Mittelschmerz – Ovulation Pain and Cramping – OH! The Pain!

Ovulation Pain - Mittelschmerz
Most women are fully aware that their period can come with pain and cramping, but what about the cramping (mittelschmerz)  that occurs during the middle of your cycle, around the time of ovulation?

About 1 in 5 women will experience ovulation related cramping, mittelschmerz, about two weeks before their period is due to start. For most women, this condition is associated with a sharp pain that diminishes into a dull ache.


Mittelschmerz – What It Means

The word, mittelschmerz, is German in origin and literally means:

Mittle = Middle or Medium
Schmerz = Pain

It is a very accurate description of what is going on for some women – pain in the middle of your menstrual cycle.


What is Mittelschmerz and What Causes It

Mittelschmerz is pain or cramping, either dull or sharp, that you feel around the time you ovulate.

The exact cause of ovulation related cramping and pain isn’t fully known. One theory is the growth follicle may cause the stretching of the ovary causes the pain. Alternatively, people assumed that you feel the pain when ovulation actually occurs and your egg breaks out of the follicle.  Minor leakage of blood from the ovary during ovulation might cause mittelschmerz to occur.  It is believed that when it does leak, it irritates the abdominal wall or nearby nerves and causes the painful ovulation. Depending upon your unique pain threshold and the amount of blood that does leak, mittelschmerz might affect you differently than others.

The University of Melbourne conducted a study that presented another possible cause of the ovulation pain. The research suggests that the majority women feel the pain before they actually ovulate. The pain seems to be associated with the the lutenizing hormone (LH) peaking and causing ovarian muscle to contract.


Recognizing Mittelschmerz (Ovulation Related Cramping)

  • Timing – If you are going to feel mittelschmerz, it will typically happen about 14 days before your period is due to arrive. This pain may last for a couple of hours or as long as a couple of days.
  • Location – Ovulation cramping is usually felt on one side of your body, near the hip bone. If you have ovulation pain every month, the side may vary depending on which ovary is releasing the egg that month.
  • What it Feels Like: The way women feel the pain varies. It could feel like uncomfortable pressure, twinges, sharp pains or cramps. If you are feeling cramps, they will feel different from menstrual cramps. This is because the location the cramping is different. When you have period cramps, your whole uterus is a player in the pain, but where mittelschmerz is concerned, the cramping will be located off to one side, where the ovary is located.


Mittelschmerz as an Ovulation Sign

If you are actively trying to get pregnant, you know that the best time to get pregnant is around when you ovulate. Besides the normal signs of fertility, like egg white cervical mucus, mittelschmerz is a major ovulation indicator. If the pain isn’t too bad, you might want to let your significant other know what is going on. Timing wise, now would be the best time to have sex if you are trying to get pregnant.



What Can I Do to Relieve Ovulation Pain?

No specific treatment is usually required for ovulation pain as this only occurs for a short time. If it isn’t over quickly, and the pain lingers,  there are ways to make this time of your monthly cycle much easier. Take plenty of time to rest until the pain is gone, taking warm (not hot) baths to feel relaxed, and drink plenty of fluids to keep you properly hydrated.  You can try anything that you usually use when you have period cramps.

For women with severe ovulation pain, over-the-counter pain relievers, like ibuprofen or aspirin, and a heating pad applied over the abdomen will usually provide relief from the pain. You can also try pain relievers that are marketed for menstrual pain such as Midol.

However, if the pain becomes severe and intolerable and pregnancy is not something you want to achieve for now, then oral contraceptives can be prescribed by a physician.  This can help stop ovulation and the resulting monthly mid cycle pain.



When Should I Be Concerned?

For most women, ovulation pain and cramping is not a sign of a serious problem.
There are a number of things that can cause ovulation pain. It could be caused by the ovary cramping, or a ruptured or emerging follicle.   If the cause of the pain was the follicle rupturing, you may end up seeing a bit of ovulation bleeding.



When to Contact Your Doctor


  • If you are super concerned about the pain. Seriously, doctors are there to support you. If you are concerned, get checked out.
  • Pain is lasting longer than 24 – 48 hours.
  • You are in so much pain that it is impossible to cope.
  • If spotting is too heavy to qualify as spotting.
  • Having sex causes too much pain to bear.

Endometriosis, ovarian cysts, or even appendicitis can also cause ovulation pain.  If you have pain every month during ovulation, you should talk to your doctor. It may be indicative of another medical problem, which can often be treated. Your doctor can do an exam, use blood tests, ultrasounds and more to help diagnose what exactly is going on.

Talking to your doctor will help get to the root cause of the cramping around the time you ovulate.   If there is a fertility related condition going on,  your doctor will have the necessary tools to address it.

Ovulation Spotting

Some women who are trying to get pregnant are lucky, in some ways. They have a regular cycle of exactly 28 (or maybe 25, or maybe 30) days, and so they can easily enough predict when they’re ovulating. Other women never really know when they’re going to be fertile because their cycle is irregular, and so they have to rely on other signs. Some of the most common and most reliable methods of tracking ovulation are basal body temperature and cervical mucus charting, but in some cases a woman may experience consistent ovulation spotting that can help her know when the time is right.

First, you need to understand a little something about ovulation. Ovulation is the release of a mature egg by the ovaries. The egg travels into the fallopian tube, where it can be fertilized. Ovulation takes place sometime between day 11 and day 21 of their cycle. Most women ovulate every month, but some may occasional experience anovulation (missed ovulation) from time to time, for a variety of reasons.

Sometimes a woman will experience “mittelschmerz,” which literally means “middle pain.” This is pain in the ovarian region and occurs during ovulation. If you’re a woman who typically experiences this, you might be able to help predict ovulation.

Some women will have a little bit of bleeding around this time, as well. Ovulation spotting is usually brown or pink in color. It will often be mixed along with cervical mucus. If it’s more than just a little bit of spotting, however, it’s probably not indicative of ovulation.

Ovulation spotting is most likely caused by the hormones that work with the follicle. These hormones cause the surface of the follicle to weaken, which can create a hole. This is what allows the egg to pass. In some cases, this also causes light bleeding. Other experts believe that the bleeding can be caused by a rise in estrogen that happens during ovulation.

You may not have ovulation spotting every month. It may only happen occasionally. For some women, it’s like clockwork. If yours is consistent, charting it and comparing it to basal body temperature and cervical mucus can help you get a better handle on knowing when you ovulate.

How Long Will I Ovulate?

On the average, a woman will ovulate for about one day each month during her menstrual cycle.  For some women, this may be slightly shorter or longer, but the average amount of time that you will ovulate will be right around one day.  Having said that, it is important to understand how exactly ovulation works, in relation to conception.  The fact of the matter is that, while you will only ovulate for about 24 hours, the period of time that you are actually fertile is more like 5 or 6 days.

After sexual intercourse, once the sperm are in a woman’s body, they can survive for as many as five days afterwards.  This means that, while you may not actually ovulate until perhaps around the 14th day of your menstrual cycle, you can become pregnant from sexual intercourse that occurs any time after the 9th day of your menstrual cycle.  When you add these 5 days to the actual day that you ovulate, you are looking at roughly six days each month when it would be possible for you to conceive.  For this reason, it is important not only to understand how long you do ovulate, but also how to know when you ovulate.

There are several ways you might be able to use to know when you are ovulating.  Many women have had success knowing when they ovulate by tracking changes to the cervical mucus produced during the various parts of their monthly cycle.  Other women have been able to figure out when they ovulate by using their Basal Body Temperature, and tracking the increase in Basal Body Temperature that typically occurs right after ovulation.  In addition to these methods, there are Ovulation Predictor Kits available for purchase that may also help you to know when exactly it is that you ovulate.

Knowing when and how long you ovulate can be useful.  If you are trying to conceive, for example, you greatly increase your chances of becoming pregnant if you time intercourse just before you start to ovulate.  Some couples, who prefer natural methods of birth control such as the rhythm method, may also benefit from knowing exactly when the woman is going to be ovulating.

Can You Still Conceive With High FSH Levels?

Technically speaking, it is possible that you can still conceive with high FSH levels. High FSH levels do not automatically mean that you are guaranteed to have problems with fertility. Having said that, the statistics tell us that only 1 out of every 100 women with high FSH levels will be able to conceive without some sort of fertility interventions. In many cases, the only fertility treatment that will be effective for the woman who is trying to conceive with high FSH levels will be In Vitro Fertilization (IVF) utilizing donor eggs.

To understand the relationship between trying to conceive and high FSH levels, it is important to first understand exactly what FSH is, what it does, and what high FSH levels indicate. FSH stands for follicle stimulating hormone. This hormone is produced in both men and women by the pituitary gland. FSH helps to spur the growth of eggs in women and the growth of sperm in men. High FSH levels in women typically indicate that there is some sort of a problem with the quality or the number of eggs that she has, also known as her ovarian reserve.

If you are having trouble conceiving, FSH levels are one of the first things that your health care provider will likely look at. Along with the man’s sperm count and a test to check to see if the fallopian tubes are blocked, the FSH test is a key component of an initial fertility workup. The FSH test is taken on day 3 of your menstrual cycle. A level of 10 or lower is normal. A level of 25 on your FSH test is elevated, and indicates that you will have problems trying to conceive. A FSH level between 10 and 25 is considered borderline, and you may still be able to conceive.

The odds of still conceiving with high FSH levels can be rather discouraging. However, some women have been able to help their situation with a variety of alternative medicines. In addition, not every woman that has a problem with high FSH levels will need so drastic and expensive a procedure as IVF with donor eggs.

Egg White Cervical Mucus and Conception

One of the natural secretions of a woman’s body is known as “Cervical Mucus.” The production of this fluid is prompted by the woman’s estrogen levels, and it occurs during the monthly cycle. Cervical mucus is one factor that can play a part in conception. Tracking the various stages and changes that occur to a woman’s cervical mucus throughout the month can help know when that woman is going to ovulate, and can therefore increase her chances of getting pregnant.

Now, cervical mucus changes throughout the month in terms of its color, its volume and its consistency. At the beginning of the cycle immediately after her period, a woman will have little or no cervical mucus. When it does start to show up, it will usually be white and very sticky for several days. As the woman gets closer to ovulation, she will produce more cervical mucus. It will also become more moist. At this state, cervical mucus has the consistency of hand lotion and is usually white or cream colored.

When a woman ovulates, she has the highest amount of cervical mucus. At that stage, it resembles an egg white in terms of its consistency, and is also usually fairly clear like the white of an egg. Hence, it is referred to as “Egg white cervical mucus.”

This egg white cervical mucus is necessary for conception. It helps to protect the man’s sperm from the hostile environment of the vagina and help it get past the cervix and into the fallopian tubes where it can fertilize an egg.

If you track your changes to cervical mucus, you increase your chances of conception. When you combine this with other techniques, such as tracking basal body temperature or using an Ovulation Prediction Kit to track your LH surge, you can time your conception so as to have the highest chances of success.

What is the LH Surge and Why Don’t I Have One?

One of the things about trying to conceive is that there are a number of different ways you can detect your fertility. Ultimately, all of these techniques, from cervical mucus charting to tracking your Basal Body Temperature, are designed to help you know when exactly it is that you ovulate. One way to help detect whether you’re ovulating is to watch for the LH Surge.

To detect an LH surge, you can use an Ovulation Predictor Kit, known as an OPK. The kit looks for that increase in Luteinizing Hormone that takes place just before you ovulate. That surge usually takes place about a day before ovulation, though for some women it can occur as many as three days before ovulation.

Now, the problem comes when you can’t detect your LH surge. In some cases, it means that you’re not ovulating. In other cases, however, it means that your LH surge may be mild enough that the OPK can’t detect it.

One of the most common reasons women fail to detect an LH surge is because they aren’t using the OPK at the right time. It’s hard to know when to test, for example, if you tend to have an irregular cycle. The instructions in the OPK are designed for a woman with a 28-day cycle, in many cases.

There is also the possibility that the OPK or the individual test strip that you used was defective. This is a relatively rare occurrence, however. You might not have used the strip correctly, either. But these are errors that are few and far between.

The most likely scenario if you’re not detecting an LH surge is that you’re not ovulating, and that it may be time to try some more intense fertility treatments, or even talk to your doctor.