# Intermenstrual pain (Mittelschmerz / ovulation pain) - Category: acute - Review status: reviewed (every claim checked against a document named on this page) - Sources: Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560) · MSF Essential Drugs 2024 - paracetamol (oral) · Brott NR, Le JK. Mittelschmerz. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Updated 2023 May 1. Bookshelf ID: NBK549822; PMID: 31747229. - Verified date: 2026-08 ## Verified against - MSF Essential Drugs 2024 - paracetamol (oral) - Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560) - Brott NR, Le JK. Mittelschmerz. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Updated 2023 May 1. Bookshelf ID: NBK549822; PMID: 31747229. ## Treatment metadata - Paracetamol — 500 mg — oral.solid - Ibuprofen — 400 mg — oral.solid ## Complete treatment card ```text INTERMENSTRUAL PAIN (MITTELSCHMERZ / OVULATION PAIN) Sources: Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560) · MSF Essential Drugs 2024 - paracetamol (oral) · Brott NR, Le JK. Mittelschmerz. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Updated 2023 May 1. Bookshelf ID: NBK549822; PMID: 31747229. Review status: REVIEWED against 3 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (6) - It does not come every month, and women may not connect it to ovulation at all - Pain sits in either iliac fossa, usually the side of the growing follicle - It normally stops within three to twelve hours - After ovarian surgery it can instead drag on until the period begins - A mild backache may go with it [back pain] - It falls at the luteinising hormone peak, so it marks the most fertile days SIGNS - what you find (1) - Gynaecological disease and appendicitis alike can give Rovsing sign, guarding, a raised white count and fever [abdominal pain · fever · guarding · right lower quadrant pain] TESTS (1) - Working up acute abdominal pain in this group means weighing gynaecological causes IF NOT THIS - what else fits (1) - In women of reproductive age this is readily mistaken for acute appendicitis Source StatPearls "Mittelschmerz" - disease-level clinical article Status traced to the source above 1. PARACETAMOL [1st line] Adult 1 g three or four times daily, maximum 4 g in 24 hours - As needed for pain or fever Peds 15 mg/kg/dose [child max 500 mg] (Child 1 month and over: 15 mg/kg per dose, 3 or 4 times daily, maximum 60 mg/kg daily. Child under 1 month: 10 mg/kg per dose, 3 or 4 times daily, maximum 40 mg/kg daily. MSF's own weight table gives one 500 mg tablet three times daily from 30 kg to under 50 kg, so 500 mg is the per-dose ceiling; the 60 mg/kg daily total still applies.) 3kg -> 45 mg/dose 4kg -> 60 mg/dose 5kg -> 75 mg/dose 6kg -> 90 mg/dose 7kg -> 105 mg/dose 8kg -> 120 mg/dose 9kg -> 135 mg/dose 10kg -> 150 mg/dose 11kg -> 165 mg/dose 12kg -> 180 mg/dose 13kg -> 195 mg/dose 14kg -> 210 mg/dose 15kg -> 225 mg/dose 16kg -> 240 mg/dose 17kg -> 255 mg/dose 18kg -> 270 mg/dose 19kg -> 285 mg/dose 20kg -> 300 mg/dose 21kg -> 315 mg/dose 22kg -> 330 mg/dose 23kg -> 345 mg/dose 24kg -> 360 mg/dose 25kg -> 375 mg/dose 26kg -> 390 mg/dose 27kg -> 405 mg/dose 28kg -> 420 mg/dose 29kg -> 435 mg/dose 30kg -> 450 mg/dose 31kg -> 465 mg/dose 32kg -> 480 mg/dose 33kg -> 495 mg/dose 34kg -> 500 mg/dose (capped) 35kg -> 500 mg/dose (capped) 36kg -> 500 mg/dose (capped) 37kg -> 500 mg/dose (capped) 38kg -> 500 mg/dose (capped) 39kg -> 500 mg/dose (capped) 40kg -> 500 mg/dose (capped) 41kg -> 500 mg/dose (capped) 42kg -> 500 mg/dose (capped) 43kg -> 500 mg/dose (capped) 44kg -> 500 mg/dose (capped) 45kg -> 500 mg/dose (capped) 46kg -> 500 mg/dose (capped) 47kg -> 500 mg/dose (capped) 48kg -> 500 mg/dose (capped) 49kg -> 500 mg/dose (capped) 50kg -> 500 mg/dose (capped) Source MSF Essential Drugs 2024 - paracetamol (oral) Why Symptomatic relief only; it does not treat the cause. The dose is MSF's, under its mild- pain indication: an adult takes 1 g either 3 or 4 times a day, with a daily ceiling of 4 g. The dose claim holds and the indication claim does not, because no disease-level document here recommends an analgesic for mittelschmerz. Caution NO DOCUMENT HELD HERE RECOMMENDS AN ANALGESIC FOR THIS CONDITION. The card's own cited article (StatPearls, Mittelschmerz, NBK549822) was opened and read in full: it has no management section, names no analgesic, and the single treatment sentence in it points at an oral contraceptive, not at a painkiller. This dose is a general analgesic dose for mild pain, offered because the pain is real, not because a source recommends this drug for this diagnosis. The article's own view of the course: the pain usually settles inside three to twelve hours. The exception is the woman who has had ovarian surgery, in whom it can carry on until her period starts. A short analgesic course is all that should be needed. Relief only - it does not treat what is causing the pain or fever. Check every other product the patient is taking for paracetamol; combination cold and flu preparations are the usual route to an accidental overdose. Reduce the dose in significant liver disease, chronic alcohol use, or low body weight. RED FLAG - Pain lasting well beyond the usual day or two, or fever or abnormal vaginal bleeding accompanying the pain (consider ectopic pregnancy or pelvic infection instead). Egypt FEBRIMOL 500 MG 20 TAB. PHARCO 3.50 EGP (0.17/unit) CETAMOL 500 MG 20 TABS. MEMPHIS 8.00 EGP (0.40/unit) PARACETAMOL-MUP 500MG B.P. 20 TABS. MUP 13.00 EGP (0.65/unit) CETAL 500 MG 20 TABS. EIPICO 24.00 EGP (1.20/unit) ARKADOLOW 500 MG 30 F.C. TABS. UTOPIA 42.00 EGP (1.40/unit) PARAMOL 500MG 20 TAB. MISR 38.00 EGP (1.90/unit) ADOL 500MG 24 CAPLETS JULPHAR 32.00 EGP AUGICETAMIDE 500 MG 20 SACHETS AUG PHARMA 50.00 EGP FEBRIMOL ORAL DROPS 20 ML PHARCO 4.00 EGP -> ? strength differs, ? different route - not oral solid THERA-LO 3.2G/100ML ORAL SUSP. 100 ML PHAROPHARMA 5.00 EGP -> ? strength differs, ? different route - not oral solid 2. IBUPROFEN [add-on - not a substitute] Adult 200 to 400 mg up to three times a day, at least 4 hours between doses, maximum 1200 mg in 24 hours - Short-term use only; the shortest effective course Peds 3 to 5 months: 2.5 mL of the 100 mg/5 ml suspension three times daily. Not under 3 months. 6 to 11 months: 2.5 mL three to four times daily 1 to 3 years: 5 ml three times daily 4 to 6 years: 7.5 ml three times daily 7 to 11 years: 10 ml three times daily (Label verbatim: "For pain and fever 20 mg/kg/day in divided doses (including OTC use)." The label's age bands for the 100 mg/5 ml suspension are 3-6 months 2.5 ml three times daily, 6-12 months 2.5 ml three to four times daily, 1-4 years 5 ml three times daily, 4-7 years 7.5 ml three times daily, 7-12 years 10 ml three times daily. Not to be given under 3 months.) Source Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560) Why An anti-inflammatory analgesic for the pain. The row once read 200 to 400 mg by mouth every 6 to 8 hours as needed, which permits four doses a day, where the label it cites permits three. The label's own figures are 200 mg to 400 mg - 10 to 20 ml - up to three times daily as required, at least four hours apart, and never more than 1200 mg or 60 ml within any 24 hour period. The daily maximum was already right. The citation was also rewritten from a bare URL to the label's name, which is the same document under the form docs/SOURCES.md asks for. Caution NO DOCUMENT HELD HERE RECOMMENDS AN ANALGESIC FOR THIS CONDITION. The card's own cited article (StatPearls, Mittelschmerz, NBK549822) was opened and read in full: it has no management section, names no analgesic, and the single treatment sentence in it points at an oral contraceptive, not at a painkiller. This dose is a general analgesic dose for mild pain, offered because the pain is real, not because a source recommends this drug for this diagnosis. The label's own indication is symptomatic - it is licensed for mild to moderate muscle pain, for fever following immunisation, for headache and earache, for dental pain, and for backache. It does not name this condition. Relief only - it does not treat what is causing the pain. Take with or after food, and give gastroprotection if it is needed for more than a short course or the patient is over 65. Avoid in dehydration and in anyone not drinking - the kidney risk is highest there. Egypt DAJUANOFEN 400 MG 20 F.C. TABS. COPAD PHARMA 5.00 EGP (0.25/unit) FLABU 400MG 10 F.C.TAB. DELTA PHARMA 3.75 EGP (0.38/unit) NOVA-PROFEN 400MG 30 F.C. TABLETS SANOFI 12.75 EGP (0.42/unit) IBUPROFEN 400 MG 10 TAB. SEDICO 6.00 EGP (0.60/unit) MAFO 400 MG 30 F.C.TABS EIPICO 42.00 EGP (1.40/unit) BRUFEN 400 MG 30 TABS. KAHIRA > ABBO... 78.00 EGP (2.60/unit) PROFUSOL 400MG 20 S.G CAPS. EUROPEAN EGYP... 31.00 EGP ANALGIPROF 400 MG 25 SACHETS EVA PHARMA 37.50 EGP NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML SANOFI 2.25 EGP -> ? strength differs, ? different route - not oral solid BRUFEMOL-N SUSP. 60 ML ARAB DRUG COM... 4.50 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)