Ovulation Pain or Mittelschmerz

Ovulation pain or mittelschmerz is more common than most women realize.

I have had women ask me if other women are also reporting similar pains.

Some have often wondered if such monthly discomfort is a disease or part of the normal ovulation process for some women.

This article briefly discusses the definition, symptoms, causes and treatment of this pain associated with ovulation.

What Is Ovulation Pain?

As the name suggests, it is pain associated with the process of ovulation. It is also called Middle Pain, Mid Cycle pain or Mittelschmerz (pronounced MITT-ul-shmurz).

The terms ‘mid cycle’ or ‘middle’ are used to describe the time of the ovulation cycle
at which it occurs, typically mid way or Day 14 of the average 28-day
cycle. That is usually the time for the release of the ovum or ovulation
about 2 weeks before menses hence the synonym name of ovulation pain.
The pain is located at the side of the ovary that ovulates and so can
switch from side to side depending on the ovulating ovary.This pain is
not menstruation cramps.

About 20% of women experience this middle pain, some every cycle while others have the pain only intermittently.

Symptoms Of Mittelschmerz

Ovulation pain is characterized by the following

• One-sided location in the lower abdomen or pelvis. Rarely on both sides.
• Recurrent or with similar pain in past
• Typically lasting minutes to a few hours, possibly as long as 2-3 days
• Usually sharp, cramping, distinctive pain
• Usually mild. Rarely severe
• May switch sides from month to month or from one episode to another
• Begins midway through the menstrual cycle

As
usual, it is worth noting here that not all pain occurring during the
ovulatory period is necessarily Middle pain or Mittelschmerz . Seek
medical care in the following cases

1. Vaginal bleeding occurring. Note that mild mid cycle bleeding may occur due to normal ovulation itself, a condition called Mid Cycle bleeding.
   Vaginal bleeding may be a sign of serious conditions such as an
   ectopic pregnancy so do not hesitate to seek medical care if there is
   any doubt.
2. If there are other symptoms such as
   fever, nausea or vomiting. Appendicitis is a likely diagnosis that can
   be mistaken for ovulatory pain.

Causes Of Middle Pain

How does mid cycle pain come about? The following are possible causes

1. Irritation:
   At the time of ovulation, blood or other fluid is released from the
   ruptured egg follicle. This fluid may cause irritation of the abdominal
   lining and cause pain.
2. Follicular swelling prior
   to ovulation. Because follicles develop on both sides, this theory
   explains mittelschmerz that occurs simultaneously on both sides of the
   abdomen.
3. Ovarian wall rupture: The ovaries have no
   natural openings for the egg to exit and so it has to break its way
   through the ovary’s wall.. This may make ovulation itself painful for
   some women.
4. Smooth muscle contraction of the tubes,ligaments or ovary.

Treatment Of Ovulation Pain

Middle pain is usually mild and requires no treatment.

In most
women,medications will not be required. In fact many women do not want
drugs for it. For those that do not need or want drugs, a hot water
bottle(not burning!) and the fetal position will suffice. The fetal
position is just lying on the bed like a fetus in the mother’s uterus,
with the knees drawn towards the chest.

In the event that it is
serious enough to warrant therapy, anti-inflammatory medications like
Ibuprofen (Advil is a familiar brand name), naproxen (Aleve, Naprosyn),
and ketoprofen (Orudis) are available without a prescription and can
provide significant relief.

In the rare case of very severe pain,
medical care should be sought. Birth pills could be provided in such
cases to provide relief.

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