Gynecology / Women's Health Expert Forum
Irregular periods breast tenderness...
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Irregular periods breast tenderness...

Hi and thank  you for taking the time to answer my questions. I am a 40 yr old woman with 3 children (2 pregnancies) through clomid/gonal-f and IUI. I am about 75 lbs overweight. Do not take birth control pills. (never have)

In June this year I noticed immediately after a normal period my breasts remained tender, on cycle day 16 I got another period. All my life Ive been a 28 day cycler(sp?)  Since Ive always been overweight I was concerned that something might be going on with my ovaries. I was never diagnosed w/pcos.

GP sent me for a ct w/o  contrast the pelvic findings were as follows:enlarged uterus suggestive of leiomyomas. Left ovary enlarged at 4.6 X 3.2 X 3.9 . No evidence of abdominal or pelvic lymphadenopathy abnormal soft tissue masses or fluid.  The right ovary was not mentioned. Because of the ovary enlargement my GP sent me for a transvag. u/s. They found that I have fibroids, and that the left ovary was enlarged 3.7 X 2.5 X 3.2, there was no evidence of abnormal solid or cyst lesions within the ovary. The right ovary was not visualized. They also found that there was homogenous thickening of the endometrium. Otherwise no fluid or solid masses.

Due to the thickening of the endometrium I had a endo biopsy done which came back normal. Now almost 6 months later, I am having the same symptoms as I did in June only this month a few days before my period I had some very sharp stabbing pains in the area of my right ovary, they lasted only seconds but were very intense. I started my period on cycle day 29 had a shorter than normal 3 days. However, my breasts have remained very sore and swollen, and I seem to be having other pms symptoms. Currently on cycle day 11.

My main question is can this be perimenopause ? Or do I need to be concerned about the right ovary, I assume the ct would have been able to visualize it and any abnormalities noted. I cannot get into a gyn until January, what questions/and or tests do I need to ask for? Thank you for your time!
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Hi!
A CT scan is not a very good modality for looking at your pelvic organs.  An ultrasound is much better, and I'll bet when you do see a gynecologist, that is what he/she will order.  If your ovary had a big cyst or mass though, it would show up on the scan, so there is nothing there that worries me enough to think you should be seen before Jan.

We can start to see peri-menopausal changes as early as 35, so in answer to your other question, yes it could be that.  It doesn't mean that menopause is anywhere close though--average age is 51.

The breast tenderness really suggests that the cause is hormonal, which is what I would suspect any way based on your history. Birth control pills would be one answer if you were interested--they would have the advantage of preventing cysts on ovaries, keeping your uterine lining healthy and regulating your periods. I'm going to bet there is some reason you have never taken them though, (they also help with breast tenderness)

A mirena IUD would help keep the uterine lining thin too, and would really reduce the amount of flow.

Honestly, your symptoms are mild enough, that if you were my patient, I would be satisfied with observation alone for the time being until things got worse--I would keep an eye on those fibroids with an ultrasound about every six-twelve months and have you keep a menstrual calendar.

Good luck!
Dr B
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