Painful Ovulation (Mittelschmerz)

Pain while ovulating can cause symptoms like lower back pain that can last from a few hours to 2-3 days.

• Mittelschmerz (pronounced MITT-ul-shmurz) is a German word that means middle pain.
• Mittelschmerz is also referred to as painful ovulation.
• This pelvic pain occurs during ovulation -- the midpoint of a woman's menstrual cycle, about two weeks before a period may begin.
• The discomfort can appear on either side of the lower abdomen depending on which ovary is producing the ovum (egg).
• Pain can be on one side of the abdomen for one month and switch to the opposite side during the following cycle.
• About 20% of women experience this type of mid-cycle pain.
• Most of the time, it is a mild annoyance. In rare instances, it can be unbearable.

Causes of painful ovulation include:

• When the egg is released: Just before the follicle ruptures and an egg is released by the ovary, it stretches the membrane covering the ovary. The follicular stretching results in symptoms like pelvic pressure and pain. The fluid from the follicle and blood is released when the egg is released from the ovary may cause discomfort.
• Infections
• Endometriosis

In severe cases, the pain may be mistaken for appendicitis.

• Many women do not have any discomfort during ovulation.
• The severity of the pain and location of it varies for each woman.

The pain associated with ovulation may take on various forms:

• Pain occurs on one side of the lower abdomen (can be either side).
• Pain occurs midway between menstrual periods (during ovulation).
• Pain can occur every month.

• Some women may have few symptoms of ovulation pain, however; other women feel symptoms such as mild pressure or twinge that lasts a few minutes to a few hours.
• The pain of ovulation lasts anywhere from a few hours to 2-3 days.
• Rarely, the pain is intense and can last for days.

Women with ovulation pain rarely need to go to a hospital's emergency department, but some serious medical conditions such as appendicitis and ectopic pregnancy (tubal pregnancy) can mimic the pain of ovulation. A woman should go to the emergency department if it is possible one of these conditions is causing the pain.

• Appendicitis causes abdominal pain in the lower right side along with loss of appetite, nausea, and/or vomiting.
• An ectopic pregnancy is a pregnancy that most commonly develops in the Fallopian tube instead of the uterus. This might be the cause of the pain if the woman thinks she might be pregnant or if her last menstrual period was irregular.

A woman should call her doctor if mid-cycle pain lasts longer than 3 days.

No specific test can determine if a woman has mittelschmerz pain. It is a diagnosis of exclusion - meaning the doctor will order tests to make sure no other medical problems exist. The diagnosis of mittelschmerz is confirmed if the test results are normal and the pain is typical for premenstrual pain. The doctor may ask the woman to keep a diary of her menstrual cycles to determine if the pain actually occurs at mid-cycle.

• If a woman with ovulation pain and is not taking anti-inflammatory medications, her doctor may suggest over-the-counter (OTC) pain relievers or prescribe an anti-inflammatory drug. 
• If painful ovulation is severe and occurs every month, some forms of birth control may help.
• Birth control such as oral contraceptive pills (OCPs) that prevent ovulation from taking place can stop the pain from occurring.
• Birth control pills need a doctor's prescription.

• The best way to relieve midcycle pain is to take a non-prescription non-steroidal anti-inflammatory medication (NSAIDs), for example, Ibuprofen (Advil), naproxen (Aleve, Naprosyn), and ketoprofen (Orudis), moreover; these medications are effective at blocking the effects of prostaglandins.
• Pain medications can be continued as long as needed. If one type does not relieve the pain, try another because these medications vary among individuals in their effectiveness.
• Anti-inflammatory medicine can be harsh on the stomach. If there is a history of kidney or stomach problems (such as ulcers or reflux), consult with your doctor before taking this type of medication.
• Taking pain medication pills with meals may help prevent an upset stomach.

If anti-inflammatory medicine is not an option or if additional relief is needed, a heating pad applied to the pelvic area may relieve pain.