Recent onset of intense cramping symptoms

Hi. I am a 33 year old white female, 5'7", 133 lbs, no previous children. I have been menstruating since age 11 and had irregular periods as a teenager, and was treated with birth control pills from approx age 20 till just over 6 months ago. Since that time, my periods have been regular, light and relatively pain free.

This past month, I developed some varied and extreme symptoms immediately after ovulation. They first led me to conclude I was pregnant. Initially, I was getting dizzy for brief periods nearly daily. This was followed by some light abdominal cramping or cramp-like twinges, frequent urination, sore, swollen breasts, queasiness/ GI issues and even two hot flashes. The cramps worsened esp on my left side. Despite these symptoms though, I tested negative on 2HPTs.

Last night I was awoken with intense cramping. My period had started although it was more clot-like than usual. Since that time 24 hrs ago, the cramping has remained pronounced. My GYN examined me by doing a blood and urine pregnancy test to ensure there was no miscarriage or ectopic pregnancy (indeed, no evidence of that). In pressing on my uterus and left ovary, there was intense pain -- very abnormal for me during pelvic exams. She referred me to an ultrasound specialist who found no conclusive evidence of cysts, fibroids, etc.

I am concerned as to why my cramps are so intense and whether it might indicate anything more serious than for what I was evaluated. My questions: could this be a sign of endometriosis, certain cancers or a pelvic infection? I have been in a married, monogamous relationship for 10 years and have been tested for STDs, so I'm unsure if infection is likely, but is it still possible? Or, is it possible to have unexplained pain one month without specific cause? Also what would you recommend as next steps diagnostically?

[Elaine Brown, MD]

Hi!
It sounds to me as though you may be having some GI issues.  If there were no cysts on the left ovary, the other culprit in that area is the colon.
If you were my patient, I would probably prescribe some anti-inflammatories for the menstrual cramping. ( During the period the body produces lots of prostaglandins--which are similar to hormones--these cause uterine cramping as well as GI side effects such as spasms and diarrhea ) I would also encourage you to take a fiber supplement and drink extra water during the next cycle.  I would then wait to see what happened with that period.  If you had severe symptoms again my next step would be laparoscopy looking for endometriosis.  Given your history and lab findings infection or cancer would be extremely low on my list of suspicions.
If your symptoms resolved completely or were milder next cycle, I would just watch and wait.  It could still be some adjustment to stopping pills.  Unless you are trying to conceive, you might want to re-start them--they work very well for reducing cramping. and many other PMS symptoms.

Hope this helps!
Dr B