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.
Mittelschmerz is due to swelling and stretching of the surface of the ovary in the area of the follicle, leakage of the follicular fluid or blood, or 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.)
Does ovulation pain (Mittelschmerz) come before or after ovulation?
Mittelschmerz is the result of the distention of the ovary either shortly before, during, or after ovulation. 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, and you can still ovulate normally and never experience it.
Some women with endometriosis experience pain well before ovulation. Keep in mind, 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.
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 since eggs are released randomly from the left or right ovary each month
Pain in your right lower abdominal area can also indicate other more severe problems such as appedicitis. If you have this severe pain, especially if it is accompanied by fever, you should immediately call your doctor or go to the emergency room.
Could the pain be 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 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 should consult your doctor.