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    I don't know what it is, but it seems to be getting worse....
    ivyjbres posted:
    My problem started in June. I had my usual PMS, my usual 5 day period, felt fine for 3 days, and then had 5 days of the worst period-like pain/cramps I've had in my life, but no bleeding. July was the same pattern, but not as painful, August was again the same pattern, but again slightly less painful than July, September slightly less painful than August. And now again in October, same pattern, same period-like pain with no bleeding. Except now I'm bleeding during/after sex. In 10 years, this has never happened, so I'm a bit freaked out.

    I've been putting off going to the doctor, but obviously with this new development I'll have to just suck it up and go. Of course, that won't be until after Tuesday because of the holiday. I'm usually very in touch with my body, and usually know ahead of time what I'm going to the doctor for. What freaks me out is that in all the searches I've done, I can't find anything that would explain 5 days of pain in between periods. Any insight?
    Jane Harrison Hohner, RN, RNP responded:
    Dear ivyjbres: Some of the more common GYN causes of pain between periods can include:

    1. Ovarian or tubal mass---Ovarian cysts of all types can prompt continued pelvic pain. As can a benign collection of fluid in a tube ("hydrosalpinx").

    2. Partial ovarian torsion---If there is a large ovarian cyst (eg greater than 8 cm) the heavy cyst can prompt the ovary to twist on itself like a heavy flower on a too fragile stalk. This twisting ("ovarian torsion") causes intense pain as it cuts off the blood supply to the ovary.

    3. Pelvic infection--Pain is usually worse during intercourse, but an infected, inflamed lining of the uterus can make for spotting after sex as well.

    4. Degenerating fibroid---Uterine fibroids can lose their blood supply causing them to "die". This can produce significant pain although it tends not to be so predictable as you have described.

    There are also non-GYN causes for marked abdominal pain. The most common is pain from the bowel (eg irritable bowel syndrome or diverticulitis) . Second most common is pain from the bladder (eg interstitial cystitis). You are doing the right thing in seeing your GYN for a work up. You can expect a through abdominal/pelvic exam and some imaging (eg ultrasound and other scans). After the GYN has evaluated for GYN culprits you might be referred to a GI MD for an assessment of bowel conditions.

    Cwhite responded:
    I've expreienced some of the same things I cramp two weeks bbefore my period and after my period, its almost as if I never hhave a break between periods. I suffer great pain during my period and although I've had a ablasion procedure and the bleeding is minimal the Pain makes me want to die. I've complained to the Dr and an ultrasound was done and they stated oh you just have a small cyst on your left side which is the side I've been complaining about. After sex I bleed my stomach is very tender I realize I have bowel issues however I just need some relieft my quality of life as a result is horrible!
    gr8day22 responded:
    MittelschmerzOvulation pain; Midcycle painLast reviewed: June 2, 2011.
    Mittelschmerz is one-sided, lower abdominal pain that occurs in women at or around the time of an egg is released from the ovaries (ovulation).
    Causes, incidence, and risk factorsAbout 1 in 5 women have mittelschmerz, or pain associated with ovulation. The pain may occur just before, during, or after ovulation.
    There are several explanations for the cause of this pain. Just prior to ovulation, follicle growth may stretch the surface of the ovary, causing pain. At the time of ovulation, fluid or blood is released from the ruptured egg follicle and may cause irritation of the abdominal lining.
    SymptomsMittelschmerz may be felt on one side one month, then switch to the opposite side the next month, or it may be felt on the same side for several months in succession.
    Symptoms include lower-abdominal pain that is:
    • One-sided
    • Typically lasting minutes to a few hours, possibly as long as 24-48 hours
    • Usually sharp, cramping, distinctive pain
    • Severe (rare)
    • May switch sides from month to month or from one episode to another
    • Begins midway through the menstrual cycle
    Signs and testsA pelvic examination shows no problems. Other tests (such as an abdominal ultrasound or transvaginal pelvic ultrasound) may be done to look for other causes of ovarian or pelvic pain, if the pain lasts a while.
    TreatmentNo treatment is usually necessary. Pain relievers (analgesics) may be needed in cases of prolonged or intense pain.
    Expectations (prognosis)Mittelschmerz can be painful, but it is not harmful. It is not a sign of disease. In fact, women who feel this pain may be at an advantage when planning or trying to avoid pregnancy. Mittelscmerz pain is felt around the time of ovulation. A woman is most likely to become pregnant just before ovulation, on the day of ovulation, or immediately after ovulation.
    ComplicationsThere are usually no complications.
    Calling your health care providerCall for an appointment with your health care provider if ovulation pain seems to change, lasts longer than usual, or occurs with vaginal bleeding.
    PreventionBirth control pills can be taken to prevent ovulation and help reduce ovulation-related pain.
    1. Won HR, Abbott J. Optimal management of chronic cyclical pelvic pain: an evidence-based and pragmatic approach. Int J Womens Health. 2010; 2: 263—277.

    Review Date: 6/2/2011.
    Reviewed by: Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; Susan Storck, MD, FACOG, Chief, Eastside Department

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