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1. Mittelschmerz
middle pain
Done by: Mohammed Qazzaz

2. Definition
Mittelschmerz is one-sided, lower
abdominal pain associated with
ovulation. "Mittelschmerz" is a
German word that means "middle
pain." The condition occurs midway
through a menstrual cycle — about
14 days before your next menstrual
period.

3. In most cases, mittelschmerz doesn't
require medical attention. For minor
mittelschmerz discomfort, over-thecounter pain relievers and home
remedies are often effective.
If your mittelschmerz pain is
troublesome, oral contraceptive stop
ovulation and prevent midcycle pain.

4. Mittelschmerz pain usually lasts a few minutes
to a few hours, but it may continue for as long
as a day or two. Pain from mittelschmerz may
be:
On one side of your lower abdomen
Dull and cramp-like
Sharp and sudden
Accompanied by mild vaginal bleeding or
discharge
Rarely, severe

5. Mittelschmerz pain occurs on the side of the
ovary that's ovulating — releasing an egg —
in that menstrual cycle.
The pain may switch sides every other
month, but women may feel pain on the
same side for several months in a row.

6. For the patient:
Keep track of your menstrual cycle for
several months and note when you
experience lower abdominal pain. If it occurs
midcycle and goes away without treatment,
it's most likely mittelschmerz.

8. When to see a doctor
In the vast majority of cases,
mittelschmerz requires no medical
intervention. However, contact your
doctor if a new pelvic pain becomes
severe, if it's accompanied by nausea or
fever, or if it persists — any of which
could indicate you have a condition more
serious than mittelschmerz, such as
appendicitis pelvic inflammatory disease
or even an ectopic pregnancy

9. How this happen
During your menstrual cycle, the female sex
hormone estrogen causes the uterine lining
to thicken every month to create a
nourishing environment for a fertilized egg.
Soon afterward, a follicle — a tiny sac in the
ovary that contains a single egg — ruptures
and releases its egg (ovulation).

10. If the egg becomes fertilized on its way to
uterus by contact with a sperm, the egg
implants in the lining of the uterus. However,
most often the unfertilized egg passes
through uterus and out of your body. Shortly
thereafter, your uterus releases this lining
and the menstrual flow begins.

11. Mittelschmerz occurs during ovulation,
when the follicle ruptures and releases its
egg. It's estimated that 1 in 5 women
experience ovulation discomfort. Some
have mittelschmerz every month, while
others have it only occasionally.

12. The exact cause of mittelschmerz is
unknown, but possible reasons for the pain
include these:
•Just before an egg is released with
ovulation, follicle growth stretches the
surface of your ovary, causing pain.
•Blood or fluid released from the ruptured
follicle irritates the lining of your abdomen
(peritoneum), leading to pain.

13. Pain at any other point in menstrual cycle
isn't mittelschmerz.
It may be normal menstrual cramping
(dysmenorrhea) if it occurs during the
period, or it may be from other abdominal
or pelvic problems.
If your pain is severe during the time of
ovulation or at any other time during your
cycle, see your doctor.

14. What could be the others causes?
UPPER ABDOMINAL PAIN SYNDROMES
Biliary disease
Acute pancreatitis
Dyspepsia
Hiatus hernia
Pneumonia
Myocardial infarction
Splenic abscess or infarction

15. LOWER ABDOMINAL PAIN SYNDROMES
Appendicitis
Diverticular disease
Kidney stones
Bladder distension
Pelvic pain

16. DIFFUSE ABDOMINAL PAIN SYNDROMES
Mesenteric ischemia and infarction
Ruptured aneurysm
Peritonitis
Intestinal obstruction

17. ABDOMINAL PAIN IN FEMALES
- Pelvic inflammatory disease
- Adnexal pathology
- Endometriosis
- Ectopic pregnancy
- Endometritis
- Leiomyomas

19. If you need relief from the discomfort of
mittelschmerz, try an over-the-counter pain
reliever, such as acetaminophen (Tylenol,
others), aspirin, ibuprofen (Advil, Motrin,
others) or naproxen (Aleve).

20. If you experience mittelschmerz nearly every
month and it causes you quite a bit of
discomfort, talk to your doctor about the option
of taking a birth control pill (oral contraceptive).
Birth control pills prevent ovulation, which
prevents mittelschmerz because the condition
can only occur if an ovary releases an egg

21. Lifestyle and home remedies
If the discomfort from mittelschmerz lasts
more than a few minutes, try some home
remedies to gain relief. Because heat
increases blood flow, relaxes tense muscles
and eases cramping, you might want to try:
Soaking in a hot bath
Using a heating pad on the side of your
abdomen where the pain occurs

23. Reference: mayo clinic web site