Help with cyclical, one-sided pelvic pain
August 6, 2017 7:36 AM   Subscribe

Looking for ideas on ways to manage cyclical pelvic pain without surgery or hormone-based treatment.

For years I've been experiencing pain on my right side, which like clockwork, starts on cycle day 16, and lasts for up to two weeks. I wondered whether it's mittelschmerz, but it's always on the same side, so I'm not sure.

At first the pain was most pronounced deep in my back, causing soreness in my QL muscle. I went through two rounds of physical therapy, thinking this was a back issue. The pain is now more pronounced in the front right pelvis, and so I started tracking it and found that it always starts on cycle day 16. I have had ultrasounds to check the area, which show fibroids and ovarian cysts. Despite these issues, it's not really clear to me what causes the pain and why it's so dependably cyclical.

I don't wan't to take hormonal drugs like birth control. My doctor's only other solution is surgery to remove the uterus. Right now I try to manage the pain with pain patches and ibuprofen, but both are too short-acting, so provide only intermittent relief.

Would appreciate any thoughts and hearing about any similar experiences. Thanks
posted by smokyjoe to Health & Fitness (10 answers total) 1 user marked this as a favorite
I had the exact thing you're describing for over 15 years and just lived with it. Dull pain in the right front pelvis, regular as clockwork--it sucked.

By providence, I had a gyn who was filling in for my regular doctor who said, "You don't have to live like that," and she sent me to get an ultrasound done and gave me a referral to a gyn surgeon. The ultrasound showed ovarian cysts.

I got laparoscopic surgery to remove the ovary as well as the tubes which were scarred and covered in adhesions (turns out those were also part of what was so painful) on the right side; been pain-free ever since. I'd get a second opinion from a gyn surgeon; you may not have to have your uterus removed.
posted by yes I said yes I will Yes at 7:50 AM on August 6, 2017 [2 favorites]

I don't have any treatment suggestions for you, unfortunately, because I took hormonal bc pills for this when it happened to me as a teenager. I had an ovarian cyst that would painfully swell when ovulating. They prescribed me bcp, the cysts went away and never returned. I am almost 40 now, with aura migraines and a history of being a smoker, so if these returned, bcp would not be an option for me. I would not engage a doctor who suggested a hysterectomy for intermittent pain that you can mostly control with advil ever again.

I would get a new doc and ask them why not just remove the cyst and have a d&c for the fibroids?
posted by pazazygeek at 9:22 AM on August 6, 2017 [3 favorites]

Absolutely get another medical opinion, and try starting the ibuprofen (in scheduled doses) on Day 14.
posted by furtive_jackanapes at 12:47 PM on August 6, 2017

Can you share your age, your plans for future childbearing (if any), and some more details about your aversion to hormonal therapies?

Surgery and hormonal therapy are the main treatments for cyclical pelvic pain. There are other things you can try (e.g. some people find SSRIs help with this kind of pain) but surgery and hormonal therapies are by far the most commonly used and generally most successful. Depending on what your objections to each one are there may be specific procedures or medications that would be acceptable to you.
posted by telegraph at 2:10 PM on August 6, 2017

Have you seen a non-gynecologist doctor about this? I have had complicated pelvic pain since the birth of my child almost 3 years ago. My pain does get worse and better through my monthly cycle, but it's a hip problem (femoral acetabular impingement) worsened by laxity in my pelvis. The way you describe your pain is very similar to how I would describe my pain. It's a complicated area.
posted by stowaway at 2:25 PM on August 6, 2017

thanks all for the thoughtful replies and food for thought. Telegragh: I'm early-to-mid 40's, future childbearing ability is not a concern, and the aversion to hormonal BC is because i tried it years ago, and it killed my libido (tried several types/brands). thanks all
posted by smokyjoe at 3:26 PM on August 6, 2017

This sounds exactly like when I had an issue with ovarian cysts -- I wonder if you have tried Nuvaring, which has localized hormones so some people have less side effects. Can't say if it would work for you, but Nuvaring worked for me in terms of no side effects, very low effort (especially if you're not worried about pregnancy, so you don't have to be exact on timing), and 100% solved my cyst issue.
posted by rainbowbrite at 3:49 PM on August 6, 2017

I have this cyclical with ovarian cysts and fibroids as well. Avoiding hormones and surgery, you can start taking naproxen (Aleve) the day before it usually appears. I don't know why, but that seemed to manage cyst pain better than anything else. I also found that a heating pad right on that spot helped a lot. (Or laying in bed, reading, with my coffee resting on the spot. Treat yo self.)
posted by headspace at 4:47 PM on August 6, 2017

Pelvic floor physical therapy? Ive heard people get amazing results sometimes working with a skilled pelvic floor therapist
posted by Rocket26 at 5:56 PM on August 6, 2017

I'm an ER doctor.

Cyclical pelvic pain makes me think endometriosis

In seventy-five to eighty percent of women endometriosis lesions only implant superficially, and cannot be detected with ultrasound, which, while cheap and easy to do, lacks adequate resolution to identify adhesions or superficial peritoneal implants. Instead, they can only be seen on laparoscopy, during which any lesions that are found can also be taken care of.

Laparoscopy is the only way to confirm a diagnosis of endometriosis. Speak to your physician
posted by BadgerDoctor at 8:32 PM on August 6, 2017 [2 favorites]

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