ExitCare ImageMittelschmerz is lower abdominal pain that happens between menstrual periods. Mittelschmerz is a German word that means "middle pain." It may occur right before, during, or after ovulation. It is usually felt on either the right or left side, depending on which ovary is passing the egg.


Pain may be felt when:

  • There is irritation (inflammation) inside the abdomen. This is caused by the small amount of blood or fluid that may come from releasing the egg.

  • The covering of the ovary stretches.

  • Ovarian cysts develop.

  • You have endometriosis. This is when the uterine lining tissue grows outside of the uterus.

  • You have endometriomas. These are cysts that are formed by endometrial tissue.


Pain may be:

  • One-sided pain unless both ovaries are ovulating at the same time. If both ovaries are ovulating, there may be pain on both sides. This pain is often repeated every month. At times, there may be a month or two with no pain.

  • Dull, cramping, or sharp.

  • Short-lived or last up to 24 to 48 hours.

  • Felt with bowel movements, diarrhea, or intercourse.

  • Accompanied by a slight amount of vaginal bleeding.


  • Your caregiver will take a history and do a physical exam.

  • Blood tests and abdominal ultrasounds may be performed if the problem continues, becomes worse, or does not respond to the usual treatment.

  • A thin, lighted tube may be put into your abdomen (laparoscopy) to check for problems if the pain gets worse or does not go away.


Usually, no treatment is needed. If treatment is needed, it may include:

  • Taking over-the-counter pain relievers.

  • Taking birth control pills (oral contraceptives). This may be used to stop ovulation.

  • Medical or surgical treatment if you have endometriomas.

Together, you and your caregiver can decide which course of treatment is best for you.


  • Only take over-the-counter or prescription medicines for pain, discomfort, or fever as directed by your caregiver. Do not use aspirin. Aspirin may increase bleeding.

  • Write down when the pain comes in relation to your menstrual period. Write down how bad it is, if you have a fever with the pain, and how long it lasts.


  • Your pain increases and is not controlled with medicine.

  • Your pain is on both sides of your abdomen.

  • You develop vaginal bleeding (more than just spotting) with the pain.

  • You have a fever.

  • You develop nausea or vomiting.

  • You feel lightheaded or faint.


  • Understand these instructions.

  • Will watch your condition.

  • Will get help right away if you are not doing well or get worse.