Endometriosis or Mittelschmerz
September 10, 2019 10:38 PM   Subscribe

Could I have endometriosis and not know it? Or is it ovulation pain? Should I try to find out, or not worry if I am not experiencing severe pain? Plenty of details about my cycle etc inside.

I'm 31 and have had periods since I was about 11. The first day and a half of my period have often been quite painful and relatively heavy, though I don't think it's a concerning amount of blood and I am not passing any large clots. My period is fairly regular and I don't really get any unexpected bleeding or spotting at other times of my cycle. I do sometimes get the tiniest little bit of blood when I assume I am ovulating.

I was recently on the Nuvaring for just over a year, but stopped using it a few months ago so I'm just re-learning my cycles. The first day or so is still heavy, but pain is manageable with painkillers.

The one thing I am concerned about is some pain mid cycle. I've always attributed this pain to ovulation, and I still do believe that the pain is linked to that. This month I used Clearblue Advanced ovulation tests and the pain was most noticeable when I was in my "peak fertility" days.

I'm just really not sure whether the pain I experience and the location of it is typical for Mittelschmerz. The day before peak fertility, I woke up mid sleep because I needed to pee and I had some pain and feeling of pressure in my bladder, although when I did pee my bladder was not really that full. I also had some increase in the pain in my ovary and the discomfort around my bladder during sex on those peak days.

A couple of days later and I feel completely fine. So what gives? Is this within the realm of typical ovulation pain, or should I try to get it investigated? If I need to see a gyno I would need a referral and it would take a lot of time, so checking here in case I shouldn't bother.

Thank you
posted by kinddieserzeit to Health & Fitness (9 answers total) 3 users marked this as a favorite
Well, I’m not an expert so I can’t say what you should do, but I’ll just note that when I went to the doctor with similar concerns, they were very much like “well what do you want ME to do about it?” I’ve had this issue for several years (since I turned 30), and the only recommendation I’ve gotten is to go back on the pill.
posted by mustard seeds at 11:15 PM on September 10, 2019 [2 favorites]

I had the exact same period cycle, and also having to wake up in the middle of the night to pee. However, in my case, I had to wake up nearly every night, for three years or so.

A ovarian cyst got me into an ultrasound tech, who noted the large orange-sized fibroid that was growing outside of my uterus, and using my bladder as a nice, comfy pillow to sit on. That got me into an OB-GYN quickly, and three months later, the fibroid was removed via a hysterectomy. For me? BEST. DAY. EVER.

Until the ovarian cyst, the only symptom I had was having to pee in the middle of the night, which my cis male GP wrote off as 'it happens to everybody' and 'just don't drink liquids after 6pm; problem solved!'.
posted by spinifex23 at 11:17 PM on September 10, 2019 [2 favorites]

Similar symptoms were also a giant fibroid for me, removed via resection while retaining all reproductive equipment. I only got it investigated once it grew to over a litre's volume and started showing really bad bleeding symptoms, and I am still kicking myself over not getting an ultrasound sooner when it was still the size allowing for laparoscopic surgery. Get an ultrasound, with a good experienced tech.
posted by I claim sanctuary at 12:36 AM on September 11, 2019

For those who had cysts/fibroids, were symptoms only evident at key points in the cycle (ovulation/menstruation) or at pretty much all times?
posted by kinddieserzeit at 12:51 AM on September 11, 2019

This is, fortunately or unfortunately, a question for a doctor. It's always good to have a consistent OB/GYN for annual exams, regular PAPS, and problems like these. This could be SO many things. Historically, and currently, gynecological problems have been very ignored. But it does still matter how much it's bothering you, because treatments vary based on what it is.

IANAD - but I am a Full Time Sick Person with Endometriosis, among other things, some TBD. I get a plethora of abdominal pain and symptoms.

Endometriosis cannot be diagnosed without surgery. The only effective surgery is resection or excision (NOT cauterization). Treatments only manage symptoms, not the disease itself, but can relieve problems.
Fibroids and ovarian cysts can usually be seen on imaging, but not always. Sometimes hormone testing is required or can give more information (for example PCOS.) Treatment for that depends on what it is.
It could also just be how your cycle works (though many doctors are dismissive when there are actually things "wrong.")

In my case, endo [and whatever else may be going on that is not fibroids] means a mix of constant and fluctuating pain, pressure, and more. It flares at two points in my cycle, depending on hormones. Especially around ovulation I get pain in my remaining ovary side.

Really though, we cannot diagnose you and there is no "typical", and I encourage you to find an OB/GYN who is responsive and caring about your pain and knowledgeable of treating problems.
posted by Crystalinne at 12:58 AM on September 11, 2019 [4 favorites]

Before surgery I was convinced that my fibroid was giving symptoms (dull pain plus cramps, bladder pressure, bleeding) only at period and ovulation. Once the surgery site healed up, I realised that background gut pain I'd blamed on IBS for years cleared up in amazing ways. I went from a daily 3-4 on a 0-10 painscale to a 0 baseline (with the worst period symptoms being about a 6-7 before).

Imagining really can't hurt, a good tech can see a lot of things transabdominally, and it'll rule out a few possible causes at the very least. I went for years undiagnosed because no-one expected the other symptoms to have a gynecological reason.
posted by I claim sanctuary at 1:46 AM on September 11, 2019 [1 favorite]

I've had Mittelschmerz since I was 14. For me, that pain feels more like a knife in the lower back accompanied by nausea. Does not come with any pain or pressure around my bladder. The only thing that stops the Mittelschmerz pain is Naproxen (500mg), taken at the earliest onset of symptons (took me until I was 30 for a doctor to take my pain seriously and recommend this, so leaving this here for others).

I would also recommend going to a doctor.
posted by devonia at 6:29 AM on September 11, 2019

Pain during ovulation freaked me out this year because it was on the appendix side and (as far as I remember) I had never had it on the right side. I agree with devonia that it was a sharp stabbing pain that was not associated with any bladder pain. I was so relieved to learn that it had a name and a name that I enjoyed muttering while I waited for the naproxen (brand name Aleve) to kick in. Mittelschmerz, mittelschmerz.
posted by spamandkimchi at 12:28 PM on September 11, 2019

Thanks everyone. I am going to keep an eye on it over the next couple of months and then talk to my doctor if I am concerned/whenever I see them next (whichever comes first).

I'm in Australia where we just get our cervical smear tests done by a GP, so we don't really have regular gynaecologists we can easily make appointments with.
posted by kinddieserzeit at 4:09 PM on September 11, 2019

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