Mittelschmerz Syndrome: Symptoms, Causes, and Treatment

Mittelschmerz syndrome is characterized by lateralized lower abdominal pain that coincides with ovulation. Learn more.

Written and verified by the doctor Diego Pereira.

Last update: 28 March, 2023

Mittelschmerz syndrome is nothing more than the presence of intermenstrual pain associated with ovulation. This is usually mild and transient, so it doesn’t require treatment in most cases. However, in people with an atypical clinical course, it may even require the use of contraceptive drugs. We’ll tell you more about it below.

What is Mittelschmerz syndrome?

The name comes from the German word Mittelschmerz, which means “pain in the middle”. It’s a set of signs and symptoms characterized by moderate pain affecting the lower abdomen. Sometimes it can be on the right side and sometimes on the left.

This sensation appears just between two menstrual cycles, a time that coincides with ovulation. Ovulation is the process through which an egg is released from the corresponding ovarian follicle. For this reason, it’s also known as intermenstrual pain.

Symptoms

According to a Mayo Clinic publication, Mittelschmerz syndrome is characterized by sudden onset pain located in the lower abdomen. It’s felt on the side (right or left) that coincides with ovulation. Therefore, the location may vary with each episode. Also characteristic is the presence of vaginal discharge of moderate quantity and sometimes accompanied by scanty bleeding.

Causes

Anatomical and physiological changes that accompany the ovulation process best explain Mittelschmerz syndrome. Some of the following factors that may influence its occurrence are as follows:

• Stretching of the ovarian surface while rupture of the corresponding follicle occurs.
• Irritation of the nerve fibers of the peritoneum due to the release of blood during ovulation.

However, both statements are possible theories considering that the process is almost certainly associated with ovulation.

Treatment

There are different treatment modalities, according to the severity of the symptoms. If the symptoms are mild and are only described as discomfort, in general, no drugs are required. If the pain is more intense and interferes with daily activities, the use of over-the-counter anti-inflammatory drugs (such as ibuprofen) can help control the symptoms.

However, in a small proportion of women, the pain can become very uncomfortable and uncontrollable. In such a case, a medical consultation is necessary to evaluate the use of drugs that intervene in the ovulation process, such as oral contraceptives (OCPs). Of course, this is a measure related to the appearance of several adverse effects, besides being an excellent method of birth control. The advantages and disadvantages need to be carefully weighed.

Can it be prevented?

The onset of pain can be completely random. Many people report feeling it sporadically, so there’s no element to warn of the discomfort. For this reason, it’s difficult to prevent it. For example, the use of OCPs can prevent ovulation and thus prevent the onset of pain. However, it’s not a measure that’s used from the outset in all affected women.

When to be concerned

While any intermenstrual pain with the above characteristics may be associated with Mittelschmerz syndrome, sometimes there may be a condition that’s more serious than it appears. For example, major diseases such as appendicitis, pelvic inflammatory disease, and ectopic pregnancies may be mistaken for intermenstrual pain. For this reason, it’s important to monitor the pain and be alert to any of the following symptoms:

• Fever (temperature greater than 101 °F), with or without chills
• Heavy vaginal discharge
• Pallor of the skin
• Loss of appetite
• Nausea or diarrhea

In case of severe symptoms, seek medical attention

Mittelschmerz syndrome isn’t necessarily experienced during a woman’s entire fertile life, as many women report feeling it sporadically. In fact, the duration is only a few minutes or a few hours, while the intensity is variable. For this reason, no treatment is usually required, although an anti-inflammatory or ibuprofen may be used if the pain sensation is intense.

On the other hand, if symptoms appear that could be associated with a potentially more serious condition, it’s important to see a doctor as soon as possible. This will help to determine what it is and to treat it accordingly.