Mittelschmerz

Some women experience pain on one side of the lower abdomen midway through their menstrual cycles. This cyclic pelvic pain is known as mittelschmerz.

Update Date: 21.05.2026

Overview
Symptoms
Causes
Risk factors
Complications
Prevention
Diagnosis
Treatment
Lifestyle and home remedies
Preparing for an appointment

Overview

Mittelschmerz is one-sided lower belly pain. It occurs with ovulation. German for "middle pain," mittelschmerz occurs midway through a menstrual cycle. That's about 14 days before your next menstrual period.

In most people, mittelschmerz doesn't require medical attention. For minor mittelschmerz discomfort, pain relievers you can buy without a prescription and home remedies are often effective. If the pain really bothers you, your healthcare professional may have you try birth control pills, also called oral contraceptives, to stop ovulation and prevent midcycle pain.

Female reproductive system

The ovaries, fallopian tubes, uterus, cervix and vagina, also called the vaginal canal, make up the reproductive system of people assigned female at birth.

Symptoms

Mittelschmerz often lasts a few minutes to a few hours, but sometimes it lasts for as long as a day or two. The pain of mittelschmerz may be:

  • On one side of the lower belly.
  • Dull and achy, like menstrual cramps.
  • Sharp and sudden.
  • Present with slight vaginal bleeding or discharge.
  • Severe, rarely.

Mittelschmerz occurs on the same side of your body as the ovary that's releasing an egg during a process called ovulation. The pain may switch sides from month to month, or you may feel pain on the same side for a few months in a row.

Keep track of your menstrual cycle for a few months and note when you feel lower belly pain. If it happens midcycle and goes away without treatment, it's most likely mittelschmerz.

When to see a doctor

Mittelschmerz rarely needs medical treatment. But contact your healthcare professional if new pelvic pain becomes severe, if it includes nausea or fever, or if it doesn't go away. Any of these symptoms could mean that you have a condition that's more serious than mittelschmerz. For example, pelvic pain can be due to appendicitis, pelvic inflammatory disease or even an ectopic pregnancy, which happens when an embryo implants and grows outside of the uterus.

Causes

Mittelschmerz occurs during ovulation, when a follicle on the ovary ruptures and releases its egg. Some people have mittelschmerz every month; others have it only sometimes.

The exact cause of mittelschmerz is not known. Possible reasons for the pain include:

  • Follicle growth that stretches the ovary surface just before an egg is released with ovulation.
  • Blood or fluid released from a ruptured follicle that irritates the tissue lining the stomach area, called the peritoneum.

Pain at any other point in the menstrual cycle isn't mittelschmerz. If pain occurs during your period, it may be typical menstrual cramping called dysmenorrhea. Other stomach or pelvic conditions also may cause pain. If you have bad pain, see a healthcare professional.

Risk factors

Mittelschmerz has no clear risk factors. But it may be more likely to happen between the ages of 15 and 25.

Complications

Mittelschmerz doesn't lead to other health conditions, also called complications. The pain often goes away on its own or with medicine or home remedies.

Prevention

Mittelschmerz can't be prevented. It's linked to natural changes in the body that happen during the menstrual cycle.

Diagnosis

To diagnose mittelschmerz, a healthcare professional may ask you questions about your symptoms and especially about your medical history. Be ready to answer questions about your periods.

You also may have a physical exam, including a pelvic exam. This is to check for another cause for the pain.

Pelvic exam

During a pelvic exam, a healthcare professional puts two gloved fingers inside the vagina. Pressing down on your belly at the same time, the healthcare professional can check the uterus, ovaries and other organs.

Treatment

Possible treatments for mittelschmerz include:

  • Pain relievers. To lessen discomfort from mittelschmerz, try a pain reliever that you can buy without a prescription. For example, you may use acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve).
  • Birth control pills. If you have a lot of pain from mittelschmerz and it happens regularly each month, ask your healthcare professional about taking birth control pills. Some types of birth control pills suppress ovulation, which may ease pain due to ovulation.

Lifestyle and home remedies

Certain home remedies may help ease discomfort from mittelschmerz that lasts more than a few minutes. Because heat increases blood flow, relaxes tense muscles and eases cramping, you might want to:

  • Soak in a warm bath.
  • Place a heating pad where the pain is and hold it in place for a short time.

Preparing for an appointment

You probably won't need to see a healthcare professional for mittelschmerz. But if your pain really bothers you, make an appointment with your healthcare professional to get checked out and learn about treatment options.

What you can do

You may want to write a list that includes:

  • Detailed descriptions of your symptoms.
  • The dates when your last two periods began.
  • Information about medical conditions you've had.
  • Information about the medical conditions of your parents or siblings.
  • All the medicines and dietary supplements you take.
  • Questions to ask your healthcare team.

For mittelschmerz, some basic questions to ask include:

  • What's likely causing my symptoms?
  • Are there other possible causes for my symptoms?
  • Are my symptoms likely to change over time?
  • Do I need any tests?
  • What treatments or home remedies might help?
  • Where can I find more information?
Don't hesitate to ask other questions that you think of during your appointment.

What to expect from your doctor

Your healthcare team is likely to ask you questions, such as:

  • How many days apart are your menstrual periods, and how long do they last?
  • How would you describe your symptoms?
  • Where is your pain?
  • How long have you had this pain? Is it constant or does it go away after a few minutes or hours?
  • On a scale of 1 to 10, how bad is your pain?
  • How long before or after your period does the pain occur?
  • Do you have other symptoms, such as nausea, vomiting, diarrhea, back pain, dizziness or headache?

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