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Painful Ovulation (Mittelschmerz)

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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 ovulation 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.

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Who Has Painful Ovulation?

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

What Causes Painful Ovulation?

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 my Pain Is Due to Ovulation?

Ovulation usually occurs about two 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 ovulation usually occurs on one side of your lower abdomen). Your doctor also may perform an abdominal and pelvic exam 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.

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