What is Mittelschmerz (middle pain), also known as ovulatory pain?

From the Guidelines

Mittelschmerz, or ovulatory pain, is a type of abdominal pain that occurs during ovulation, typically in the middle of a woman's menstrual cycle, and is usually felt on one side of the lower abdomen. This condition is characterized by mild to moderate discomfort, lasting from a few hours to a couple of days, and is often accompanied by other symptoms such as nausea and vomiting 1. The pain is thought to be caused by the release of follicular fluid and sometimes blood when the egg breaks through the ovarian wall, which can irritate the abdominal lining. Key features of mittelschmerz include:

• Occurs during ovulation, typically in the middle of a woman's menstrual cycle
• Usually felt on one side of the lower abdomen
• Discomfort ranges from mild to moderate
• Lasts anywhere from a few hours to a couple of days
• Can be accompanied by other symptoms such as nausea and vomiting For relief, over-the-counter pain medications like ibuprofen (200-400mg every 4-6 hours) or naproxen (220mg every 8-12 hours) are typically effective, as well as applying a heating pad to the painful area 1. It's essential to note that while mittelschmerz is generally a benign condition, severe or persistent pain, or pain accompanied by other concerning symptoms like fever or abnormal bleeding, may require medical attention to rule out other potential causes of pelvic pain, such as ectopic pregnancy or ovarian torsion 1.

From the Research

Definition of Mittelschmerz

Mittelschmerz, also known as ovulatory pain, is a type of pelvic pain that occurs during ovulation. The exact cause of Mittelschmerz is not well understood, but it is thought to be related to the release of an egg from the ovary.

Characteristics of Mittelschmerz

• Mittelschmerz is typically a sharp, stabbing pain that occurs on one side of the pelvis
• The pain is usually mild to moderate and can last from a few minutes to several hours
• Mittelschmerz can occur at any time during the menstrual cycle, but it is most common during ovulation (around day 14 of a 28-day cycle)
• The pain can be accompanied by other symptoms such as bloating, breast tenderness, and mood changes

Treatment of Mittelschmerz

• Over-the-counter pain relievers such as ibuprofen or acetaminophen can help alleviate the pain 2, 3, 4
• Hormonal contraceptives, such as birth control pills, can also help reduce the severity of Mittelschmerz by suppressing ovulation 5
• Other treatments, such as applying heat or cold to the affected area, can also help relieve the pain

Relationship between Mittelschmerz and Ovarian Cancer

• Some studies suggest that women who experience Mittelschmerz may be at lower risk of ovarian cancer, particularly if they use analgesics such as aspirin or acetaminophen to treat their pain 6
• However, more research is needed to fully understand the relationship between Mittelschmerz and ovarian cancer risk

Management of Mittelschmerz

• Women who experience Mittelschmerz can try over-the-counter pain relievers or hormonal contraceptives to alleviate their symptoms
• If the pain is severe or persistent, women should consult their healthcare provider for further evaluation and treatment
• Women who are concerned about their risk of ovarian cancer should discuss their individual risk factors with their healthcare provider 6