Mittelschmerz 


Mittelschmerz (German: “middle pain”) is a medical term for “ovulation pain” or “midcycle pain”.


Pathophysiology

Proposed mechanisms:

  • Follicular swelling
    • Swelling of follicles in the ovaries prior to ovulation.
  • Ovarian wall rupture
    • At ovulation, the egg breaks through the ovary’s wall as ovaries have no openings
  • Fallopian tube contraction
    • After ovulation, the fallopian tubes contract (similar to peristalsis of the oesophagus), which may cause pain
  • Smooth muscle cell contraction
    • At ovulation, this pain may be related to smooth muscle cell contraction in the ovary as well as in its ligaments in response to ↑ prostaglandin F2-alpha, itself mediated by the surge of luteinizing hormone (LH)
  • Irritation
    • At the time of ovulation, blood or other fluid is released from the ruptured egg follicle causing irritation of the abdominal lining

Clinical features

  • One-sided abdominal pain coinciding with ovulation
    • Lasts for minutes-days

Diagnosis

Differential diagnosis

  • Appendicitis
  • Dysmenorrhoea

Management

  • Over-the-counter analgesics
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