Mittelschmerz

Mittelschmerz Overview

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.

Mittelschmerz Causes

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.

Mittelschmerz Symptoms

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.

When to Seek Medical Care

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

Exams and Tests

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.