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Women's Health

Abnormal Menstruation w/Lower-Right Abd Pain

02/12/2010

Question:

I have had continuous, usually dull pain in my lower-right abdomen (just lower than and inside my right hipbone) for about two years. Occasionally, the pain will flare suddenly into a piercing pain that makes it difficult and at times impossible to stand or sit. This piercing pain can last from a minute to over a day and does not coincide with either menstruation or ovulation (as far as I can tell). My menstrual periods have been more irregular for the past three to four months: I will have two to three days of heavy bleeding and burning, sharp cramps; my bleeding will stop abruptly for a day; it will gush the next day; I will skip another day or two; and then it will gush again for a day or two until it dwindles down and stops.

Recently, the pain from my abdomen is traveling to my upper thighs. I am also experiencing fatigue and shortness of breath with the barest of exercise.

My questions are 1) whether these symptoms could be or are likely to be connected; and 2) what the possible causes could be, within reason.

My last pap (2 1/2 years ago) was normal. I do not drink, smoke, or take any prescription or non-prescription drugs apart from Motrin. I am in my thirties, and I have two children by c-section. I am married and not pregnant.

For the last few months, I have been trying to see a gyn for these symptoms, but University Hospital (at CWRU) has mis-scheduled my appointments twice (as recently as today), and the next available appointment is in late March. I would appreciate knowing whether I should continue to bother trying to see a gyn. Given my months-long and extremely frustrating attempts to date, I am ready to give up.

Answer:

Don't give up! Obviously there is something that is causing your pain in that area. Possibilities include muscular or skeletal pain, scar tissue from your C-section, ovarian pain (for example, a large cyst), or uterine pain (for example, a large fibroid tumor on that side). It's really hard to know without a good examination. Your irregular periods may be related to this pain (if it is from your ovary or uterus), but they may be totally unrelated; again, it is hard to know without that examination.

It sounds like you have been taking good care of yourself. Your fatigue and shortness of breath may be due to an anemia from your heavy periods. I would recommend that you continue to pursue seeing a gynecologist (or family physician). In the meantime, taking an iron tablet (325 mg) twice a day will help build up your blood supply. If you do start an iron tablet, know that some women will notice that their stools become darker or more hard; if so, increasing fiber in your diet would help.

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Response by:

W. Fred Miser, MD W. Fred Miser, MD
Professor of Family Medicine
Director of Ohio State Medicine Residency Program
College of Medicine
The Ohio State University