Gynecology And Obstetrics-

The middle pain

What is the middle pain?

Middle pain is understood to mean all complaints that occur in the middle of the female cycle.
In most cases, the cause is hormone fluctuations during ovulation exactly in half of the cycle. The term middle pain can have several meanings and includes both abdominal pain itself and symptoms associated with ovulation, such as a pulling in the chest or slight hot flashes.

causes

The causes of middle pain are the changes in female sex hormones just before ovulation.
In fact, it's the two hormones estrogen and LH (luteinizing hormone). Estrogen in particular is responsible for many complaints in the female cycle. Its concentration increases until ovulation in order to achieve perfect preparation of the uterus for a possible pregnancy. This means that it builds up the lining of the uterus. This is supposed to create optimal implantation conditions for the fertilized egg cell after ovulation.

However, estrogen not only affects target structures in the uterus, it also causes changes in the female breast. There it represents a growth stimulus for the tissue. As a result, the volume of the breast increases and the affected woman can perceive this as stretching pain.

The classic middle pain, however, is the pain in the lower abdomen that is caused by ovulation itself. It is triggered by the hormone LH and causes a small tear in the tissue of the ovary. Only in this way can the matured egg cell be released. This naturally created sore can cause pain. Typically, however, it is reported as non-specific pelvic pain by many women. Once the egg has cracked, the middle pain usually subsides quickly. In fact, it is above all the tension on the tissue over the overgrown egg that causes pain. If the pressure is relieved, the discomfort subsides.

You may also be interested in this topic: Chest pain when ovulating

Does it come before, with or after ovulation?

Middle pain can occur two days before to two days after ovulation. This period is the sensitive phase for hormone fluctuations. Strictly speaking, this means that during these cycle days the increase in hormones is strongest and reaches its maximum. If a woman is very sensitive to hormonal fluctuations, she can have symptoms up to two days before ovulation. If a woman is not sensitive to hormone fluctuations, she has no complaints at all.

Experience has shown that only a few women have significant middle pain. The duration is limited to a few days after ovulation. In fact, after ovulation, the symptoms usually decrease quickly. Persistent or very severe pain always requires clarification by a gynecologist. However, it is normal if a woman does not feel as productive or perhaps has slight discomfort around 14 days after her last menstrual period. However, she should not be restricted in her ability to work.

More information can be found here: Ovulation pain

When exactly does middle pain occur?

You can't tell exactly when a woman will experience middle pain because it doesn't have to occur at all. However, it is characteristic of middle pain that it occurs approximately 14 days after the last menstrual period.
Depending on how sensitively a woman reacts to the hormone fluctuations, she may feel the middle pain a day earlier or later. For a self-diagnosis at home, it is therefore suitable to enter the days of the menstrual period on a calendar. If the symptoms appear about two weeks later, this goes well with middle pain.

Duration of the middle pain

Middle pain should only last for a few days and should not drastically reduce performance.
If symptomatic treatment with warmth or home remedies such as tea helps, middle pain is still within limits. If they last longer than 3 days or if the symptoms can only be relieved with painkillers, a specialist should be consulted. Exactly the same is true for ailments that are repeated in each cycle. The gynecologist should also be informed here - regardless of whether during the next routine examination or at an individually agreed appointment out of sequence.

Other accompanying symptoms

The term “middle pain” is often used as a generic term for various cycle-specific complaints. Thus, the term does not only mean pelvic pain, but also other symptoms such as headache, chest pain or subjective hot flashes. The cause are the female sex hormones, with the hormone estrogen causing the symptoms.

Headaches arise because the hormone causes the blood vessels to expand. As a result, the meninges are better supplied with blood, which in turn leads to headaches.
The pulling in the breast is triggered by the growth stimulus from the hormone in the breast, since the volume of the tissue simply leads to a stretching of the overlying structures through this stimulus.
The hot flashes arise on the one hand from the increased blood flow to the organs and on the other hand from a centrally caused upregulation of the body temperature shortly before ovulation.

Other symptoms are also conceivable, but these are not the norm. Thus, short-term water retention in the legs or even psychological changes such as irritability can be other accompanying complaints.

Read more on the topic:

These symptoms accompany ovulation
Ovulation bleeding

Back pain

Back pain is a common symptom associated with middle pain. If the abdominal muscles cramp as a result of abdominal pain, the back muscles also tense as a reflex. This in turn leads to tension, which manifests itself in back pain.
Often it is mainly the lower back area that causes problems with middle pain. In this area there is part of the uterus holding apparatus, which is also connected to the bones by ligaments. The application of heat or magnesium often brings relief here.

stomach pain

Stomach pain has nothing to do with middle pain purely causally.
The influence of female sex hormones in a normally regulated cycle is extremely small on organs of the gastrointestinal tract. Typical for stomach pain is an increased acid production in the stomach, which is caused, for example, by stress or nicotine consumption can be conditional. The brief increase in sex hormones around ovulation is of no consequence. If the stomach pain persists, you should therefore see a general practitioner or gastroenterologist.

Read about it too: Abdominal pain when ovulating

Bloated stomach

A bloated stomach also has nothing to do with middle pain causally. However, there is a risk of confusion with an increased water retention in the abdominal tissue, which can simulate a bloated stomach. In both cases, the waist circumference increases.
In the case of increased water retention, female sex hormones can really be the cause. Namely, they increase the water-binding capacity of tissues. However, it is not extreme and should only be limited to a few days.

treatment

Usually, middle pain does not require medication. In most cases, simple means such as the application of heat using a hot water bottle or some physical protection are sufficient. Herbal remedies such as chamomile tea or monk's pepper can often relieve the menstrual cycle problems well. The great advantage of these measures is that they have no other side effects such as painkillers.

However, if the pain is very severe, these drugs should also be used. Preparations such as Ibuprofen® or Novalgin® are particularly suitable here. However, the application should be restricted to the case of need. As a rule, middle pains only exist a few days around ovulation and quickly decrease in intensity after ovulation. Persistent pain should be clarified with a gynecologist.

In individual cases then even giving hormone preparations can be useful. They are also often the drug of choice for repetitive moderate pain in each cycle of high intensity.

Diagnosis of middle pain

The diagnosis is determined in the classic way using the calendar method.
For this purpose, the first day of the last menstruation is asked and the acute symptoms that have now arisen are placed in a temporal context. If they occur about 14 days after the last menstrual period and there are no other abnormalities, it is referred to as middle pain.

Can you have middle pain without ovulation?

In theory, you can have middle pain without ovulation. In women of childbearing age, an egg cell matures every month and will then "jump". If, for various reasons, this matured egg cell does not jump, the woman will go through a normal cycle with the possible symptoms. What really matters here is to distinguish exactly whether the woman is developing egg cells and what her hormone levels are.

For example, a girl well before her first menstrual period has no ovulation and no middle pain. Therefore, this question is a bit difficult to answer and needs to be clarified on a case-by-case basis. In any case, a woman must have a cycle to go through the classic hormone fluctuations that then make the typical mean pain.

Women who do not ovulate often take the pill. She deliberately suppresses ovulation by giving small amounts of hormones every day. These women, of course, also have a cycle. However, the changes in hormone levels are affected by the pill. Therefore, one can also speak of middle pain in these women, but this is not directly related to ovulation.

Another topic could also be of interest to you: Can you feel ovulation?

Can you have middle pain despite taking the pill?

The classic pill suppresses ovulation in women.
It achieves this by suppressing the release of the body's own sex hormones through an artificial supply from outside. Nevertheless, the woman has a regular cycle of around 28 days. With the classic pill, this can be recognized by the monthly withdrawal bleeding (menstrual bleeding). Therefore, these women can also indicate exactly the middle of their cycle and suffer from complaints there too.

Middle pain only describes the timing of pain in terms of the length of the woman's cycle. But then it is usually not the classic middle pain that a woman complains about without contraception. Rather, symptoms such as a feeling of fullness, slight abdominal pain or fatigue are in the foreground. They are based on the far lower hormone fluctuations caused by the pill. In addition, the middle pain is then not caused by ovulation itself, but by other effects of the hormones.

You might also be interested in: Ovulation despite the pill

Can middle pain also indicate implantation?

In terms of time, an egg cell must first be released from the ovary in order to be fertilized. The fertilized egg then implanted around the 5th-9th. Day after fertilization. Thus, middle pain is not an indication of implantation, as its duration is limited to about 2 days around ovulation. However, if ovulation is seen as a prerequisite for possible fertilization, middle pain can signal the fertile days.

Learn more about: The implantation of the egg cell

What does a middle pain indicate that lasts for several days?

Primary middle pain that lasts for several days means that the affected woman is very sensitive to the hormone fluctuations. It is important to find out in each individual case whether there are factors that can be influenced or not. Middle pain is a well-known problem for many young women who have not had frequent menstrual periods. Experience has shown that changing the body and thus also the hormones during puberty takes some time.

In an older woman, on the other hand, significant middle pain can indicate an imbalance in hormones. This in turn can have many causes. In the simplest case, it is cysts in the ovary that cause the symptoms. It is important to distinguish unhindered complaints from warning signals. A slight pulling in the lower abdomen can thus be observed for a few days, while the onset of bleeding with severe pain should be clarified immediately. Accordingly, it is up to every woman to assess how severe her symptoms are. A good comparison for assessing severity is the monthly bleeding at the end of each cycle. If women have clear symptoms here too, they are also more prone to moderate pain. If they have no symptoms, they are less likely to have mid-cycle symptoms.

How do I distinguish middle pain from appendicitis?

Appendicitis typically manifests itself first with indefinable pain around the navel, which then migrates over time to the right lower abdomen and becomes increasingly easier to localize. They are also often accompanied by nausea and vomiting.
Middle pain typically causes pain in the lower abdomen. However, the motto here is to go to the doctor and have the pain clarified than to overlook appendicitis at first.

Read more on this topic: These are the symptoms you can tell if you have appendicitis