Mittelschmerz
Encyclopedia
Mittelschmerz is a medical
term for "ovulation pain" or "midcycle pain". About 20% of women experience mittelschmerz, some every cycle, some intermittently.
. 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.
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.
The pain of mittelschmerz is sometimes mistaken for appendicitis
and is one of the differential diagnoses
for appendicitis in women of child-bearing age.
s) may be needed in cases of prolonged or intense pain.
Hormonal forms of contraception
can be taken to prevent ovulation -- and therefore ovulatory pain -- but otherwise there is no known prevention.
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.
may find mittelschmerz to be a helpful secondary sign in detecting ovulation. Because normal sperm life is up to five days, however, mittelschmerz alone does not provide sufficient advance warning to avoid pregnancy. Because other causes of minor abdominal pain are common, mittelschmerz alone also cannot be used to confirm the beginning of the post-ovulatory infertile period.
Medicine
Medicine is the science and art of healing. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness....
term for "ovulation pain" or "midcycle pain". About 20% of women experience mittelschmerz, some every cycle, some intermittently.
Symptoms and diagnosis
Mittelschmerz is characterized by lower abdominal and pelvic pain that occurs roughly midway through a woman's menstrual cycleMenstrual cycle
The menstrual cycle is the scientific term for the physiological changes that can occur in fertile women for the purpose of sexual reproduction. This article focuses on the human 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
Ovary
The ovary is an ovum-producing reproductive organ, often found in pairs as part of the vertebrate female reproductive system. Ovaries in anatomically female individuals are analogous to testes in anatomically male individuals, in that they are both gonads and endocrine glands.-Human anatomy: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.
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
Medical ultrasonography
Diagnostic sonography is an ultrasound-based diagnostic imaging technique used for visualizing subcutaneous body structures including tendons, muscles, joints, vessels and internal organs for possible pathology or lesions...
may be performed to rule out other causes of abdominal pain.
The pain of mittelschmerz is sometimes mistaken for appendicitis
Appendicitis
Appendicitis is a condition characterized by inflammation of the appendix. It is classified as a medical emergency and many cases require removal of the inflamed appendix, either by laparotomy or laparoscopy. Untreated, mortality is high, mainly because of the risk of rupture leading to...
and is one of the differential diagnoses
Differential diagnosis
A differential diagnosis is a systematic diagnostic method used to identify the presence of an entity where multiple alternatives are possible , and may also refer to any of the included candidate alternatives A differential diagnosis (sometimes abbreviated DDx, ddx, DD, D/Dx, or ΔΔ) is a...
for appendicitis in women of child-bearing age.
Treatment
The pain is not harmful and does not signify the presence of disease. No treatment is usually necessary. Pain relievers (analgesicAnalgesic
An analgesic is any member of the group of drugs used to relieve pain . The word analgesic derives from Greek an- and algos ....
s) may be needed in cases of prolonged or intense pain.
Hormonal forms of contraception
Hormonal contraception
Hormonal contraception refers to birth control methods that act on the endocrine system. Almost all methods are composed of steroid hormones, although in India one selective estrogen receptor modulator is marketed as a contraceptive. The original hormonal method—the combined oral contraceptive...
can be taken to prevent ovulation -- and therefore ovulatory pain -- but otherwise there is no known prevention.
Self Treatment for Mittelschmerz 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.
Causes
Mittelschmerz is believed to have a variety of causes:- Follicular swelling: The swelling of follicles in the ovaries prior to ovulationOvulationOvulation is the process in a female's menstrual cycle by which a mature ovarian follicle ruptures and discharges an ovum . Ovulation also occurs in the estrous cycle of other female mammals, which differs in many fundamental ways from the menstrual cycle...
. 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 tubeFallopian tubeThe Fallopian tubes, also known as oviducts, uterine tubes, and salpinges are two very fine tubes lined with ciliated epithelia, leading from the ovaries of female mammals into the uterus, via the utero-tubal junction...
s contract (similar to peristalsisPeristalsisPeristalsis is a radially symmetrical contraction and relaxation of muscles which propagates in a wave down the muscular tube, in an anterograde fashion. In humans, peristalsis is found in the contraction of smooth muscles to propel contents through the digestive tract. Earthworms use a similar...
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, bloodBloodBlood is a specialized bodily fluid in animals that delivers necessary substances such as nutrients and oxygen to the cells and transports metabolic waste products away from those same cells....
or other fluidBodily fluidBody fluid or bodily fluids are liquids originating from inside the bodies of living people. They include fluids that are excreted or secreted from the body as well as body water that normally is not.Body fluids include:-Body fluids and health:...
is released from the ruptured egg follicle. This fluid may cause irritation of the abdominal lining.
Usefulness
Women charting with some form of fertility awarenessFertility awareness
Fertility awareness refers to a set of practices used to determine the fertile and infertile phases of a woman's menstrual cycle. Fertility awareness methods may be used to avoid pregnancy, to achieve pregnancy, or as a way to monitor gynecological health....
may find mittelschmerz to be a helpful secondary sign in detecting ovulation. Because normal sperm life is up to five days, however, mittelschmerz alone does not provide sufficient advance warning to avoid pregnancy. Because other causes of minor abdominal pain are common, mittelschmerz alone also cannot be used to confirm the beginning of the post-ovulatory infertile period.
Other ovulation symptoms
Women may notice other physical symptoms associated with their mittelschmerz, or near ovulation. The most common sign is the appearance of fertile cervical mucus in the days leading up to ovulation. Cervical mucus is one of the primary signs used by various fertility awareness methods. Other symptoms are sometimes called secondary fertility signs to distinguish from the three primary signs.- Mid-cycle or ovulatory bleeding is thought to result from the sudden drop in estrogen that occurs just before ovulation. This drop in hormones can trigger withdrawal bleeding in the same way that switching from active to placebo birth control pills does. The rise in hormones that occurs after ovulation prevents such mid-cycle spotting from becoming as heavy or long lasting as a typical menstruation. Spotting is more common in longer cycles.
- A woman's vulvaVulvaThe vulva consists of the external genital organs of the female mammal. This article deals with the vulva of the human being, although the structures are similar for other mammals....
may swell just prior to ovulation, especially the side on which ovulation will occur.
- One of the groin lymph nodes (on the side on which ovulation will occur) will swell to about the size of a pea, and may become tender.