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Had miscarriage. On medicine for anxiety. Having muscle pain before periods. Should I be concerned?

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Posted on Wed, 10 Oct 2012
Question: Hello. I am 37 year old female. Ever since I had a miscarriage last year, I have had many health issues. I started having anxiety and have tried several medications for it. My concern is that every month I have dealt with muscle pain in my upper arms, shoulder during the second half of my menstural cycle...esp. painful right before and beginning of period. Is this any reason for concern? I have had my thyroid checked and it was all in normal levels. Is there anything else you suggest. I also had a mamogram in Dec. 2011 and it was normal. Thanks
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Answered by Dr. Timothy Raichle (1 hour later)
Hello, I would be happy to help you with your question.

I find the occurrence of pain in the arms and shoulders associated with your cycle the most intriguing part of your story. It is also interesting that the pain is greater just before the onset of menses.

Perhaps your pain and miscarriage are connected. One theory might be: You have some backwards flow of blood from the uterus out the tubes at the start of your period. This blood is very irritating to the lining of the abdomen inside. This "irritation", if it reaches the level of the diaphragm can cause referred pain to your shoulder / arm (this is because the nerves that innervate the diaphragm, roots 3-5, are the same nerve roots that provide sensation to the shoulder and upper arm). This is stretch, but it might connect the two events: menstrual cycle and pain in the upper extremities.

With regard to the miscarriage, perhaps there is a reason, and perhaps this is related to my theory above. There could be some congenital problem with the uterus or some acquired change, such as fibroids (which are common benign tumors).

Given that this is a re-occurring event, there is probably not much concern. But, here is how I would approach your problem:

1. With the onset of pain, you need to contact your OB/GYN
2. You need to have an exam (which is a way to localize the pain) and an ultrasound (which would be a way to see if there is any fluid in the abdomen)
4. The ultrasound is also a great way to look at the uterus to assess for anatomic changes, such as fibroids.

That you have had a normal test of thyroid function and a normal mammogram is reassuring, but I think they are unrelated.

With regard to your main concern, I hope this helps. Please let me know if you have more questions! Good luck - DR XXXXXXX
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Timothy Raichle (10 minutes later)
I actually had this test done earlier this year...they filled my uterus with fluid and checked with ultrasound. No fibroids, and lining of uteris was normal. I guess I was more concerened if the muscle pain could be caused by some change in hormone levels? Or maybe if hormonal change can cause inflamation if I had tendonitis possibly...thank you for your time. I have three doctors in my family so I know how limited your time is. Sometimes its just hard to ask family continually, and wanted and outside opinion. Thanks!
doctor
Answered by Dr. Timothy Raichle (3 hours later)
No, I do not believe that the muscle pain is related to hormones. It is a relatively non-specific complaint, and not one typical with fluctuations in hormones. I really do not mind helping you with this question.

I still find the association of your cycle and pain interesting. One thought would be to treat your cycles with birth control pills or the depo shot to essentially shut-down your cycle. This is a way of taking GYN causes out of the picture in terms of sorting out what exactly is going on.

Again, I will reinforce the value in seeing your doctor WHEN you are in pain. Localization of the pain is really key to figuring this out! DR XXXXXXX
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Timothy Raichle

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Had miscarriage. On medicine for anxiety. Having muscle pain before periods. Should I be concerned?

Hello, I would be happy to help you with your question.

I find the occurrence of pain in the arms and shoulders associated with your cycle the most intriguing part of your story. It is also interesting that the pain is greater just before the onset of menses.

Perhaps your pain and miscarriage are connected. One theory might be: You have some backwards flow of blood from the uterus out the tubes at the start of your period. This blood is very irritating to the lining of the abdomen inside. This "irritation", if it reaches the level of the diaphragm can cause referred pain to your shoulder / arm (this is because the nerves that innervate the diaphragm, roots 3-5, are the same nerve roots that provide sensation to the shoulder and upper arm). This is stretch, but it might connect the two events: menstrual cycle and pain in the upper extremities.

With regard to the miscarriage, perhaps there is a reason, and perhaps this is related to my theory above. There could be some congenital problem with the uterus or some acquired change, such as fibroids (which are common benign tumors).

Given that this is a re-occurring event, there is probably not much concern. But, here is how I would approach your problem:

1. With the onset of pain, you need to contact your OB/GYN
2. You need to have an exam (which is a way to localize the pain) and an ultrasound (which would be a way to see if there is any fluid in the abdomen)
4. The ultrasound is also a great way to look at the uterus to assess for anatomic changes, such as fibroids.

That you have had a normal test of thyroid function and a normal mammogram is reassuring, but I think they are unrelated.

With regard to your main concern, I hope this helps. Please let me know if you have more questions! Good luck - DR XXXXXXX