What Is Mittelschmerz?

Do you experience pain or cramps between periods? If you do, you may be experiencing Mittelschmerz.

Overview

Mittelschmerz is pelvic pain and cramping that occurs during ovulation in some women. The word Mittelschmerz originates from Germany and translated means "middle pain." It typically refers to the discomfort some women feel around the time that an egg is released from the ovary. Ovulation occurs at roughly the midpoint of your menstrual cycle. Mittelschmerz is also referred to as painful ovulation, mid-cycle pain, and middle cramps or pain.

Causes

Ovulation normally occurs about two weeks after the first day of menstruation. During these two weeks, hormonal changes occur that stimulate your ovary to release an egg. Each of your eggs develops inside their own compartment known as a follicle. Stimulation of the ovary causes swelling of several follicles to prepare them to release their egg which can cause some discomfort. Ultimately only one of these swelling follicles releases an ovum, or egg, which enters the fallopian tube.

At the time of egg release or ovulation, this dominant follicle breaks open and releases an egg along with some fluid. Sometimes there is also some bleeding from the ruptured ovarian follicle. This fluid and possibly blood are released into your pelvis. This is referred to as free fluid and it is an irritant to the lining of your abdomen and pelvis which contains pain fibers. The free fluid can also cause your bowels to slow down a bit. You may become distended from backed-up gas adding to your discomfort.

About 20% of women experience severe pain or cramps with ovulation. Women who experience Mittelschmerz, feel severe or sharp pain or cramping on one side of the lower abdomen, and although it may feel like something serious is wrong, Mittelschmerz is almost never serious.

Other symptoms that sometimes occur with Mittelschmerz include nausea and/or light bleeding or spotting. The good news is that the pain, cramps, and other symptoms associated with this condition can last a few minutes to a few hours.

Treatment

Fortunately, you have several options to ease the pain and symptoms of Mittelschmerz. Your options include:

• Apply Heat: Use a warm pack or a heating pad to help relieve the discomfort.
• Use NSAIDs: Anti-inflammatory drugs such as ibuprofen or naproxen sodium may help relieve pain. Remember not to take these medications on an empty stomach.
• Apply Pressure: Gentle pressure or a massage of your abdomen may help relieve gassy distention.
• Try an Anti-Gas Tablet: You may find taking a medication containing simethicone will help gas pass through your intestines. This can help relieve some of the discomforts from your distended bowels.

Prevention

It is common to have an occasional cycle with significant ovulatory discomfort. However, if you are having significant Mittelschmerz every month you may want to consider using hormonal contraception. The birth control pill, contraceptive patch, or contraceptive ring all work by suppressing your ovulation. If you do not ovulate you will not have ovulatory pain or Mittelschmerz. 

When to Call Your Healthcare Provider

Sometimes mid-cycle pain can be a sign of a more significant problem with your ovary or possibly a pelvic infection. Certain signs and symptoms indicate a need to call your practitioner for diagnosis and treatment. These symptoms include:

• Call your healthcare provider if you have a fever because you may have an infection that is unrelated to Mittelschmerz
• Pain not relieved by these tips
• Pain that lasts longer than two or three days
• Heavy bleeding during ovulation
• Having a vaginal discharge in addition to pelvic pain

Seek emergency care if any of the following occur:

• Increasing pain
• Abdominal pain with pain in one or both shoulder blades
• Vomiting blood
• Bloody stools
• Feeling faint or dizzy
• A high fever
• Difficult or painful urination
• Problems breathing
• Swelling or bloating of the abdomen

As always, be sure to discuss any pain or other period problems you may have with your healthcare provider.