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Query about lower abdomen pain with breast enlargement and tenderness - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Very Good Posted in: Women's Health
Answered by

General & Family Physician
Practicing since : 2009
Answered : 595 Questions
Doctor :   Hi
Doctor :   How can I help you?
User :   hi,
User :   are you a male or female doctor?
Doctor :   I am male, general physician.
Doctor :   I believe, I can help you within my expertise.
User :   ok, thank you, i feel a little nervous and embarassed seeing you know
User :   that is why i try this to have some more information
Doctor :   I shall help you in the best way as I can. Please proceed with your query.
User :   i have had some pain in my lower abdomen and some tenderness/lumpy breasts, but i'm not pregnant
Doctor :   Ok
Doctor :   Since when are you having these symptoms?
User :   2-4 weeks
Doctor :   May I know your age?
User :   29
Doctor :   Are you on any pills?
Doctor :   Are your periods regular?
User :   may i ask your age to know if you are a young or older doctor?
Doctor :   30 years.
User :   no pills, i have been some years ago, regular periods, may differ 1-3 days, but I think that is normal?
Doctor :   May I know when was your last menstrual period?
User :   ended about one week ago
Doctor :   Can you describe the nature of pain?
User :   in the abdomen it is a dull pain
User :   sometimes more "intensive"
Doctor :   Are you active sexually?
User :   yes, i have boyfriend, but always condom
Doctor :   Ok
Doctor :   Do you have vaginal discharge?
Doctor :   Do you have any problem while passing urine?
Doctor :   Are you running fever?
User :   no, nothing unusual
User :   no problems going to toilet
User :   i have not taken my temperature
User :   is it helpful?
Doctor :   Ok
Doctor :   Let me brief you.
Doctor :   Lower abdomen pain with breast enlargement and tenderness can occur due to hormonal disturbances.
Doctor :   Most common causes for such hormonal disturbances are pregnancy, birth control pill (especially if you have used progesterone containing medications such as emergency contraceptive pills or progesterone implants).
Doctor :   Since you reported that you have not used such medications, you will need to rule out pregnancy, by means of urine pregnancy test or blood HCG levels.
Doctor :   There are few other causes that can also cause similar symptoms, however, from this far, without a physical examination, I cannot predict if such conditions are causing your symptoms.
User :   thank you very much, may i ask some questions regarding eventually doctor visit?
Doctor :   The other causes(commonest) apart from pregnancy and medications are stressful conditions and infection.
Doctor :   Yes, you may proceed with your next query.
User :   as i think i wrote, i feel a little nervous seeing a doctor, if i had made an appointment and was booked to you, what would you have done? first asked me to describe me feelings and the ask more questions like you did here?
User :   sorry for my english, hope you understand, otherwise please ask me to describe what i mean once more
Doctor :   That would be fine.
Doctor :   If I were to be your treating/consulting doctor,
Doctor :   I would take the basic history, similar to what I have asked now.
Doctor :   To summarize,
Doctor :   the history will contain, details of your age, duration of complaints, medical history, sexual history, past history,
User :   do you work in a family doctor clinic?
Doctor :   and menstrual history.
Doctor :   Followed by physical examination,
Doctor :   a gynaecologist will include gynaecological examination too.
Doctor :   This will be followed by investigation.
Doctor :   The first choice of test will definitely be pregnancy test.
Doctor :   If that were to be negative, other tests will follow.
Doctor :   I was practising at a family doctor clinic for 4 and half years.
Doctor :   Have you followed?
User :   are most of the appointments made by patient talking to nurse, or mostly patient directly speaking to you during some kind of telephone hours?
Doctor :   May I know your location?
User :   europe, you?
Doctor :   I am from India.
Doctor :   You can fix an appointment over phone, speaking to a nurse or through NHS if its applicable at your location.
Doctor :   * You can call up a family clinic or a gynecology clinic directly..
User :   ok, thx! how much information do you normally get before you go out to the waiting room to pick-up the patient, what is normally the description you get in your booking calendar this case?
Doctor :   The history is not taken over phone, it is done at the consultation room.
Doctor :   Your details will be taken down on personal file, meant specifically for you.
Doctor :   This offcourse is a confidential document.
User :   so in this case you normally see something like "woman, 29 years old, abdominal pain" before you pick me as patient up in the waiting room?
Doctor :   Urine pregnancy test can be performed at home without going to a doctor, using a urine pregnancy kit that is easily available at your local chemist/pharmacy.
Doctor :   Yes.
User :   may i ask what you would have included in your physical exam?
Doctor :   The conclusive diagnosis of your problem is based on the history, clinical examination and if necessary the test, which is done at the examining room and not at the waiting room.
Doctor :   In general, examination will include, general physical examination which includes recording of pulse, blood pressure and other vital signs;
Doctor :   the next examination is based on history,
Doctor :   in your case, a gynecological examination to see if there are any signs of hormone disturbances, infection, or pregnancy.
User :   is this something you perform as family doctor?
Doctor :   followed by systemic examination - lung, heart and abdomen.
Doctor :   As family physician, I wouldn't perform a gynecological examination.
Doctor :   This will be done by a gynecologist.
User :   ok, so you send me to gyn if necessary?
Doctor :   Yes. I would refer you to a gynecologist if its absolutely necessary - that is if there are evidence of pelvic infection, or positive pregnancy.
Doctor :   Have you followed?
User :   embarassing question, but to be prepared, what would you have asked me to disrobe for the exam in this case?
Doctor :   A routine examination ( performed by a family physician) doesn't need removal of clothes.
Doctor :   It is done only if its absolutely necessary.
Doctor :   And in your case, only if a pelvic examination is needed, a gynecologist may include examination of genital organs.
Doctor :   Have you followed?
User :   absolutely, thank you very, very much
Doctor :   Do you have any further query?
User :   i think you are a very good doctor
Doctor :   Thank you.
User :   i think you have noticed that i'm a little nervous, maybe especially seeing a male doctor
Doctor :   You need not be nervous. If you are not comfortable with a male doctor examining your and treating you, you can ask for a female doctor.
Doctor :   Doctors do understand your concern and will do as you intend.
User :   ok, but i think you as a male doctor is very used to examine also females
Doctor :   Your consent for any examination is the most important criteria before a doctor attends you.
Doctor :   Yes, but that doesn't include gynecological examination, as my expertise are restricted.
Doctor :   Do you have any other query?
User :   have you made any gynecological exam?
Doctor :   Yes, I have performed gynecological examination during my internship.
Doctor :   Do you have any other query?
User :   difficult exam for doctor?
Doctor :   No, an experienced doctor, examination is a routine.
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