Hormones Matter TM

Mittelschmerz – what should you know

February 29, 2012  |  Sergei Avdiushko, PhD

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Have you ever experienced severe midcycle pain? Does pain and cramping seem to occur during ovulation? What you are experiencing may be Mittelschmerz (German: “middle pain”) which is a medical term for “ovulation pain” or “midcycle pain”.  About 20% of women experience mittelschmerz, some every cycle, some intermittently.

Mittelschmerz is characterized by lower abdominal and pelvic pain that occurs roughly midway through a woman’s menstrual cycle. The pain can appear suddenly and usually subsides within hours, although it may sometimes last two or three days. 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 two ovaries provided the egg in a given month. 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.

Mittelschmerz is believed to have a variety of causes:

Follicular swelling: The swelling of follicles in the ovaries prior to ovulation. While only one or two eggs mature to the point of being released, a number of follicles grows during the follicular phase of the menstrual cycle (non-dominant follicles atrophy prior to ovulation). Because follicles develop on both sides, this theory explains mittelschmerz that occurs simultaneously on both sides of the abdomen.

Ovarian wall rupture: The ovaries have no openings; at ovulation the egg breaks through the ovary’s wall. This may make ovulation itself painful for some women.

Fallopian tube contraction: After ovulation, the fallopian tubes contract (similar to peristalsis of the esophagus), which may cause pain in some women.

Smooth muscle cell contraction: At ovulation, this pain may be related to smooth muscle cell contraction in the ovary as well as in its ligaments. These contractions occur in response to an increased level of prostaglandin F2-alpha, itself mediated by the surge of luteinizing hormone (LH).

Irritation: At the time of ovulation, blood or other fluid is released from the ruptured egg follicle. This fluid may cause irritation of the abdominal lining.

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 abdominal ultrasound may be performed to rule out other causes of abdominal pain.

Self treatment is often the best way to alleviate cramps that you experience mid-cycle. Here are some tried and tested ways of getting rid of those aches and pains.

Drink Water: Try to drink between six and eight glasses of water every day. Water will help to keep you hydrated, which will alleviate cramps.

Use a Heating Pad: Heat helps to soothe cramps. Get an electric heating pad and keep it on your abdomen for 15 minutes or so.

Take a Warm Bath: Fill your tub up with warm water and just relax. The heat of the water will help to relieve any pain.