Painful Ovulation (Mittelschmerz)

Mittelschmerz is the pelvic and lower abdominal pain that some women experience during ovulation. (Ovulation generally occurs about midway between menstrual cycles hence the term mittelschmerz, which comes from the German words for "middle" and "pain."

The pain of mittelschmerz can range from a mild twinge to severe discomfort and usually lasts from minutes to hours. It is generally felt on one side of the abdomen and may vary each month, depending on which ovary is releasing the egg during that cycle. In some cases, a small amount of vaginal bleeding or discharge may occur. Some women experience nausea, especially if the pain is severe.

Who Gets Mittelschmerz?

Many women never experience pain at ovulation. Some women, however, have mid-cycle pain every month and can determine by the pain that they are ovulating.

What Causes Mittelschmerz?

As an egg develops in the ovary, it is surrounded by follicular fluid. During ovulation, the egg and the fluid, as well as some blood, are released from the ovary. While the exact cause of mittelschmerz is unknown, it is believed that the fluid or blood may irritate the lining of the abdominal cavity, causing pain. The pain goes away once the body absorbs the fluid or blood.

How Do I Know If I Have Mittelschmerz?

Ovulation usually occurs about 2 weeks after the first day of each menstrual cycle, so the timing of the pain makes mittelschmerz easy to recognize. To help determine if your pain is related to ovulation, your doctor may ask you to chart your menstrual cycles, noting any episodes of pain, as well as the location of the pain (the pain of mittelschmerz usually occurs on one side of your lower abdomen). Your doctor also may perform an abdominal and pelvic examination to help rule out other possible causes of pain, such as endometriosis or a cyst on your ovary. If your pain is severe or if the doctor notices any irregularities on the exam, he or she may order blood tests or X-rays to help determine the cause of your pain.

How Is Mittelschmerz Treated?

The pain usually goes away within about 24 hours, so specific treatment is not required. Over-the-counter pain medicines -- such as Aleve (naproxen) or Motrin (ibuprofen) -- generally are effective in relieving mittelschmerz. Applying a heating pad to the lower abdomen or taking a warm bath may also help with the discomfort. Women with particularly painful ovulation may find relief by taking birth control pills, which prevent ovulation.

Can Mittelschmerz Be Prevented?

Preventing ovulation, which can be done with birth control pills, is the only way to effectively prevent mittelschmerz.

When Should I Call My Doctor?

Call your doctor if you experience any of the following symptoms during ovulation:

• Fever
• Pain with urination
• Redness or burning of the skin at the site of the pain
• Vomiting
• Mid-cycle pain lasting longer than a day

You should also call your doctor if you missed your last menstrual period.

Reviewed by the doctors at The Cleveland Clinic Department of Obstetrics and Gynecology.