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On alesse birth control. Pelvic pain, bladder discomfort. Scan showed adenomyosis and ovarian cyst. Concerned

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Practicing since : 1999
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Hello Dr. Raichle,

I am a 30 year old female, and I have been on Alesse birth control for approx. 10 years. That is the only medication that I take, and I have no significant medical history. I am approx. 5 foot 6, and weigh 150 lbs. I am very physically active. There is no history of ovarian or breast cancer in my family, that I am aware of (however, my paternal grandmother passed away at age 30 from a heart condition, and I am unaware of her genetics with respect to those diseases).

In mid-November 2012, I developed a nagging pain in my right pelvic area, and increased pressure on my bladder. I brushed it off as muscle strain, as I sit all day for my job, and an osteopath suggested that it might be a shortened ileopsoas muscle. The pain went away, but returned in mid-December and has not disappeared again (I suppose if anything, it ebbs and flows, getting worse after my period and when I probe the area). I went for a physical exam on January 8, and my GP immediately referred me for a pelvic and intravaginal ultrasound the next day. Today I got the results, which say:

"The uterus is anteverted and has a non-homogenous XXXXXXX echo pattern with asymmetric walls. It measures 4.5 (w) x 3.5 (a.p.) cm.

The double layer of the endometrial lining measures 0.4 cm in thickness.

Both ovaries are seen.

The right ovary measures 2.7 x 1.7 x 3.0 cm and shows a 1.2 x 0.7 x 1.7 cm cyst with XXXXXXX echoes.

The left ovary measures 2.9 x 2.3 x 2.5 cm.

The urinary bladder is distended; it contains 375 mL urine pre-void and 20 mL post-void. No fluid collection is demonstrated.

OPINION: Adenomyosis (2) Right ovaria cyst XXXXXXX

My GP didn't seem terribly concerned, but from everything I've read online, it is concerning that the cyst hasn't resolved itself after a few mentrual cycles (if the pain from November is in fact related). Also, I am a bit alarmed by the term 'internal echoes', as doesn't this indicate a complex cyst? My GP has referred me to an OBGYN, but it will be a month or so before I can be seen, and I would like a bit more explanation of what my results could mean, and what might happen moving forward (for some reason I am more concerned about the cyst, although I have never heard of adenomyosis!).

Posted Fri, 8 Feb 2013 in Women's Health
Answered by Dr. Timothy Raichle 3 hours later
Hello, and thank you for the question. I am sorry about the delay, but I will try and give you the best answer possible.

First of all, I can't stand when someone has a test done and noone is able to sit down and really explain the results right away. I will help you today, as the results are really not that concerning. But to summarize, here is what I am hearing:

You are a 30 year old female on birth control pills, who I will assume had no problems before November, who developed intermittent right lower quadrant pain / bladder discomfort. The pain went away, but then returned and has been present ever since. There is some association, maybe, with your cycle. There is an association with the location of your bladder.

It was appropriate to get an ultrasound. I would have also obtained a urine sample as well, because kidney stones might also present in this manner. As far as the ultrasound findings, here is how I would interpret what you are saying:
1. The dimensions of the uterus are normal
2. The lining (the part that grows and sheds) is normal at 4mm
3. The ovaries are normal

The comment about the right ovarian cyst obviously concerns you. The size of the ovary itself is normal, and the cyst of concern is actually quite small. In all likelihood, it represents a small amount of bleeding within the cyst. It is quite possible that if you had an ultrasound in November when this pain started, this cyst might have appeared larger, and what you are seeing in December / January represents decreasing size of the same area. The best plan, in this case, and based on your persistent pain, is to repeat the ultrasound about 6-8 weeks after it was performed. If the cyst is still there and your pain is still present, you can discuss with your OB/GYN whether the cyst should be removed.

Finally, the comment about adenomyosis is a bit annoying. This is virtually impossible to diagnosis on ultrasound and the pain you are describing does not fit with this condition. Adenomyosis is a benign condition where there is some invasion of the muscle wall of the uterus by the lining or glandular layer. It is a condition associated with heavy cycles and significant cycle related cramping. Your pain does not follow such an obvious pattern.

So you are left with a diagnosis of a probable "hemorrhagic ovarian cyst" that is small and likely will resolve over time. If your pain resolves with the resolution of the cyst, then the cyst was the cause of the pain. If the cyst resolves and your pain persists, then your pain is something else!

I hope that this helps. Please let me know if there is anything that I am missing!!
Above answer was peer-reviewed by
Follow-up: On alesse birth control. Pelvic pain, bladder discomfort. Scan showed adenomyosis and ovarian cyst. Concerned 11 hours later
Dear Dr. Raichle,

Thank you very much for the clear answer, and interpretation of my results! I should have mentioned that my GP did in fact do a urine test. There were some leukocytes in the sample, but no sign of bacteria. In any case, knowing that the cyst is likely nothing to worry about, and that adenomyosis is benign definitely eases my mind until I can follow up with my real-life OBGYN appointment next month. Thanks again!

Answered by Dr. Timothy Raichle 6 hours later
Thank you for the followup. I think that you are on the right track. If anything comes up or there are further questions, you are welcome to direct a question to me as you did. Good luck!
Above answer was peer-reviewed by
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