Mittelschmerz (Painful Ovulation)

What is Mittelschmerz?

            Mittelschmerz is the medical term for painful ovulation or midcycle pain.1 The term Mittelschmerz comes from the German words for “middle” and “pain.” In the middle of the menstrual cycle, the ovaries produce an egg, or ova, which causes some females discomfort. Approximately 20% of women have experienced at one time or another painful symptoms during the time of ovulation.2 Although it may be painful, it is not a serious medical condition and does not indicate an underlying medical problem.


What does Mittelschmerz feel like?

            Pain from Mittelschmerz is felt in the pelvic and lower abdomen region. Symptoms range from mild to severe, and women may not experience discomfort every menstrual cycle. Symptoms are often reported as resembling those experienced during menstruation. Mittelschmerz may occur as acute, localized pain felt on only one side of the pelvic region or experienced as overall mild pelvic discomfort.3 Only one ovary produces an egg per cycle, so the pain may also switch from one side of the abdomen to the other.


What causes Mittelschmerz?

           The cause of Mittelschmerz is not yet definitively known. However, the following are several theories that explain the aches during ovulation:4

  • Swelling of ovarian follicles: Follicles inside the ovaries are responsible for developing ova. Before ovulation, the follicles swell as a number of eggs develop, although only one dominant ovum from one ovary will be released. The swelling of follicles within both ovaries may be an explaining factor for women who suffer from Mittelschmerz on both pelvic sides.
  • Ovarian wall rupture: During ovulation, a matured egg is pushed through the wall of the ovary. Since there is no open pathway for an egg to follow, the process of an egg breaking through the ovary wall may be produce pain in some women.
  • Irritation: Blood and other bodily fluids are also discharged from a follicle when a developed egg is released, which may irritate the abdominal lining and cause pain.
  • Smooth muscle contraction: The process of ovulation requires the smooth muscles of the reproductive organs to contract. Muscle cells within and surrounding the ovary contract and can provoke discomfort in women.
  • Contraction of the fallopian tube: The released ovum is then caught by the fimbria, the fingerlike projections of the fallopian tube. The fallopian tube then contracts to continue the menstrual cycle, which may cause pain in some women.

Check out our article that overviews the female reproductive system to become familiar with the female anatomy.


How is Mittelschmerz Diagnosed and Treated?

            A physician can diagnose Mittelschmerz if a woman has the corresponding symptoms of midcycle pain and a healthy pelvic exam is established. A pelvic exam and abdominal ultrasound can eliminate the possibility that the pain is due to any pelvic abnormalities (such as appendicitis).5 If diagnosed with Mittelschmerz, keep in mind that painful ovulation is not a serious medical condition and does not indicate an underlying medical problem.

            To treat Mittelschmerz, over-the-counter pain-killers (such as Advil, Tylenol, or Aleve) may be taken to reduce pain that lasts for an extended amount of time.6 Some forms of hormonal contraceptives, such as combination birth control pills, prevent pregnancy by inhibiting ovulation. By preventing ovulation, the hormonal contraceptives can reduce the distress aroused by Mittelschmerz.


Mittelschmerz as a sign of fertility:

            Mittelschmerz may be a midcycle nuisance, but many women utilize the symptoms as a fertility sign. Mittelschmerz occurs either right before, during, or after ovulation. When a woman experiences the lower abdominal pain, she is signaled that her body is ovulating. Ovulation is the time a woman is most likely to become pregnant, and her Mittelschmerz indicates she is at highest chance of pregnancy. Therefore, women who experience painful ovulation may be at advantage of becoming pregnant or avoiding pregnancy.7


Further Remarks:

            There are other bodily signs besides Mittelschmerz that indicate if a female is close to ovulation or currently ovulating. Discretion of clear, sticky cervical mucus by the vagina is one of the most common signs that a woman is ovulating. Our articles on fertility awareness methods such as the BBT, the Calendar Method, and Cervical Mucus Method go into greater detail of what signs to look for when predicting the ovulation phase of the menstrual cycle.



5-6Mayo Clinic. (11 June 2011). Mittelschmerz. Mayo Foundation for Medical Education

and Research. Retrieved from

1-3,7PubMed Health. (2 June 2011). Mittelschmerz. U.S. National Library of Medicine.

Retrieved from

4Weschler, Toni (2002). Taking Charge of Your Fertility (Revised ed.). New York:

HarperCollins. pp. 65–68, 228. ISBN 0-06-093764-5.


Last Updated: 5 February 2013