Mid Cycle Pain

As if it wasn't bad enough having cramps during your period, now it turns out that some women suffer from cramping in the middle of their cycles too. This problem is called mittelschmerz - that's a German word meaning "middle pain." It's called middle pain because it affects women right in the midpoint of their menstrual cycles, namely, around the time of ovulation.

How It Happens

So far, medical professionals have been able to come up with only theories as to what exactly causes mittelschmerz. Basically, what happens is this:

During the first 14 days of the menstrual cycle, the hormone estrogen triggers one of the follicles in your ovaries to nurture an egg to full maturity - ready to be released and then fertilized (if you have unprotected sex). Around day 14 of the cycle, the egg is released and begins its journey down the fallopian tube to the uterus. (This doesn't always happen on day 14, different women have cycles of different lengths, but egg release always happens mid cycle).

What Causes Mid-Cycle Pain? Should You Worry?

Now why would this process cause pain? Well, it's possible that just before the egg is released, the follicle which is growing to accommodate the developing egg forces the surface of the ovary to stretch - this could potentially cause discomfort. Another theory is that blood or fluids exiting the follicle after it has burst to release the egg could irritate the lining of the abdomen - this might also cause pain.

Mittelschmerz Symptoms

Symptoms of pain caused by ovulation include:

- A dull, crampy ache occurring on one side of the abdomen at approximately the midpoint of your cycle. (You should record your cycles and mark the days on which you feel pain to determine whether your discomfort is really mittelschmerz or not.) The pain can be felt on the side of the ovulating ovary. This means that the pain may switch from one side of your abdomen to the other from month to month. Ovulation does not always, however, alternate on a monthly basis between ovaries. It's therefore possible to feel mittelschmerz pain on the same side several months in a row. This dull pain can last from only a few minutes, to several hours, to a couple of days.

- A sharp sudden pain on one side of your abdomen (although this is less common than the dull, painful sensation).

- Light spotting or vaginal discharge in combination with the pain described above.

In rare cases, mittelschmerz can be severe, but this doesn't mean that there's a serious problem. If the pain is accompanied by nausea or fever, it could be a symptom of something more sinister, including an ectopic pregnancy (which is potentially fatal). If you experience severe pain mid cycle, it's best to play it safe and get checked out by a doctor.


Medical intervention is rarely required in the treatment of mittelschmerz. Non-prescription pain killers and a hot water bottle for the cramps should do the trick.

If you are suffering from mittelschmerz on a regular basis, and it's disrupting your life, you might want to consider taking the oral contraceptive pill. The hormones in the pill prevent ovulation, and will therefore put an end to the mittelschmerz for as long as you are taking them. However, bear in mind that there's a recommended limit to the number of years for which you should use oral contraceptives - so if you have no need of them as a contraceptive now, but may want to use them for that purpose in the future, it might be best to use other methods of alleviating mittelschmerz pain.

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