What is Mittelschmerz?
Mittelschmerz is a pain which is felt during ovulation. This pain is located on one-side and is felt in the lower abdomen. "Mittelschmerz" is derived from German language which means "middle pain," and this condition is named "Mittelschmerz," as the pain occurs midway through a menstrual cycle, i.e. around 14 days before the next menstrual period. Most of the times, mittelschmerz doesn't warrant any medical attention, as minor mittelschmerz pain/discomfort can be relieved by over-the-counter pain medications. Home remedies are also effective in alleviating this pain. If the pain of mittelschmerz is bothersome, then an oral contraceptive pill to stop the ovulation in order to prevent the mid-cycle mittelschmerz pain can be prescribed by the doctor.
Pathophysiology of Mittelschmerz or Ovulation Pain or Midcycle Pain
During the menstrual cycle, the uterine lining gets thickened by the female sex hormone estrogen in order to create a wholesome environment for the fertilized egg. After this, the follicles in the ovary rupture and release the egg (ovulation). This egg may become fertilized by a sperm along the way as it passes to the uterus. This fertilized egg then implants in the uterine lining. The eggs which aren't fertilized pass through the uterus and out of the body where after sometime the uterus releases its endometrial lining thus causing menstrual flow to begin. Mittelschmerz is experienced during ovulation, when the follicle ruptures and the egg is released.
Causes of Mittelschmerz or Ovulation Pain or Midcycle Pain
The exact cause of mittelschmerz is not known; however, given below are some possible reasons for the pain:
- Before the release of the egg with ovulation, the growth of the follicle causes the surface of the ovary to stretch resulting in pain.
- The ruptured follicle may cause release of blood or fluid leading to irritation of the abdominal lining (peritoneum) and causing pain.
- If the patient suffers from pain during other time of the menstrual cycle, then it isn't mittelschmerz. It could be dysmenorrhea which is a normal menstrual cramping during the period, or it may be occurring due to other abdominal or pelvic problems. In case of severe pain, consult your doctor immediately.
Signs and Symptoms of Mittelschmerz or Ovulation Pain or Midcycle Pain
Mittelschmerz pain may subside in a few minutes to a few hours. However, it may also persist for a day or two. The characteristics of mittelschmerz pain are:
- Mittelschmerz pain is felt on one side in the lower abdomen.
- Pain is felt as dull and cramp-like.
- Pain can also be abrupt and sharp.
- Pain is felt midway during the menstrual cycle.
- Mittelschmerz pain may also switch from one side to another from month to month.
- There may be slight vaginal bleeding or discharge.
- In rare cases, the pain may be very severe where the patient should visit a doctor immediately.
- Serious Symptoms Requiring Immediate Medical Attention Are: Severe pelvic pain which is new along with nausea or fever. If it persists then patient should seek treatment immediately, as this could indicate other conditions which are more serious than mittelschmerz, e.g. pelvic inflammatory disease, appendicitis or an ectopic pregnancy.
Tests to Diagnose Mittelschmerz or Ovulation Pain or Midcycle Pain
If the pain is persistent, then these tests may be done to look for other causes of the pain.
- Pelvic exam.
- Abdominal ultrasound.
- Transvaginal pelvic ultrasound.
Treatment for Mittelschmerz or Ovulation Pain or Midcycle Pain
- For mild pain/discomfort of mittelschmerz, over-the-counter pain relievers such as acetaminophen, aspirin, ibuprofen or naproxen can be given.
- If the patient is experiencing mittelschmerz pain every month and it's causing significant discomfort, then a visit to the doctor is advised to discuss about other options such as taking oral contraceptives to prevent ovulation and thus preventing the mittelschmerz pain, as the pain occurs upon the release of the egg from the ovary.
- Lifestyle and Home Remedies can also help in relieving the pain and discomfort such as a long soak in a hot bath or applying a heating pad at the site of the pain. This will lead to increased blood circulation to that area and thus relaxes the tense muscles and alleviates cramping.