Mittelschmerz: What in the World Is This Mid-Cycle Pain?
If you’ve ever felt a sharp twinge or dull ache on one side of your lower abdomen right in the middle of your cycle, you’re not alone. Many women experience this mid-cycle discomfort — a normal physiological phenomenon called mittelschmerz, also known as ovulation pain or mid-cycle pain. Fun name, right? Yet like many aspects of women’s health, it’s rarely talked about, and in my clinical experience, a lot of women don’t realize this type of ovulation cramp even has a name — or that it can be completely normal.
What Is Mittelschmerz?
The word mittelschmerz is German for “middle pain.”
It refers to one-sided, lower abdominal pain that happens during ovulation, typically around the midpoint of your menstrual cycle. Some women feel it every month, others only feel it occasionally, and some never experience ovulation pain at all.
All of these patterns can fall within the range of normal.
Why Does This Happen?
During ovulation, a mature egg breaks through its follicle in the ovary. When this happens, a small amount of fluid — or sometimes a tiny bit of blood — can spill into the abdominal cavity. That fluid may irritate nearby tissues, leading to temporary one-sided pelvic pain or ovulation cramps.
Fun fact: Typically only one ovary releases an egg each month, and while it’s about a 50/50 chance whether it’s the left or right, it doesn’t alternate in a predictable way. It’s random!
I personally love announcing to my husband which ovary I ovulated from based on the side of my Mittelschmerz pain… bless his heart.
How Long Does Mittelschmerz Last?
For most women, ovulation pain is mild to moderate, and lasts minutes to a few hours. Some women notice discomfort lasting 1-2 days, which is less common, but may still be a normal variation for some. The pain is typically described as sharp, cramping, and/or aching in nature. It is important to note that most women develop a familiar pattern of symptoms, and it is important to pay attention to your unique normal.
When Should You Be Concerned?
While mittelschmerz is usually harmless, some symptoms can signal something other than normal ovulation pain.
Reach out to a clinician if you experience:
severe or worsening abdominal pain
pain that lasts longer than your usual pattern
fever, nausea/vomiting, or unexpected bleeding
pelvic pain that feels different from your typical mid-cycle discomfort
pain that is concerning to you
It is important to always listen to your body. If something feels off or unusual for you, it’s worth checking in with your trusted doctor.
Understanding Your Cycle More Deeply
Whether you notice mid-cycle pain every month, only occasionally, or not at all, Mittelschmerz can be a helpful clue about where you are in your cycle. For some women, it’s a natural way to understand their fertile window or hormone rhythm more deeply.
Tracking these changes — even small ones — can help you feel more connected to your cycle and your reproductive health overall.
And if you’re ever unsure about pelvic pain or new cycle symptoms, checking in with a clinician is always a good idea. If you are interested in working with me, I am currently offering Individualized Educational Consultations (book here), and will be seeing patients starting in 2027 (join waitlist here).
All my love,
Hannah Thornburg, MD