1. Keep a Diary of Symptoms
Mittelschmerz, a German word for "middle pain," means pain during ovulation. About 1 in 5 women will experience mittelschmerz, and it usually doesn't cause any severe problems. However, if a woman has pain during the middle of her cycle, she should consider visiting her doctor. One of the first steps in diagnosing mittelschmerz is having the woman keep a diary of her symptoms. In this diary, a woman should note the type of pain experienced as well as the specific location of the pain. She should also write down what treatment remedies she used (if any) to alleviate the pain, if the pain responded to those treatment remedies, and how long the pain lasted. Recording the date of the pain as well as the date of the start of her menstrual period can also prove useful in diagnosing ovulation pain or mittelschmerz.
2. Chart One's Menstrual Cycles
Because mittelschmerz is associated with a woman's ovulation, a doctor may want to know the date on which the woman ovulated. To do this, he may request that the patient chart her menstrual cycles. By taking her temperature upon waking every morning (basal body temperature), a woman can chart her menstrual cycle and determine the day of ovulation (the day on which the basal body temperature rises to a new sustained level until the start of the next menstrual period). If a woman can pinpoint the day on which she ovulated, she and her doctor can then see if the pain from her symptom diary coincides with her ovulation. If the pain coincides with ovulation, her doctor will typically diagnose mittelschmerz or pain with ovulation.
3. Rule Out Other Conditions With a Physical Exam
Anytime that a woman experiences pelvic pain in the middle of her cycle, a doctor will want to rule out other conditions before diagnosing mittelschmerz or ovulation pains. A doctor may choose to perform a physical examination to check for enlarged ovaries, which can signify ovarian cysts, or to check for appendicitis. If the doctor rules out other conditions that can cause pelvic pain, he may make the diagnosis of mittelschmerz.
4. Look Closely With an Ultrasound
For some women who experience severe pain mid-cycle, a doctor may want to give an ultrasound examination. Ultrasound, either abdominal or vaginal, can give the doctor a closer look at the woman's reproductive organs to look for, or rule out, other possible causes of abdominal or pelvic pain. A doctor may look for ovarian cysts or endometriosis, as both of these can cause a woman pelvic pain mid-cycle. If a doctor doesn't see anything abnormal on the ultrasound, and if the pain lines up with the time of ovulation, the doctor can diagnose mittelschmerz.
