Mittelschmerz

Mittelschmerz, from the German term for “middle pain,” refers to mid‑cycle abdominal discomfort associated with ovulation in some women. It typically occurs around the time of ovulation, roughly in the middle of the menstrual cycle, and is usually felt on one side of the lower abdomen.

The pain is caused by the process of the ovarian follicle rupturing to release an egg, with minor irritation from follicular fluid or small amounts of bleeding into the peritoneal cavity. Symptoms vary and can include sharp or cramping lower abdominal pain that lasts from a few minutes to one or two days. Some individuals may experience mild vaginal spotting, nausea, or back or groin discomfort. Mittelschmerz is self‑limited and not typically accompanied by fever or systemic symptoms.

Diagnosis is clinical and based on timing with ovulation and the absence of alternative explanations. A pregnancy test is commonly performed to rule out pregnancy-related causes. If symptoms are unusual, persistent, or severe, or if there is concern for conditions such as ectopic pregnancy, ovarian torsion, or pelvic inflammatory disease, further evaluation, including pelvic examination or imaging, may be warranted. It is a diagnosis of exclusion when other conditions have been ruled out.

Management focuses on symptom relief and reassurance. Over‑the‑counter nonsteroidal anti‑inflammatory drugs or acetaminophen can ease pain; heat or rest may help. In some cases, recurrent or bothersome Mittelschmerz may be managed with hormonal contraceptives that suppress ovulation. Although uncomfortable, it does not typically indicate a serious underlying disease and does not imply infertility. Seek medical care for sudden, severe, persistent pain, fever, vomiting, fainting, or signs of pregnancy.