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Disease: Mittelschmerz Mittelschmerz
Category: Gynecological diseases
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Disease Definition:

The pain that occurs with ovulation is mittelschmerz, a German word that means "middle pain". When a woman experiences pain on one side of her lower abdomen and she doesn't know what it is, she should keep track of its timing by observing and recording several menstrual cycles. She's most likely experiencing a condition called mittelschmerz if this pain occurs midway through her menstrual cycle — about 14 days before her next menstrual period.

Medical attention is not required in the most cases of mittelschmerz. Home remedies and over-the-counter pain relievers are often effective for minor mittelschmerz discomfort. An oral contraceptive may be prescribed if the mittelschmerz pain is troublesome.

Work Group:

Prepared by: Scientific Section

Symptoms, Causes


A distinctive, one-sided lower abdominal pain or discomfort is the main symptom of mittelschmerz. Every other month or every other time the woman feels it, the pain may switch sides. Feeling it on the same side for several months in a row is possible as well.  The pain occurs on the side in which the woman is ovulating.

The pain may continue for as long as a day or two, though it usually lasts a few minutes to a few hours. The pain from mittelschmerz may be the following:


  • Sharp, sudden pain
  • A dull ache that feels like a cramp
  • Rarely, severe
  • Accompanied by mild vaginal bleeding or discharge

If a woman has a history of mittelschmerz, the timing and the location of the pain can help her identify it. So one should keep track of her menstrual cycle for several months and note when she experiences this pain. It's most likely mittelschmerz if it occurs midcycle and goes away without treatment.

Mittelschmerz requires no medical intervention in the vast majority of cases. However, if the pain persists, if it's   accompanied by fever or nausea, or if a new pelvic pain becomes severe, a woman should contact her doctor, as any of these cases could indicate that she has a condition more serious than mittelschmerz, such as pelvic inflammatory disease, appendicitis or even an ectopic pregnancy.


Estrogen, the female sex hormone, causes the uterine lining (endometrium) to thicken every month to create a nourishing environment for a fertilized egg during the menstrual cycle. A follicle, which is a tiny sac in the ovary that contains a single egg (ovum), ruptures and releases its egg (ovulation) soon afterward.

The egg implants in the lining of the uterus if it becomes fertilized by contact with a sperm on its way to the uterus. However, most often, the unfertilized egg passes through the uterus and out of the body. The uterus releases this lining and the menstrual flow begins shortly after that.

When the follicle ruptures and releases its egg during ovulation, mittelschmerz occurs. It has been estimated that about 1 in 5 women experience ovulation discomfort. While some have mittelschmerz only occasionally, others have it every month.

The following are possible reasons for a woman to feel pain, though the exact cause of mittelschmerz is unknown:


  • The lining of the abdomen may be irritated (peritoneum) just before an egg is released with ovulation, which could cause pain.
  • Follicle growth stretches the surface of the ovary just before an egg is released with ovulation, which ends up causing pain.

The pain that a woman may feel in any other point in her menstrual cycle isn't mittelschmerz. It may be from other pelvic or abdominal problems, or it may be normal menstrual cramping (dysmenorrhea) if it occurs during the period. A woman should see her doctor if the pain is severe during the time of ovulation or at any other time during the cycle.





A woman could try an over-the-counter pain reliever such as acetylsalicylic acid, naproxen, acetaminophen or ibuprofen if she needs relief from the discomfort of mittelschmerz.

As birth control pills prevent ovulation, which in turn prevents mittelschmerz, a woman may talk to the doctor about the option of taking a birth control pill (oral contraceptive) if she experiences mittelschmerz nearly every month and it causes her quite a bit of discomfort. Birth control pills help because only if an ovary releases an egg the condition occurs.


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