In this article, we explore what Mittelschmerz is, its causes, and self-care treatments for Mittelschmerz. Mittelschmerz usually doesn’t require medical treatment, but self-care treatments can lessen or eliminate the pain. Ovarian pain can mean different things depending on whether it’s before or after ovulation, or before or after menses. The more you know and can document these events, the better you can communicate with your physician and get to the root cause. Pay attention to patterns and consult your physician if you experience intense pain, nausea, fever, or other concerning symptoms.
Mittelschmerz means “middle pain” in German. It is a pain in the lower abdomen that occurs at or around the time of ovulation. The pain may last a few minutes to a couple of days. It usually happens just on the ovulating side or may be felt throughout the pelvis. For me, it would happen only when I ovulated on the right.
What Causes Mittelschmerz?
If the pain happens right BEFORE ovulation, the cause may be the growing follicle. A follicle is like a fluid-filled sac that pushes against the wall of the ovary and contains the ovum (egg). This growth may stretch the ovarian site, resulting in pain.
If the pain happens right AFTER ovulation, it may be caused by blood irritating the peritoneum. As Dr. Aviva Romm explains, “Upon rupture of the follicle, the cavity that held the ovum collapses, its cells enlarge, and the cavity that has formed becomes blood-filled, forming what is called the corpus hemorrhagicum (bloody body). “Mittleschmerz” is a result of minor bleeding from this site that may cause peritoneal irritation and mild lower abdominal pain of short duration. The blood is soon replaced with yellowish, lipid-rich luteal cells, forming the corpus luteum, hence the name of the luteal phase of the menstrual cycle.”
Knowing how to track your cycle and knowing how a particular stage of your cycle may relate to your symptoms is extremely useful, both for you and your physician.
Another cause of ovarian pain, not considered Mittelschmerz, is if you get ovarian pain WITH or right AFTER menses, it may be a Corpus Luteum cyst, which is a type of ovarian cyst that may rupture about the time of menstruation.
I’ve also had ovulation pain that irritated my psoas (or maybe my psoas was irritating my ovary?). The ovaries typically lie right over the psoas! That’s why I never let anyone “massage my psoas with their elbow”. You can read more about the psoas/ovarian connection and how it caused my knee pain here.
Image: Moving from the lower left (primary follicle) in a counter-clockwise motion to the corpus albicans shows the stages of the follicular cycle throughout the month.
Mittelschmerz Self-Care Treatment
Some women find that Castor Oil Packs may be helpful during episodes of ovulation pain.
Abdominal massage can also be beneficial in reducing pain and aiding lymphatic drainage. I teach abdominal massage and pelvic alignment for uterine and ovarian health in my Womb Care Online Course.
Author: Barbara Horsley has more than 26 years of experience as a licensed massage therapist. She specializes in abdominal massage and Visceral Manipulation™ and is an NCBTMB-approved educator. In addition to being certified in abdominal massage, she also studied biomechanics and restorative exercise. She is also a Certified Women’s Herbal Educator and a graduate of the IWHI Perimenopause & Menopause Certificate Program.