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Period delay, tired, sick, headaches, back and shoulder pain, dizziness, transvaginal ultrasound, HPT, cysts, PCOS

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General & Family Physician
Practicing since : 2005
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Hi Doc! My last period was in April 4. In May 4 I thought I would be having my period coz I had a very faint blood (light pink streak) on my underwear and had lower back pain. However, my period didn't arrive. Instead, I had a feeling of being sick and tired, with headaches, backaches including a pain on my left shoulder and upper left arm (for few days). After 2 weeks delay, I made my first home pregnancy test and got a very slight line, and I did 2 more tests on the succeeding days but no line appeared. At that time I had headaches, lower back pain, dizziness and sometimes pain on my lower abdomen. Not content with the HPT, I went to my doctor on my 3rd week and he made a transvaginal ultrasound but there was no gestational sac. After one week the doctor repeated the ultrasound and he said I have cysts in my 2 ovaries which he said is likely pcos. He made a urine exam and results came negative and he said that I'm not pregnant. He explained to me that I have a thick uterus lining and he told me that 3-4 days my period will arrive. He gave me 5 Lutoral pills (had taken it once per day) to bring back my menstruation. He told me to go back on my 2nd or 3rd day of menstruation so he could perform a blood test. It's been 6 days now since then, but I still have no period. Do I have to wait for my period to come before I visit again my doctor? (Today is Sunday here in Japan and the clinic is closed.)
One more thing, I asked him why is it that I have been experiencing pain in my right lower right abdomen for 2 weeks but he said he doesn't know. He gave me pain reliever (voltaren tablets) for 5 days, and I finished the last yesterday. Got no medicine now and I'm experiencing again this pain on my lower right side abdomen. What could be a possible cause this pain? Is there a relationship in my delayed menstruation with this lower abdominal pain I have? Hope I will be enlightened. Thank you very much! :)
Posted Thu, 12 Apr 2012 in Menstruation and Miscarriage
Answered by Dr. Prasad 6 hours later

Thanks for your detailed and descriptive query.

It would have been better if you could have specified your age and the regularity of your periods in the past.

Nevertheless, your description is sufficient to give an opinion.

If pregnancy is ruled out, Ovarian cyst and the hypertrophied uterine wall can explain all your symptoms. Ovarian cyst is associated with prolonged secretory phase (second phase) of menstrual cycle, which is responsible for thickening of the uterine wall leading to lower abdomen pain. Presence of cyst in the right side ovaries along with the thickened uterine wall could be causing the pain in you.

In such cases the recommended treatment are as follows:

1. Hormone pills similar to that of birth control pills are tried for 5-7 days. 'Withdrawl bleeding' occurs after the completion of the course.
You have been given one such pill. You could be having the withdrawl bleeding in a day or two now.

2. If pills fail to induce bleeding, you may need dilatation and curettage - a procedure in which the thickened uterine wall is manually scrapped off. A gynecologist is trained in this procedure. Consult them if you do not have withdrawl bleeding in a day or two.

3. Hormones will be assessed on day 2 -3 of menstrual cycle (1st day refers to the first day of bleeding). Accordingly the further steps of managements towards PCOS can be formulated.

As far as treating the abdominal pain, few options are:

1. Local heat therapy - You may find the intensity of pain is lower on applying hot water bag over the lower abdomen.
2. Continue NSAID's - Voltaren tablets is an effective NSAID's. Discuss with your doctor and continue the use of the same till you get your periods.
3. If the severity of pain is increased, you may advised to repeat the ultrasound scans to look for changes in the cyst. Surgical treatment is entailed if the cyst is large or ruptured.

Hope I have give you the necessary information which you were looking for.
I will be available to answer your follow up queries should you have any.

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