Mittelschmerz refers to lower abdominal pain occurring in a woman in the mid-portion of the menstrual cycle.


Timing: just prior to ovulation, during the peak in serum LH. The elevated level of LH may trigger smooth muscle contractions.


Clinical features:

(1) The woman experiences cramping lower abdominal pain between days 12-16 of the menstrual cycle (with the first day of bleeding being #1). Dating the onset of pain relative to the ovulatory cycle may be difficult in a woman with a varying cycle.

(2) The pain is often unilateral. It peaks within 24 hours after onset then decreases and disappears.

(3) The patient is afebrile and the white blood cell count is normal.

(4) Mild, diffuse abdominal tenderness may be present.

(5) Some women may experience a small amount of vaginal bleeding.



(1) Pain control is often achieved with an NSAID (ibuprofen 800 mg po tid).

(2) Acute pain can be treated with ketorolac 30-60 mg IM.

(3) Suppression of the ovulatory cycle with an oral contraceptive is preventative.


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