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Cramps and nausea during periods. Due to ovarian cysts rupturing? Preconception ultrasound needed?

Mar 2013
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Practicing since : 1998
Answered : 5972 Questions
I am in my 30s and hoping to conceive this year for the first time. I usually get mildly debilitating cramps on day one of my period that can be treated with Advil etc. About every six to eight months I am in agony. This is happening now - intense uterine contractions, nausea, no way to sit without pain, must move around room etc. have taken 2 naproxen and still feel terrible. Could I have ovarian cysts which are rupturing sporadically? How can you explain this occasional agony? Should I get a preconception ultrasound? Thanks.
Posted Tue, 9 Apr 2013 in Women's Health
Answered by Dr. Aarti Abraham 1 hour later
Thanks for your query.
The occasional pain you describe on the first day of periods is normal.
However, the intense pain described by you every 6 to 8 months is not at all normal.
There could be a few reasons for this condition.
You could be suffering from endometriosis , which could lead to painful cysts in the ovaries which could be excruciatingly painful.
Other causes could be simple ovarian cysts or haemorrhagic ovarian cysts, which as you correctly guessed, could be sporadically rupturing or twisting, causing pain.
A latent pelvic or uterine infection can also present in this way.
Rarely, uterine or ovarian tumours can cause such periodic pain.
Since you are planning a pregnancy, i would insist on a full pre conceptional counselling.
This would include a thorough history, complete pelvic examination, a pelvic ultrasound and other relevant pre conceptional tests.
Continue taking folic acid supplements and maintain a healthy BMI and an active lifestyle.

Take care, and feel free to discuss further.
Above answer was peer-reviewed by
Follow-up: Cramps and nausea during periods. Due to ovarian cysts rupturing? Preconception ultrasound needed? 13 hours later
Thanks for your response! I plan to go and get a full physical overhaul. Before I sign off, can I ask, if I were your patient, what primary tests and actions would you recommend I did at my preconception checkup and over the next 3 months if I provided you with the following information?

- I have just turned 36 and have some potential high risk factors (twins in family and my mother had extreme post partum psychosis
with my sister, her second child, which sadly resulted in her suicide in England in the '80's.)

-My husband is 44. Both of us caucasian.

- I believe I may have had a very early 'chemical pregnancy' lost at 2 weeks post implantation in November 2012 but apart from
that I have never conceived. I have never actively tried to conceive but when younger, I didn't understand the menstrual cycle and
had unprotected sex during my fertile window which never resulted in conception.

- Although I have always had discomfort and pain on day one of my 34 day cycle, I have been having sporadic agonizing menstrual cramps about every 5-8 months since I turned 30.
Last night was the worst they have ever been. As I'm wondering about cysts and other issues, I would like to do a full XXXXXXX ultrasound as part of
my preconception checkup. Must I do it at a certain point in the cycle?

- I am due for a PAP - can this be done on the same cycle day as the above ultrasound?

- I take Caltrate with Vit D, Prenatal vitamins, MACA powder in my fresh juice and occasionally some royal jelly. I have no known health issues apart from oddly elevated cholesterol though I am a healthy weight.

Thank you!
Answered by Dr. Aarti Abraham 11 hours later
Glad to hear from you again.
Let me answer your queries one by one.

1. Regarding your pre conceptional check up .
- Elicitation of complete Medical History
- Complete reproductive history .
- History of past diseases / allergies / blood transfusions
- Assessment of built and nutrition, BMI, systemic body check up, BP measurement
- Family history - Twinning is relevant if present on the maternal side, and that too it does not significantly increase your chances of a twin pregnancy. However, twins are common in ladies conceiving after the age of 35, and those who are tall and well built.
The most severe form of postnatal depression, which affects one in 500 new mothers and has been linked to suicide and infanticide, could be genetic, according to new research.
However, there is no way to " test " for it. Only you are the best indicator to know if you need psychological help. However, a thorough psychological assessment and counselling to prep you for the forthcoming pregnancy is essential, given the ominous history.
Also, vitamin d deficiency is increasingly linked to depression. So continue taking teh supplements you mentioned, as vitamin D is included in them.
Try and incorporate lots of fresh fruits and vegetables and moderate exercise in your lifestyle, as that wards off depression to a great extent.

- Social history : consumption of alcohol, smoking, recreational drugs, job related concerns etc.

- Recommended laboratory tests that should be done preconceptionally are listed below :

Blood grouping
Rubella serology, immunization if indicated
Varicella titer, immunization if indicated
Syphilis serology
Screenings for
Hepatitis B surface antigen
Human immunodeficiency virus
Tay-Sachs disease
Cystic fibrosis
Sickle cell

- Complete liver and kidney function tests.

- Pap smear also should be done. A transvaginal pelvic sonogram is indicated and this is best done on cycle day 2, that is the second day of your period. However, a Pap smear cannot be done at this time. A pap smear is done when you are not bleeding, and have not had intercourse for a week, and havent used vaginal douches, tampons or gels for a week. So, you need a separate visit for that.

- Given your age, I would ask you to get your blood sugars tested, thyroid hormone profile done, ovarian reserve tested ( this is by combination of pelvic ultrasound which measures number of active follicles in your ovary on day 2 and blood tests like FSH, LH, AMH on day 2 of your cycle ).

- As your husband is 44, his semen analysis would be recommended. Also he should be screened for infectious diseases, diabetes and hypothyroidism.

- If you fail to conceive for a year or more, go in for testing of patency of your fallopian tubes, as you mention that when you were young, you did go in for unprotected intercourse around fertile days, but never conceived.

- During the first three months, in case you conceive, you would need to do the following ,

Repeat your hematocrit, blood sugars and thyroid hormone measurements when pregnancy is confirmed.
Have an ultrasound ( transvaginal ) around 8 weeks to date the pregnancy and confirm cardiac activity.
Continue taking the supplements as prescribed by your doctor - important being folic acid in the first trimester.
Further on in the pregnancy, go for relevant tests at various stages - Double marker, Triple marker, quadruple marker, anomaly scan etc as risk of having babies with abnormalities increases as the maternal age increases. I could guide you on this better once you conceive, providing you specific dates.

I have done my best to clarify your queries.
It is heartening to see you take interest in your forthcoming pregnancy, and I wish you all the best with it.
take care.
Feel free to contact me anytime to discuss further

Above answer was peer-reviewed by
Follow-up: Cramps and nausea during periods. Due to ovarian cysts rupturing? Preconception ultrasound needed? 11 hours later
Thank you. I think you are absolutely fantastic! What city do you practice in? I'm guessing it's not Los Angeles, otherwise I wish I could become your patient in person.

I was wondering - is there a way that I can find you directly from now on on this site, to purchase more questions in the future? I would love to have you as my guide!

Many thanks again for such a comprehensive response. This is most unusual, and very impressive.


Answered by Dr. Aarti Abraham 11 hours later
Firstly you made my day, with your genuine appreciation and generous praise.
Am humbled !
Thanks, dear.
Well, I am in India right now.
You definitely can contact me directly.
Here is the link through which you can directly ask me a question specifically :

I would be honoured to guide such an intelligent, appreciative and sincere person.
It was great knowing you.
Take care.
Above answer was peer-reviewed by
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