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Mayo Clinic Health Library

Mittelschmerz

Updated: 09-25-2020

Overview

Mittelschmerz is one-sided, lower abdominal pain associated with ovulation. German for "middle pain," mittelschmerz occurs midway through a menstrual cycle — about 14 days before your next menstrual period.

In most cases, mittelschmerz doesn't require medical attention. For minor mittelschmerz discomfort, over-the-counter pain relievers and home remedies are often effective. If your mittelschmerz pain is troublesome, your doctor may prescribe an oral contraceptive to stop ovulation and prevent midcycle pain.

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Symptoms

Mittelschmerz pain usually lasts a few minutes to a few hours, but it may continue for as long as a day or two. Pain from mittelschmerz may be:

  • On one side of your lower abdomen
  • Dull and achy, similar to menstrual cramps
  • Sharp and sudden
  • Accompanied by slight vaginal bleeding or discharge
  • Rarely, severe

Mittelschmerz pain occurs on the side of the ovary that's releasing an egg (ovulating). The pain may switch sides every other month, or you may feel pain on the same side for several months.

Keep track of your menstrual cycle for several months and note when you feel lower abdominal pain. If it occurs midcycle and goes away without treatment, it's most likely mittelschmerz.

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Causes

Mittelschmerz occurs during ovulation, when the follicle ruptures and releases its egg. Some women have mittelschmerz every month; others have it only occasionally.

The exact cause of mittelschmerz is unknown, but possible reasons for the pain include these:

  • Just before an egg is released with ovulation, follicle growth stretches the surface of your ovary, causing pain.
  • Blood or fluid released from the ruptured follicle irritates the lining of your abdomen (peritoneum), leading to pain.

Pain at any other point in your menstrual cycle isn't mittelschmerz. It may be normal menstrual cramping (dysmenorrhea) if it occurs during your period, or it may be from other abdominal or pelvic problems. If you have severe pain, see your doctor.

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Treatment

Possible treatments for mittelschmerz include:

  • Pain relievers. For the relief of discomfort from mittelschmerz, try an over-the-counter drug such as acetaminophen (Tylenol, others), aspirin, ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve).
  • Birth control pills (oral contraceptives). If mittelschmerz causes you a lot of discomfort or occurs monthly, ask your doctor about taking birth control pills. Some types of birth control pills suppress ovulation, which could help ease ovulation pain while you're taking them.
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Lifestyle and home remedies

To ease mittelschmerz discomfort that lasts more than a few minutes, try some home remedies. Because heat increases blood flow, relaxes tense muscles and eases cramping, you might want to:

  • Soak in a hot bath
  • Use a heating pad where the pain is
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Preparing for an appointment

In most cases, you won't need to see a doctor for mittelschmerz. However, if your pain is especially troublesome, you may make an appointment to confirm a diagnosis of mittelschmerz or to explore treatment options.

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