Aches and pains during menstruation are par for the course for many women. But some women experience pain in the middle of their cycle, which is caused by a condition called Mittleschmerz, a.k.a., painful ovulation. What causes painful ovulation and what can you do about it?

Ovulation typically occurs about two weeks after the start of your period and two weeks before your next period starts. Most women are only aware they're ovulating when they notice a change in their vaginal discharge. Approximately 20 percent of women, however, know without a doubt they're ovulating because they get sharp, one-sided pain in their lower abdomen. This pain might last just a few hours or may drag on for several days. One month, the pain might present on one side of the abdomen and the next month, the other side, as the ovaries trade off releasing eggs. 

The majority of women who experience Mittleschmerz only experience mild to moderate pain, but for some, the pain is so severe, it interrupts their ability to participate in their normal, everyday activities.

The Cause of Mittleschmerz

Just before the ovary releases an egg, the egg stretches the membrane covering the ovary. This can cause pain and pressure. Then, when the egg is released, along with fluid and blood, the pain may become much worse. The blood and other fluids released from the ovary are very irritating to the surrounding tissues and those that line the abdominal cavity.

There's no specific test to confirm Mittleschmerz, so your doctor will diagnose it based on your symptoms and physical exam.

Researchers don't know why some women feel ovulation pain and others don't. Pain is a very subjective experience. It's possible that some women release more fluid and blood from the ovary than others, which might irritate more abdominal tissue. It may also be that some women have more sensitive nerve endings in that area of the body than others. Or, it might have to do with individual pain responses generated by the brain.

How to Treat Mittleschmerz

The best treatment for painful ovulation is to take over-the-counter anti-inflammatory medications like ibuprofen. If you can take it before you develop symptoms (a day or so before you're due to ovulate), it may help ward off the pain in advance. Soaking in a warm tub or applying heat to your abdomen might help too. If your pain does not respond to these at-home treatments, consult your gynecologist. She might prescribe hormonal contraceptives to block ovulation or stronger pain medications.

Heather Weldon, MD, OB-GYN, reviewed this article.