Mittelschmerz syndrome: symptoms, causes and treatment

It is estimated that 20% of women experience ovulation-related discomfort in the middle of the menstrual cycle. The pain is sharp but annoying, accompanied by expulsion of blood and slowing of the intestines.

This problem is called Mittelschmerz syndrome and, although in most cases it usually lasts less than two days and is not dangerous, it can be a sign that something is wrong with the ovaries.

Below, we will dig deeper into this syndrome, what are its main symptoms, what causes it, treatment, prevention, and when to be concerned.

    What is Mittelschmerz syndrome?

    Mittelschmerz syndrome, also called breakthrough pain, is one-sided pain in the lower abdomen associated with ovulation. The word “Mittelschmerz” comes from German and means “average disease”, with reference to the fact that occurs in the middle of your period, about two weeks after the previous one and two weeks before the next.

    Gynecologists believe that this syndrome manifests in 20% of women and usually manifests as pelvic pain and cramping that occurs during ovulation. These discomforts are directly associated with the release by the ovary of one of its eggs, a phenomenon that occurs in about half of the menstrual cycle.

    Although in most cases the pain is not strong enough to require medical help, if it occurs every month and is very severe, it could be a sign of a hormonal, infectious, or abdominal problem.


    Mittelschmerz syndrome usually manifests as abdominal discomfort which can last from a few minutes to a few hours, being normal between 6 and 8 hours, Although in some cases this may last a day or two. It is usually not serious or involves too much pain, although it is annoying. A woman may be suspected of having this syndrome if she experiences abdominal pain around 14 days after the start of her menstrual cycle.

    The pain usually occurs on one side of the lower abdomen, being dull and cramp-like. It can come on suddenly and suddenly, in addition to being accompanied by light vaginal bleeding and nausea.

    Pain appears next to the ovary which expels the egg during that particular menstrual cycle, which may change sides every month or there may be several consecutive months in which the painful side is the same.

    the causes

    Although the exact causes of Mittelschmerz syndrome are not known for sure, it is clear that it is linked to ovulation. Ovulation usually takes place two weeks after the first day of your period.

    It is during these 14 days that they occur a series of hormonal changes that stimulate the ovary to release its eggs. Each of these eggs develops in its own compartment, called a follicle. As the follicle grows, it stretches the surface of the ovary, causing pain.

    When the ovary is stimulated, its follicles swell, preparing to release the egg they harbor inside, a phenomenon that can cause some discomfort. Only one of these follicles, what we might call the dominant, he will eventually release his egg and deposit it in the fallopian tube.

    It is during this process that bleeding can occur due to the rupture of the ovarian follicle, pouring blood and fluid into the pelvis. These fluids irritate the lining of the abdomen and pelvis, areas sensitive to pain. In addition, this fluid can slow down the activity of the intestines, causing gas retention and abdominal discomfort.

    As we said, Mittelschmerz syndrome occurs in the middle of the menstrual cycle, therefore, any pain that occurs at another time in the cycle cannot be considered breakthrough pain.

    These discomforts can be normal menstrual cramps, i.e. dysmenorrhea, or be caused by other abdominal or pelvic problems not associated with the cycle, such as infection, indigestion, or drug poisoning. In all these cases, it is better to consult a gynecologist.


      Mittelschmerz syndrome has a relatively short duration. In many cases, it can last for around 8 hours at most, although its discomfort can interfere with the daily life of the affected woman. Fortunately, there are several inexpensive, homemade, and effective ways to reduce the pain of PTSD.

      One of the most common remedies is to apply heat to the abdomen, Either with a dressing soaked in hot water, or with a thermal pad. Another, also to be at home, is to apply light pressure or massage on the abdomen, relieving the distension produced by the accumulation of gases produced by slowing down intestinal activity. It is recommended to drink plenty of water.

      The other fastest and most effective way is to use drugs. On the one hand, we have the use of anti-inflammatory drugs, such as ibuprofen or naproxen sodium, which can reduce pain even if they have to be consumed on a full stomach. On the other hand, we have consumption of tablets for the expulsion of gas containing simethicone and, also, the use of infusions which help to evacuate gas, reducing intestinal pain by making the intestines less relaxed.


      Normal menstruation is not a pathology or a problem to be treated. It is a natural part of the life of any woman who has healthy ovaries and associated structures. Before pathologizing and eradicating the normal discomforts associated with this process it is best to learn strategies to be able to cope and manage the occasional pain of this process. It is not healthy to take medicine every month if the pain is relatively mild and you can continue to lead a normal life.

      However, any woman is free to decide whether she prefers to suffer from the symptoms of this syndrome briefly or prefers to avoid them, especially if they are very intense and prevent her from leading a normal life. The main preventive options for Mittelschmerz syndrome involve the consumption of hormonal contraceptives, contraceptive patches, and rings.. These treatments suppress ovulation and, with it, the irritation and pain associated with the rupture of the follicle.

      These measures should be recommended and monitored by a gynecologist because, like any other treatment, they involve side effects. It should be assessed whether the benefits of stopping Mittelschmerz syndrome outweigh any possible disadvantages associated with the mechanism of action or hormonal alterations of drugs and contraceptive interventions. Any decision assessed by the doctor must be taken with the primary objective of ensuring the well-being and good health of people with the syndrome.

      When to worry

      As we mentioned, Mittelschmerz syndrome is a relatively common and mild problem. However, if the discomfort is very severe and occurs very frequently with each menstrual cycle, it may be a sign that something is wrong. This can sometimes indicate that the ovaries have disease or that there is an infection in the pelvic floor.. Symptoms that can alert us that something is wrong are:

      • high fever
      • Pain that is not relieved by heat, massage, or medication
      • Pelvic pain that lasts more than two or three days
      • Heavy bleeding during ovulation
      • Vaginal discharge and pelvic pain together
      • increasing pain
      • Pain in the abdomen and in one or both shoulder blades
      • Vomiting blood
      • Stool with blood
      • dizziness
      • painful urination
      • Difficulty in breathing
      • Swelling or bloating

      If one or more of these symptoms appear, see a doctor immediately.. The symptoms presented here are not due to normal Mittelschmerz syndrome, but to a much more aggravated syndrome accompanied by other medical problems. Blood stools and vomiting are especially serious because they can indicate internal bleeding.

      Bibliographical references:

      • Stone C et al. (2011). Current diagnosis and treatment Emergency medicine. 7th ed. New York, New York: The McGraw-Hill Company.
      • He won HA, et al (2010). Optimal management of chronic cyclic pelvic pain: a pragmatic and evidence-based approach. International Journal of Women’s Health. 2: 263.

      Leave a Comment