Mittelschmerz, also known as ovulation pain, is a benign preovulatory lower abdominal pain occurring mid-cycle (between days 7 and 24) in women.
Affects over 40% of women of reproductive age, often recurring monthly.
Typically begins a few years post-menarche when true ovulatory cycles are established.
Pain severity ranges from a mild ache to agonizing pain, generally felt near the ovaries on the same side as the developing follicle.
Coincides with the peak in plasma luteinizing hormone (LH) levels, increasing ovarian perifollicular smooth muscle contractility via a prostaglandin-mediated pathway.
Issues of Concern:
Presentation: Acute lower quadrant pain, usually right-sided, ranging from mild to intense.
Differential Diagnosis:
Can mimic acute appendicitis, leading to potential misdiagnosis and unnecessary surgery.
Should be considered in differential diagnosis before diagnosing appendicitis in young women of reproductive age.
Recognition: Essential for all medical providers to recognize and diagnose mittelschmerz to avoid unnecessary interventions.
Interprofessional Communication: Important to improve patient outcomes and reduce harm.
Clinical Significance:
Frequency: Women may not experience mittelschmerz every month and may not associate it with their ovulatory cycles.
Location: Pain can present in either iliac fossa, typically on the same side as the developing follicle. , ‘horse-kick pain’, tends to move centrally, heavy feeling.
Duration: Average duration of pain 5 hours, usually ceases within three to twelve hours but may persist until menstruation in patients with a history of ovarian surgery.
Associated Symptoms: Mild backache may also be reported.
Management:
Oral contraceptive use may improve symptoms.
Understanding the timing with peak LH levels can aid in identifying fertile days, useful for family planning.
Differential Diagnosis:
Must consider gynecological pathologies when diagnosing acute abdominal pain to avoid mistaking it for appendicitis.
Both gynecological pathologies and appendicitis can present with similar symptoms like Rovsing’s sign, defense, elevated leukocyte count, and elevated temperature.
Patient Outcomes: Awareness and proper diagnosis of mittelschmerz can improve patient outcomes and reduce unnecessary interventions.