Ovulatory Pain


Ovulatory Pain, Mittelschmerz, Ovulation Pain, Midcycle Pain

  • Definitions
  1. Ovulatory Pain (Mittelschmerz or Midcycle Pain)
    1. Unilateral acute pelvic between Menstrual Cycles, in the time around release of ovum from ovarian follicle
  • Epidemiology
  1. Prevalence: Up to 40% of reproductive age women
  • Pathophysiology
  1. Luteinizing Hormone (LH) surge leads to increased ovarian perifollicular Smooth Muscle contractility (Prostaglandin mediated)
  • Symptoms
  1. Unilateral Pelvic Pain or lower abdominal quadrant pain, more often on the right side
  2. Radiation may occur to the low back
  3. Onset mid-Menstrual Cycle
  4. Duration 3 to 12 hours (longer with prior ovarian surgery)
  5. Variable severity (mild to severe)
  • Differential Diagnosis
  • Management
  1. Symptomatic Analgesic use (esp. NSAIDs)
  2. Oral Contraceptives