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Dr. Andrew Rynne

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Suggest treatment for pelvic and lower back pain

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Dr. Jacqueline Brown

OBGYN

Practicing since :1996

Answered : 1425 Questions

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Posted on Fri, 16 Oct 2015 in General Health
Question: I have been having pelvic pain and low back pain. I went to multiple Doctors (prinary care, gasstro and OB/gyn). After a lumbar MRI and a full CT scan, the only thing they found was a 2.2 cm ovarian cyst. I also had a Pap smear that came back normal. The cyst is believed to not be a concern but will have an ultrasound in late Oct. the ob/gyn put me on birth control. I am on day 11 of a 28 cycle pill (last week placebo pills). I missed one pill on Friday morning and doubled up yesterday morning. Within 2 hours of doubling up, I was having brown spotting. It started dark brown, was black this morning and is now bright red and heavier. I even feel like I am cramping and having low back pain.

I started my period two weeks ago (9-14) which was bright red for three days. One day of nothing and then 2-3 days of minor brown spotting.

I also began the birth control on 9/27 and did not have any issues until yesterday.

To my questions.
Is the bleeding a concern? Is it due to the pills or possibly the cyst? Could it be more serious? I know a CT scan is not a great way to view the pelvic area but read that it would like detect large masses/cysts and only miss small things. Is this true?

My big concern is that this may be an undiagnosed cancer and my OB is not taking my issues seriously.

Last point to note, I had a baby 4 months ago and the period was my first since the birth.

doctor
Answered by Dr. Jacqueline Brown 1 hour later
Brief Answer:
The bleeding is from missing the pill and has nothing to do with the cyst

Detailed Answer:
Hello and I hope I can help you today.

Vaginal bleeding is common if you miss a birth control pill, even if you double up, especially in the first three months of use. Most modern birth control brands are also very low dose, so breakthrough bleeding (bleeding when you are not supposed to have your period) is the most common side effect reported by patients on low dose birth control pills.

Ovarian cysts are a normal part of a woman's menstrual cycle and are produced every month when women ovulate. Some women experience pain from them, which is why birth control pills, which inhibit ovulation, help to suppress them and treat the pain.

A pelvic MRI and a CT scan really eliminate the possibilty of this small (less than 5cm is considered small) cyst being malignant. So you really do not have to worry that this bleeding could be anything dangerous.

I would finish your pill pack, even if you're still bleeding, wait the prescribed amount of time before starting another, and then see what happens the next months. Really try to take the pill as close to the same time every day as possible. If at three months you still have irregular bleeding, you should see your GYN back and consider trying a different kind of pill.

I hope I was able to adequately answer your question and that my advice was helpful. If you need anything further, please do not hesitate to contact me.

Best wishes, Dr. Brown
Above answer was peer-reviewed by : Dr. Neel Kudchadkar
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Follow up: Dr. Jacqueline Brown 15 hours later
This is very helpful. So even though the blood flow and cramps are equivalent toanother period, i should not be concerned that there is a more serious issue? Also the MRI was for the spine and not pelvic area. I've only had a CT of that area showing the small cyst.
doctor
Answered by Dr. Jacqueline Brown 1 hour later
Brief Answer:
The ultrasound will give your doctors a look better at your ovaries

Detailed Answer:
When your uterus bleeds it normally cramps no matter what the cause. So the cramping still is nothing to worry about. However if you did not have an MRI that actually images your ovaries, a pelvic ultrasound provides the best detail in looking at the ovaries. A CT will rule out any other signs of malignancy, like fluid in the abdomen, or enlarged lymph nodes. Again, a less than 5 cm cyst in a menstruating woman is completely normal at the correct point in your menstrual cycle. There are many kinds of ovarian cysts and we can tell what type you have from the ultrasound findings.

Again I want to re-emphasize that ovarian cancer presents on the average at the age of 59. Unless you have a strong family history of ovarian cancer or breast cancer in women under the age of 45 it is extremely unlikely you have ovarian cancer. In the U.S. out of 300 million people there are only about 27,000 cases per year.

So I think it is safe and OK to wait until your ultrasound in October for further clarification. I hope this reassures you and that this information was helpful. Take care, Dr. Brown
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
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Follow up: Dr. Jacqueline Brown 15 minutes later
Thanks. Ovarian and uterine cancer are what i am most concerned.

Based upon both your responses are you still favoring that the bleeding (equivalent to a light period) is breakthrough bleeding from the low dose BC pill?

Thanks for final confirmation.
doctor
Answered by Dr. Jacqueline Brown 7 minutes later
Brief Answer:
Yes... The bleeding is from the pill...

Detailed Answer:
Just so you know, birth control pills reduce the risk of both uterine and ovarian cancer. The pelvic ultrasound you will get also examines your uterus so you will also find out then if there is any cause for concern.

The most common presentation for uterine cancer is postmenopausal bleeding. You are very young to worry about uterine cancer as well because it usually presents in women over 50.

Try to relax and wait until your ultrasound. I know it is difficult but I am sure your doctor will be able to reassure you.

Regards, Dr. Brown
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
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