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What causes pelvic pain and spotting while suffering from irregular periods?

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Practicing since : 1999
Answered : 1677 Questions
Hello, I am 37. I received transvaginal results today. I have to redo my test within two months. The test was unclear but is showing an endometrial stripe, a loss of definition between the basement membrane and the adjacent myometrium posterior. Trace of free fluid and left ovary is not visualized. I have irregular cycles. Either heavy and painful or spotting when I do. Pain in the left pelvic area when I do as well as when I go to the bathroom sometimes to the point of faint or keeling over in pain. I am a little confused as to what any of this may be telling me??? Hoping to hear a little guidance for the time being. Thank you!
Posted Sun, 16 Feb 2014 in Vaginal and Uterus Health
Answered by Dr. Timothy Raichle 37 minutes later
Brief Answer: Hello, I would be happy to help... Detailed Answer: So you are 37 years old with two prior C-sections, and now with heavier more irregular cycles and left sided pelvic pain. You had an ultrasound where the lining (the part that grows and sheds each month) is ill defined towards the back of the uterus. There is subtle variation in the reading of ultrasounds, and sometimes more is read into the scan than is clinically relevant. Usually in the setting of abormal bleeding your are looking for fibroids, polyps or abnormal thickening of the lining. It sounds like they are over-describing that part of the scan related to the uterine lining, to be honest. It might be normal, or it might represent something called adenomyosis - invasion of the muscle wall by endometrial glands. Adenomyosis is associated with heavier, more painful periods. The question is, what are your options: 1. Doing nothing - probably not an option for you given the quality of life issues 2. Medications - hormones such as birth control pills 3. Surgery - the pain AND the bleeding should be addressed together. The two approaches would include: a. Laparoscopy to look in the pelvis + an ablation of the uterine lining b. Laparoscopy to look in the pelvis + a hysterectomy (leaving ovaries) This is a typical approach to a patient with your complaint. I do not think that the reading of the ultrasound helps except to rule out big changes in the uterus, which are not present. Of note, patients in whom adenomyosis exists do not do as well long term after ablations. I hope that this helps!
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