Mittelschmerz is pain on one side of the belly that can happen once a month when you ovulate. It’s a sign that an egg has been released from one of your ovaries and you are most fertile at this time of the month.
This is different from regular menstrual cramping (dysmenorrhea) that happens earlier in the menstrual cycle.
Causes
Sometimes your menstrual cycle can feel like a terrible a la carte menu, with painful dishes thrown in at random times. One such dish is Mittelschmerz, a mid-cycle pelvic pain that’s linked to ovulation. It’s often described as a sharp, cramping sensation in your lower abdomen, though it can be dull and achy, too. The pain can change from month to month and even switch sides within a single cycle. It’s not usually a cause for alarm but can be an indicator of pregnancy, so it should be noted by your doctor.
Experts aren’t sure exactly what causes mittelschmerz, but they know it’s tied to the process of ovulation. Around day 12 or 14 of the average 28-day menstrual cycle, hormonal fluctuations cause a follicle in your ovary to grow and then rupture to release an egg. When a follicle ruptures, it can stretch or irritate the lining of your uterus (peritoneum) and cause pain. This is why the pain can switch sides from month to month and even appear on both ovaries in some cases.
For women who want to become pregnant, ovulation pain can be a useful tool to help pinpoint the best time of their cycle for conception. But it’s not always enough on its own, as sperm can keep swimming for up to seven days after you’ve ovulated. For this reason, it’s best to use other methods of conception like using birth control that prevents ovulation or hormone-based methods, like a pill or implant.
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Other reasons for mittelschmerz include endometriosis, which is when tissue from the inside of your womb grows outside your ovaries and bleeds during periods. If the pain is accompanied by other symptoms like fever, bleeding, or vomiting, it’s important to see a health care provider to screen for other conditions. Fortunately, the vast majority of ovulation pain is harmless. But knowing more about the symptom can help you navigate it better and feel confident in your own ability to conceive.
Symptoms
There’s not a lot of research on this symptom, but gynecologists know that it happens around the time of ovulation. Ovulation pain is a type of lower abdominal or pelvic pain that affects some women during ovulation. It’s typically mild, and it happens when one of the ovaries releases an egg. If you’re trying to conceive, knowing when you’re ovulating is important. You can use the pain to help you plan when to have sex and avoid pregnancy.
During ovulation, the follicle where the egg develops grows, and then it ruptures to release an egg. This may cause a sudden, sharp pain in the middle of your abdomen. Blood and fluid released from the ruptured follicle also may irritate the lining of your abdomen. The pain is usually one-sided, and it lasts for a few minutes to a few hours. Some women describe it as a cramping sensation that feels similar to menstrual cramps. The pain is usually not severe, and it usually doesn’t happen more than a few times a month.
Some people don’t get ovulation pain at all, and for others the pain isn’t strong enough to notice. This is why tracking your ovulation cycle can be helpful. Tracking your basal body temperature, or the first temperature you take in the morning, is also a good way to know when you’re close to ovulating.
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When you’re ovulating, your fertility is at its highest, so it’s important to be careful when having sex. You can prevent a pregnancy by taking a type of birth control that stops you from ovulating, such as the pill or implant. However, it’s possible to get pregnant even if you’re using birth control. Sperm can keep swimming for up to seven days after you have sex, so you’ll still need to be cautious.
You should talk to your doctor if you have ovulation pain that’s not very strong or doesn’t go away after a few days. This could be a sign of a medical problem, such as an appendicitis or an infection in the uterus (dysmenorrhea). Talk to your doctor about how to manage your symptoms.
Diagnosis
Mittelschmerz, German for “middle pain,” is a common discomfort that occurs in the lower abdomen and pelvic area about 14 days before your menstrual period begins. It happens when an ovary in your body releases an egg, usually on one side of the belly (the ovaries are on each side of the uterus). Fortunately, mittelschmerz is usually harmless and doesn’t need medical attention. Over-the-counter pain relievers such as acetaminophen (Tylenol) or ibuprofen may help with the discomfort, and you can also try heat therapy.
During ovulation, an egg grows inside a fluid-filled sac (follicle) on the ovary until it reaches maturity and then ruptures to release the egg. As the follicle stretches, it can cause pain on the surface of the ovary. The pain can also happen because of the increased blood flow to the ovary during ovulation, or because an ovulated egg can release a burst of fluid or blood that irritates the lower abdominal tissues.
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The pain of ovulation typically comes on one side of your abdomen and pelvic area, and it can last for several minutes or hours. It may be accompanied by light spotting or discharge and possibly nausea. Because mittelschmerz can occur at the same time as other health conditions, your doctor may want to perform some tests to make sure the symptoms are caused by ovulation and not by another health condition.
Your gynaecologist will ask questions about your symptoms and medical history, and he or she may do a physical exam. Your gynaecologist might also order an ultrasound test to check for other causes of pain, such as a cyst on the ovary or endometriosis.
The best way to avoid mittelschmerz is to stay hydrated, exercise regularly and get enough sleep. You can also take hormone-based birth control pills to prevent ovulation, which will reduce mittelschmerz and other symptoms related to the menstrual cycle. Your gynaecologist can talk to you about the benefits and risks of this option.
Treatment
Most women who have mittelschmerz feel pain on one side of their abdomen. This is because the follicle that is growing the egg has to stretch and move around as it releases an egg each month, and this can cause pain. The pain is usually mild but can be quite strong. It also varies from month to month. Some people experience it every month, while others only get mittelschmerz once a month. The pain can shift from side to side because a woman has two ovaries. It’s believed that the ovary on the side of the body that is touchier (or snippier?) may experience pain more often than the other ovary.
While the exact cause of the pain is unknown, it’s thought that mittelschmerz is caused by a change in a woman’s body chemistry. It is different from menstrual cramping, which is caused by the uterus lining.
A doctor will diagnose mittelschmerz by exclusion — which means the doctor will do tests to rule out other medical conditions that can cause pelvic pain. If the doctor can’t find another reason for the pain, he or she will probably recommend treatment for mittelschmerz.
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This usually involves over-the-counter pain relievers. Taking a hot bath or using a heating pad can also help reduce the pain. Some women also find that getting plenty of rest helps. If the pain is severe, a doctor may prescribe a stronger medicine.
The good news is that mittelschmerz is usually not serious and will go away on its own. Women should talk to a doctor if they have persistent pelvic pain that is severe or accompanied by other symptoms, such as fever or nausea, though. These could be signs of a condition that is more serious than mittelschmerz, such as an ectopic pregnancy or pelvic inflammatory disease.
If a woman’s pain is so bad that over-the-counter medication doesn’t help, she can ask her doctor about hormonal birth control pills. These can prevent ovulation, so they may help to alleviate the pain of mittelschmerz. They can also help to prevent pregnancy, but they won’t stop a woman from experiencing other types of period pain, such as cramps and heavy bleeding.
