in this article:
In some women, ovulation is accompanied by the appearance of a mild abdominal or pelvic pain, called ‘mittelschmerz’, a medical term that means ‘middle pain’. Painful ovulation ovulation is the phase of the menstrual cycle that coincides with the release of ovule by the ovary. In most fertile women, except during pregnancy and lactation, ovulation occurs once a month without causing particular physical disturbances, but only general symptoms such as increased sexual desire or changes in the cervical mucus. About 20% of women experience, however, a painful ovulation, with episodic or usual occurrence, at each cycle.
What is mittelschmerz
The discomfort associated with mittelschmerz represents a common and harmless manifestation. In most cases, painful ovulation does not require medical attention. However, very intense pain may be symptomatic of other medical conditions, including endometriosis. For minor discomforts that may occur, they are often effective painkillers and some home remedies. If pain during ovulation is particularly annoying, your doctor may prescribe an oral contraceptive.
Ovulation occurs approximately 14 days before the next menstruation, from which the term mittelschmerz, which derives from the German words ‘medium’ and ‘pain’. In this regard, we recall that the phase of variable duration is primarily the first of the menstrual cycle, while the second (from ovulation at the beginning of menstruation) is rather constant.
Some women have a constant painful ovulation (every month), while others only occasionally. Painful manifestations differ from menstrual cramps and it is easy to distinguish them for a number of characteristic symptoms.
Mittelschmerz occurs with the appearance of pain in the lower abdomen or pelvis, in central or lateral position. The pain can be located on one side of the abdomen, to go to the opposite side during the next cycle, or it may be felt on the same side for several months in succession. Its location, in fact, depends on which ovary is releasing the egg cell. In this sense, it would be useful to keep track of menstrual cycles for several months, noting the period when low back pains and their features occur. Pain may appear suddenly and disappear within a few hours, though sometimes it may last one or two days. In some rare cases, the symptoms may last up to the next cycle.
In the case of painful ovulation, the symptoms may vary from person to person: you may feel a generalized heaviness, a few hours of pressure or mild fever, or acute pain with cramps of intensity equal to or greater than those which are experienced during menstrual flow. Pain can be accompanied by mild spotting or vaginal discharge. Some women may also experience nausea. In most cases, mittelschmerz does not require any medical intervention. However, it is advisable to contact a specialist if pelvic pain becomes severe or if the symptoms are particularly intense and persistent as some of these signs may also indicate more severe conditions such as pelvic inflammatory disease or ectopic pregnancy.
Women may notice other physical symptoms during or near ovulation. The most common sign is the appearance of cervical mucus in the days preceding ovulation, fundamental to natural methods of fertility recognition.
How long does mittelschmerz last?
In a normal 28-day menstrual cycle, ovulatory pain occurs approximately after 2 weeks from the beginning of menstruation and coincides with the ripening of the mature ovarian follicle and subsequent release of the egg cell. The disorder is typically unilateral, located in the lower abdomen on the right or left side, depending on which ovary is releasing an egg cell. The pain associated with ovulation may vary from a mild sting to the side of a severe discomfort. The duration extends from a few minutes to a few hours, but sometimes it may persist for a day or two. In some cases, slight bleeding may occur along with the symptoms.
Pain may occur before, during or after ovulation.
The exact cause is unknown, but there are several plausible explanations for the onset of the disorder:
- Inflammation of the follicles inside the ovaries: just before the actual ovulation, the growth of the mature follicle that contains the diluted egg cell and extends the surface of the ovary, causing pain.
- Ovarian wall breakage: with ovulation, oocyte is released by the follicle through the tear wall. For some women, this process can make painful ovulation.
- Abdominal irritation: When an egg cell develops in the ovaries, it is surrounded by follicular fluid. At the time of ovulation, at the break of the mature follicle containing the oocyte, the fluid, together with a small amount of blood, is released from the ovaries and can irritate the abdominal cavity (peritoneum). This can trigger pain that disappears once the liquid is absorbed.
- Cramps of smooth muscle cells: during ovulation, pain can be related to the contraction of smooth muscle cells in the ovary and its ligaments. These contractions occur in response to increased levels of prostaglandin F2-alpha and luteinizing hormone (LH).
- Fallopian tube contraction: after ovulation, fallopian tubes may contract (similar to peristalsis of the esophagus), causing pain in some women.
- The pain that occurs at any other time of the menstrual cycle does not match the mittelschmerz. However, it may be due to dysmenorrhea (e.g. menstrual cramps) if it occurs near menstruation, or may be due to other abdominal problems or pelvic area. If during the ovulation or at any other time of the cycle, the pain is very intense, it is advisable to consult a doctor.
Underlying health problems
Ovulation occurs about two weeks after the first day of each menstrual cycle, so the characteristic period in which the pain arises makes mittelschmerz easy to recognize. To help determine whether pain is associated with ovulation, the physician may require the patient to track menstrual cycles, noting any painful episodes and their location (ovulation pain usually occurs on one side of the lower abdomen). The physician can also perform a pelvic examination to help exclude other possible causes of pain, such as endometriosis or ovarian cyst. If the pain is severe and there are some irregularities in the physical examination, further investigations may be made to determine the cause of pelvic pain or abdominal pain.
In most cases, manifestations associated with ovulation are harmless and do not indicate the presence of a disease.
However, a severe and persistent pain located in the lower abdomen or pelvic region may be symptomatic of various medical conditions, including:
- Salpingitis – inflammatory process of fallopian tubes following an infection.
- Pelvic inflammatory disease – represents the outcome of an infection that is often responsible for sexually transmitted pathogens (e.g.: gonorrhea, chlamydia) or bacteria normally present in the vagina. Symptoms of pelvic inflammatory disease include fever, low back pain, and high concentration of white blood cells.
- Endometriosis – consists of the development of endometrial tissue outside the uterus, in an abnormal location. Abdominal pain, bleeding, compression on adjacent structures and infertility are the most common symptoms.
- Ovarian cysts – consists of an anomaly collection of liquid, surrounded by a very thin wall, which develops within an ovary. Symptoms may include bleeding and pain.
- Ectopic pregnancy – is defined when a pregnancy develops outside the uterus, most commonly in one of Fallopian tubes. Symptoms include cramping, abdominal pain and vaginal bleeding.
- Appendices – inflammation of the appendix. Sometimes it can be confused with the pain associated with ovulation. Look for immediate medical attention if the pain is intense and located in the lower right part of the abdomen (may be associated with loss of appetite, nausea or vomiting).
- Other gastrointestinal problems – Lower abdominal pain may be symptomatic of a variety of gastrointestinal problems including perforated ulcer, gastroenteritis, and inflammatory bowel disease.
In most cases, you do not need to consult a doctor in case of painful ovulation. However, if the pain is particularly annoying, it lasts more than three days or is associated with other unusual symptoms, it is possible to assure – through medical examinations – that the disorder is not caused by other problems and, in case, evaluate the treatment options.
The diagnosis of mittelschmerz is based on exclusion (i.e. the physician must ensure that no other pathological conditions exist) and is generally confirmed if the results of the tests are normal, the pelvic examination does not show anomalies and if the patient is in the middle of the cycle. If pain is persistent and / or severe, other diagnostic procedures such as abdominal ultrasound can be performed to exclude other causes of pelvic pain. The mittelschmerz pain is sometimes confused with the appendix and one of the differential diagnoses provides for the findings of this condition (in women of childbearing age).
Exams that help determine whether the pain associated with ovulation is harmless or caused by an infection or illness may include: history (collection of information about patient symptoms, possible health problems, medicines and dietary supplements that is taking, etc.); physical examination, including a pelvic examination; blood tests; cervical cultures; abdominal ultrasound; transvaginal pelvic ultrasound; laparoscopic exploration of the abdomen.
Mittelschmerz treatment and remedies
Ovulatory pain usually resolves spontaneously in about 24-48 hours, so no specific treatment is required. If the pain associated with ovulation is constant, occurs every month and is particularly annoying, it is possible, at the advice of your doctor, to seek relief by taking contraceptive pill or other forms of hormonal contraception. Oral contraceptives modify the female hormone cycle by preventing ovulation, so they can be used to prevent ovulatory pain. In cases of prolonged or intense pain, painkillers such as naproxen, paracetamol or ibuprofen can be used, generally effective in alleviating the discomfort associated with painful ovulation.
In addition, some simple remedies allow you to get relief from the symptoms. These include the application of a hot water bag on the side of the abdomen in which pain occurs, or a bath to help alleviate the discomfort: heat increases blood flow, relaxes the muscles thinning and relieves Cramps. During ovulation, it may be useful to avoid yeast and dairy foods.
About one in five women experience pain during ovulation, which can last from just a few minutes to 48 hours. Pelvic or abdominal pain that occurs in the middle of the cycle is usually harmless, but sometimes it may indicate an underlying condition such as endometriosis. Consult your doctor if ovulatory pain persists for more than three days or is associated with other unusual menstrual symptoms such as severe bleeding. Mittelschmerz can be painful, but it is not a sign of illness. Some women, in fact, experience painful ovulation as an advantage to planning or trying to avoid a pregnancy.