Ask the Expert: Mittelschmerz – Pain between periods

What is it?

Severe midcycle pain and/or cramping during ovulation.  Ovulation usually occurs about 2 weeks after the 1st day of your last period.  Mittelschmerz occurs during ovulation when an egg is released by the ovaries into the fallopian tube.  For about 20% of women this causes severe pain and cramps on one side of the lower abdomen.  Although the pain may feel like something serious is wrong, midcycle pain or cramps – Mittelschmerz is rarely serious.

Some women feel pain in the abdomen or pelvis.  Some women don’t feel anything when an egg is being released from an ovary.  Other women may feel discomfort or pain off and on or constantly.

You may feel pain in the pelvis that can range from a sense of discomfort or a mild twinge to severe pain the mimics appendicitis.  It usually lasts a short period of time, from a few minutes to hours.  It often is felt in the lower abdomen or pelvis, either in the middle or on one side.  If the pain is severe, you may even have nausea.

How is it diagnosed?

It is usually easy to recognize because its timing is so characteristic.  Your health care provider will be able to determine that you are experiencing pain from ovulation based on your menstrual cycle, the location and description of your pain, and the results of an abdominal and pelvic exam.  It is important to let your health care provider know about any other symptoms, such as fever, vomiting, changes in urination or changes in your bowel movements or appetite.

Additional blood tests, X-rays, a pelvic ultrasound or a CT scan may be necessary if your pain is severe or if your health care provider notices any unusual findings on your physical exam, such as a very tender abdomen or pelvis or an enlarged ovary.

How do I take care of myself?

  • Rest.
  • Drink at least 8 glasses of water a day.
  • Use a heating pad (try making a homemade tube sock heating pad), or take warm baths to ease the pain.
  • Use over-the-counter anti-inflammatory drugs such as acetaminophen, Advil, or Aleve.
  • Check your temperature several times a day to be sure you are not developing an infection.
  • Call your health care provider if the pain is severe and these self-help tips do not ease your midcycle pain.

If you experience midcycle ovulation pain that lasts longer than 2 or 3 days, experience heavy bleeding, or have any unusual vaginal discharge call your health care provider.  The longer episodes of pain may be due to lingering irritation from a small amount of bleeding, which sometimes happens when the egg is released.

What are the signs I might need emergency care?

  • Vomiting blood.
  • Blood in the stool.
  • Increased pain.
  • Faintness or dizziness.
  • High fever.
  • Difficult or painful urination.
  • Swollen abdomen.
  • Difficulty breathing.

How do I prevent it?

It usually is not necessary to prevent this mild, short-lived pain syndrome.  Birth control pills prevent ovulation and can be used to prevent mid-cycle pain.

What is the treatment?

Painful ovulation is generally brief, so using medication for pain relief usually is not necessary, other than over-the-counter pain medicines.

What is the prognosis?

Pain during ovulation does not have any dangerous consequences.

Ask the Expert

Diana Jones, RNC, MSN, WHNP

Women’s Health Nurse Practitioner

BSU Women’s Center

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