Mittelschmerz's syndrome

Definition:
It refers to pain at the time of ovulation. It is not that frequently encountered.

Clinical features:
Patient will complain of pain in either the suprapubic region or right/left iliac fossa. It usually starts around the mid cycle. The pain does not shift and is not associated with nausea or vomiting. It is there for less than 12 hours. Patient may have slight vaginal bleeding or leucorrhea. Relief of pain occurs spontaneously. Severity varies from patients and usually range from 3 to 5 on a scale of 10.

Mechanism:
The most probable causes are:
1) increased tension of the growing Graafian follicle just prior to rupture,
2) irritation of the peritoneum by the released follicular fluid following ovulation.

Treatment:
Non opiod analgesics and assurance do good in this condition. In difficult cases, we may look into a possibility to render the cycle anovular with contraceptive pills.

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