| Mittelschmerz | |
|---|---|
| Other names | Ovulation pain,[1] mid-cycle pain[2] |
 | |
| Approximate location of abdominal pain based on potential causes | |
| Specialty | Gynecology |
| Symptoms | One sided lowerabdominal pain,spotting[1][2] |
| Usual onset | Midmenstrual cycle[1] |
| Duration | Minutes to days[1] |
| Causes | Related toovulation but mechanism unclear[2] |
| Diagnostic method | After ruling out other potential causes[3] |
| Differential diagnosis | Appendicitis,endometriosis,ovarian cyst,ectopic pregnancy,sexually transmitted infections[1][4] |
| Prevention | Birth control pills[1] |
| Treatment | Paracetamol,ibuprofen[1] |
| Prognosis | None serious[3] |
| Frequency | 40% of women[4] |
Mittelschmerz (German:[ˈmɪtl̩ʃmɛʁt͡s]ⓘ) is a term forpain due toovulation. It occurs mid-cycle (between days 7 and 24) and can last minutes to up to several days.[4] The pain affects one side of the lower abdomen and may be dull or sharp in nature.[1][2] Other symptoms may includespotting.[1] Often it occurs monthly and may alternate sides.[4][2]
The underlying mechanism is unclear but may involve irritation due to release of blood and fluid from thefollicle or high blood levels ofluteinizing hormone causing contraction ofsmooth muscle.[2][4][3] Diagnosis involves ruling out other potential causes such asappendicitis,endometriosis,ovarian cysts,ectopic pregnancy, andsexually transmitted infections.[1][4][3]
Treatment may involveparacetamol oribuprofen.[1]Birth control pills may be used for prevention.[1] It is not serious, though may reoccur.[3]Mittelschmerz affects about 20–40% of women.[2][4] The term is from theGerman for "middle pain".[3] Its presence has been used to managefertility.[4]
Mittelschmerz is characterized by lowerabdominal andpelvic pain that occurs roughly midway through a woman'smenstrual cycle. The pain can appear suddenly and usually subsides within hours, although it may sometimes last two or three days.[5][unreliable medical source?] In some cases it can last up to the following cycle. In some women, the mittelschmerz is localized enough so that they can tell which of their twoovaries provided the egg in a given month.[citation needed] Because ovulation occurs on a random ovary each cycle, the pain may switch sides or stay on the same side from one cycle to another.
Women may notice other physical symptoms associated with their mittelschmerz, during or near ovulation. The most common sign is the appearance of fertile cervical mucus in the days leading up to ovulation. Cervical mucus is one of the primary signs used by various fertility awareness methods. Other symptoms are sometimes calledsecondary fertility signs to distinguish from thethree primary signs.[6][unreliable medical source?]
Mittelschmerz is believed to have a variety of causes:
Diagnosis of mittelschmerz is generally made if a woman is mid-cycle and a pelvic examination shows no abnormalities. If the pain is prolonged and/or severe, other diagnostic procedures such as an abdominalultrasound may be performed to rule out other causes of abdominal pain.
The pain of mittelschmerz is sometimes mistaken forappendicitis and is one of thedifferential diagnoses for appendicitis in women of child-bearing age.
The pain is not harmful and does not signify the presence of disease. No treatment is usually necessary. Pain relievers (analgesics) such as NSAIDs (non-steroidal anti inflammatories) may be needed in cases of prolonged or intense pain.[8]
Hormonal forms of contraception can be taken to prevent ovulation[8]—and therefore ovulatory pain—but otherwise there is no known prevention.
Women charting with some form offertility awareness may find mittelschmerz to be a helpful secondary sign in detecting ovulation. Because normal sperm life is up to five days, however, mittelschmerz alone does not provide sufficient advance warning to avoid pregnancy. Because other causes of minor abdominal pain are common, mittelschmerz alone also cannot be used to confirm the beginning of the post-ovulatory infertile period.[5][unreliable medical source?][6][unreliable medical source?]
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