Misunderstood Mittelschmerz: How Ovulation Pain Wrongfully Led to Appendectomy

Have you ever experienced a dull ache or sharp twinges in your lower abdomen about two week before your period? If this happens on occasion, or as often as once a month, you may be alongside more than 40% of women who have ovulation pain during their reproductive years.  Ovulation pain is also known as mittelschmerz, coming from the German term for “middle pain.” Though the phenomenon is still being researched, experts assert that ovulation pain is typically caused by one of two aspects of the ovulation process. During ovulation, the egg develops in the ovary and is surrounded by follicular fluid. When the ovary releases the egg, it also releases the surrounding follicular fluid and small amounts of blood. Mittelschmerz may be caused by the egg enlarging in the ovary and/or the released blood and follicular fluid irritating the abdomen lining. Like period pain, ovulation pain is experienced by a large number of menstruators.. Though it can be frustrating to manage, it’s not usually  a sign of irregularity or obstruction in relation to overall health. Yet, despite how common mittelschmerz is, it still isn’t broadly discussed in considerations of women’s wellness. In fact, if we are not intentional about acknowledging it now, a lack of mittelschmerz awareness may lead to unnecessary surgeries and interventions like it has in the past. 

According to a brief paper shared in The South African Medical Journal in 1958, many women were being misdiagnosed with appendicitis and undergoing appendectomies instead of being appropriately treated for mittelschmerz. (As a disclaimer, I wouldn’t venture to call this paper an epitome of scientific excellence. It articulates some problematic views. Namely, it argues that incidence of ovulation pain wasn’t recorded in Bantu women in large part because “Bantu women rarely complain of it, possibly because they are more stoical.” This reinforced toxic racist stereotypes that still plague medical studies.) The study further uncovered within hospital records that women within the 14-25 age range were twice as likely as men to undergo an appendectomy, which often included the partial or complete removal of an ovary. The conductors of this study  maintained that many of these surgeries could have been prevented if mittelschmerz were sufficiently mentioned in medical textbooks and society at-large. Admittedly, I didn’t know much about ovulation pain until very recently, so not much has changed since 1958 in terms of broader awareness. 

Mittelschmerz is often misunderstood and overlooked in discussions of women’s health.  The current lack of awareness surrounding ovulation pain reinforces how important it is to advocate for better women’s health research and resources. The stakes are too high to not take action. We need to be intentional about knowing our bodies and recognizing their rhythms, so that we can best address our needs. Of course, never hesitate to discuss potential ovulation pain symptoms with a medical professional you trust. Here are some resources with ,more information: 

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