Get a weird crampy pain in the middle of your cycle?

My Hormonology

Get a weird crampy pain in the middle of your cycle?


Sometimes, I wake up and have no idea what I’m going to write in my Hormonology blog. Like today.

So, it was kismet that this morning I received this email from Julie, a Hormonology newsletter subscriber:

“Hey, my hormone guru! Do you think you could address ovulation pain sometime? My dr thinks I am crazy and it’s frustrating.  Also, I love your iPad app!! Thanks for all you do.”

I can totally address ovulation pain, Julie. In fact, let’s address it today.

Let me start off by saying any medical doctor who doesn’t know that at least one in five women experience pain in the abdominal/pelvic area right before or during ovulation should have to go back to medical school.

This pain–called “mittelschmerz”, which aptly rhymes with “middle hurts”–has been written about in medical journals as far back as the 1940s.

And, certainly anecdotally more than one of your doctor’s many patients must have brought this up at some point considering how common it is.

But, looking back, I guess I do have to admit that yours isn’t the only doctor in the dark about mittelschmerz. There have been many other readers over the years who had no idea why they were getting what seems like menstrual cramps in the middle of their cycle–about two weeks away from their period–and their doctors were no help.

So, let’s talk mittelschmerz:

This middle-of-your-cycle pain occurs as a side effect of ovulation. It could be from the ovarian wall rupturing, which may cause bruising, or from irritation caused by blood or other fluids released from the ruptured egg follicle. But, honestly, these are just theories from researchers–the jury is still out about why exactly this pain occurs as a result of ovulation.

For some women, the pain is short-lasting–maybe an hour. Others, unfortunately, can have pain that lasts up to 48 long, grueling hours.

The pain can be dull and mild–or sharp and intense, like menstrual cramps.

It can happen every cycle, every so often, or just once in a long while.

Some doctors may mistake this pain for appendicitis. Luckily, if the pain subsides before they wheel you out on a gurney, the true cause of your problem will become clear. And, you get to keep your organ.

One interesting thing about mittelschmerz: Since typically only one ovary releases an egg at a time, the pain can actually tell you which ovary is producing an egg that month. In rarer cases, both ovaries release an egg, which is something I know about personally since I have a fraternal twin sister, which means both my mother’s ovaries coughed up an egg during her cycle.

Also handy: If you’re trying to get pregnant, this pain can be a heads-up that ovulation is here. It’s not exactly the kind of thing to put you in the mood for romance, but at least it’s useful.

So, if you get mittelschmerz what can you do about the pain?

If you get this ovulation pain regularly–and it’s something you simply can’t put up with–then use a menstrual cycle tracker (like my free Hormone Horoscope menstrual cycle tracker) to figure out when you ovulate in your cycle.

Then, if you can, take one to three nonsteroidal anti-inflammatories (NSAIDs)–like ibuprofen or naproxen–spaced apart on the two to three days leading up to ovulation. (Note: Never exceed the dosing recommendations on the label.) This can reduce the amount of pain and inflammation that occurs once ovulation takes place.

If, like me, you can’t take NSAIDs, then once the pain arrives, apply a heat patch or hot water bottle to the spot where it hurts. This easy at-home remedy has been proven in multiple studies to lessen cramp pain for several hours by reducing inflammation and blocking pain signals.

If your middle pain is so severe that it impacts your life and is making you miserable, then you may want to discuss hormone birth control with your doctor since it suppresses ovulation. While, as a rule, I prefer hormone-free birth control methods (like the hormone-free IUD) since synthetic hormones are pretty powerful and have multiple side effects, this is one of those cases where they can actually be medicinal for some women.

I hope this helps you understand your “middle pain” more!

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