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Mittelschmerz

Mittelschmerz is one-sided, lower abdominal pain in women. It occurs at or around the time of an egg is released from the ovaries (ovulation).

Alternative Names

Ovulation pain; Midcycle pain

Causes, incidence, and risk factors

About 1 in 5 women have pain around the time of ovulation. This is called mittelschmerz. The pain may occur just before, during, or after ovulation.

This pain can be explained in several ways. Just before to ovulation, the growth of the follicle where the egg develops may stretch the surface of the ovary. This can cause pain. At the time of ovulation, fluid or blood is released from the ruptured egg follicle. This may irritate lining of the abdomen.

Symptoms

Mittelschmerz may be felt on one side of the body in one month and then switch to the other side in the next month. It may also occur on the same side for many months in a row.

Symptoms include lower-abdominal pain that:

  • Occurs only on one side
  • Goes on for minutes to a few hours. It can last up to 24-48 hours.
  • Feels like a sharp, cramping pain unlike other pain
  • Severe (rare)
  • May switch sides from month to month
  • Begins midway through the menstrual cycle

Signs and tests

A pelvic exam shows no problems. Other tests (such as an abdominal ultrasound or transvaginal pelvic ultrasound) may be done to look for other causes of ovarian or pelvic pain. These tests may be done if the pain is ongoing.

Treatment

Most of the time treatment is not needed. Pain relievers may be needed if the pain is intense or lasts a long time.

Expectations (prognosis)

Mittelschmerz can be painful, but it is not harmful. It is not a sign of disease. It may help women be aware of the time in the menstrual cycle when the egg is released.

Complications

Most of the time there are no complications.

Calling your health care provider

Call your health care provider if:

  • Ovulation pain seems to change.
  • Pain lasts longer than usual.
  • Pain occurs with vaginal bleeding.

Prevention

Birth control pills can be taken to prevent ovulation. This can help reduce pain that is linked to ovulation.

References

Won HR, Abbott J. Optimal management of chronic cyclical pelvic pain: an evidence-based and pragmatic approach. Int J Womens Health. 2010; 2: 263–277.

Updated: 4/25/2013

Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Bellevue, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Black, Stephanie Slon, and Nissi Wang.


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