Menstrual cramp pain

If you have abdominal pain or cramping in the middle of your menstrual cycle, when you’re ovulating, you may be experiencing mittelschmerz, a word derived from the German for “middle” and “pain.”

Mittelschmerz occurs when the follicle — a tiny sac in the ovary that contains an egg — ruptures and releases the egg. This mid-cycle pain and discomfort can range from a minor pinch or twinge that’s over in minutes to more severe cramping that lasts for hours.

“You’ll feel it only on one side of your lower abdomen, depending on which ovary is releasing an egg,” says Amy Autry, MD, clinical professor of obstetrics-gynecology and reproductive sciences at the University of California at San Francisco.

Some women don’t feel anything when the egg is released from the ovary; others feel cramping a couple of weeks before their menstrual period. Overall, about 20 percent of women experience some type of ovulation pain, according to Dr. Autry.

While it’s unknown exactly why women experience cramping or ovulation pain, several theories exist. Before the egg is released, the follicle grows. This may stretch the surface of the ovary, causing pain. It’s also believed that blood and other fluid is released when the follicle ruptures, causing irritation that disappears as the fluid is reabsorbed. Because the ovaries have no openings, there may be some pain when the egg breaks through the ovary wall.

Six Signs of Ovulation Pain

Ovulation pain differs from menstrual cramps that come on just before or during a woman’s menstrual period. “It’s easy to recognize ovulation pain because it has a number of symptoms that are different from menstrual cramps,” says Autry.

The six signs of ovulation pain are:

• It’s one-sided.
• It comes on suddenly and without warning.
• It’s a sharp pain, twinge, or cramping rather than a dull ache.
• It often lasts only minutes, but may last a few hours or even up 24 hours.
• It may switch sides from month to month.
• It occurs about two weeks before your menstrual period starts.

Mild bleeding (spotting) or vaginal discharge may occur during this time. Some women may also experience nausea, especially if the cramping is severe. Mid-cycle pain is most common in adolescents and women in their twenties, but it can occur all the way up to age 45.

Understanding Your Body’s Signals

Women who experience ovulation pain may actually be at an advantage if they’re trying to get pregnant. Cramping in the weeks before your menstrual period is a sign that you’re ovulating and probably fertile. “You’re most likely to conceive if you have intercourse right before ovulation, on the day of ovulation, or immediately after ovulation,” says Autry.

On the other hand, mid-cycle pain may also help women who would rather not get pregnant. But while avoiding intercourse during times when you feel ovulation pain can be an effective back-up to your regular birth control method, don’t rely on it as your sole method of preventing pregnancy. “Sperm can live up to five days in a woman’s body,” cautions Autry. So you could get pregnant from unprotected sex on the days before you feel mittleschmerz pain.

Preventing and Treating Mid-Cycle Pain

For minor or brief ovulation pain, treatment is usually not necessary. For cramping that lasts more than a few minutes, over-the-counter pain relievers, such as ibuprofen (Motrin, Advil, and others) or naproxen (Aleve and others) will usually relieve the discomfort. Applying a heating pad to the site of the abdominal pain or taking a warm bath can also help. Heat increases blood flow, which relaxes tense muscles and eases cramping.

If your mid-cycle abdominal pain happens every month and is particularly bothersome, hormonal contraception (birth control pills, patches, or the vaginal ring) is an option because it prevents ovulation. And without ovulation, you can’t have ovulation pain.

Mid-cycle abdominal pain that is extreme or lasts longer than a day should be evaluated by a doctor. Appendicitis, ovarian cysts, and ectopic (tubal) pregnancy can sometimes mimic ovulation pain, although pain from these conditions is typically much more severe.

A medical exam and diagnostic tests can rule out other causes for abdominal pain. “But in the vast majority of cases, abdominal pain or cramping in the middle of the menstrual cycle simply means that you’re ovulating and the pain will disappear soon,” says Autry.