WOMENS-HEALTH Messages for April, 2007: Re: CHRONICPAIN: Tests are coming back normal, but still having PAIN!

Re: CHRONICPAIN: Tests are coming back normal, but still having PAIN!

From: Walter Futterweit, MD, FACE,FACP (anonymous@obgyn.net)
Fri, 6 Apr 2007 20:47:23 -0500 (CDT)

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In reply to: Christy: "CHRONICPAIN: Tests are coming back normal, but still having PAIN!"

At Fri, 6 Apr 2007, Christy wrote: >
>Hi all,
>
>I've been having major pelvic pain for about 2 months now. I had a
>period that was one week late in January, and has been "on time" ever
>since. But the last 2 cycles, plus the one I am currently on, has
>brought me a LOT of pain. I was doubled over several times in my last
>cycle. It has brought VERY heavy bleeding including some clotting. I
>have also had very sharp *cervical* pain. Not abdominal
>cramping...sharp pains. The PA I have seen twice now seems to not be
>getting it.
>
>I have had a thyroid and CBC panel done, both came back completely
>normal. I had a Pap done, and the PA found a slightly enlarged uterus,
>but pap results came back normal. I have had a vaginal ultrasound done,
>which came back normal.
>
>I know I'm not crazy, and I know my body. What I'm experiencing, is NOT
>normal for me. Sex is often painful, and about 2 weeks ago, my husband
>could feel my cervix during intercourse. He's never able to feel it
>unless I'm pregnant. My pelvic area is extremely tender. I have had
>one cesarean surgery, followed by a VBAC...and know that I've had
>adhesion pain before. But nothing EVER like this. This doesn't feel
>like adhesion pain. I often have round ligament pain, esp. if I've
>been sitting for a while, and go to stand up. I often have an aching in
>uterine area, as well as where my ovaries are.
>
>I'm just so tired of the constant pain, and don't know where to go from
>here since my labs and tests are coming back normal.

Intermittent and sometimes severe pelvic pains may occur for a variety of reasons. These include endometriosis, and actually is rather common in PCOS. It is not described to any extent in the medical literature, and in my experience pelvic pain is present in at least 30-40% of women with PCOS. Most of the time they are related to rupture of 1 or several of the numerous (sometimes 60-80 cysts may be present)follicles in an ovary. They typically are about 6-9 mm in size and rupture causes pain, depending on size. There do not appear to be causative factors in those that have the pain in terms of cycles, but they do occur more in women with more regular cycles, both anovulatory and ovulatory. Occasionally there are times that significant blood loss may occur and the patient has to be seen immediately to assess this. Suppression of cysts to some extent by oral contraceptives may be useful, although the woman may have possible risks associated with the OCP including worsening of insulin resistance and rarely cardiovascular events, particularly in women who are overweight and obese.

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Next message: Meg: "GYNECOLOGIC: Pain After Intercourse"
Previous message: josie: "Re: CHRONICPAIN: Complex cyst and ovary removal - THANKS BARBARA"
In reply to: Christy: "CHRONICPAIN: Tests are coming back normal, but still having PAIN!"

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