severe abdominal pain

Mid cycle sometimes I get really severe pain in what seems to be my ovaries. It usually lasts for 5-8 hours during which I can't stand up, I get freezing cold, feel nauseous and generally have a horrible time. I've gone to hospital a couple of times while it was happening and they have come up blank. My bloods are fine, urine fine, ultra sound seems normal. They just usually put me on an IV painn relief and then I'm sent home exhausted and tender in the stomach for three days. The scan showed I had no cysts and everything looked normal, I have had two c sections, do you have any idea what could cause such violent attacks and what can I do now? Please help am at the end of my tether.

[Elaine Brown, MD]

Hi!
If you were my patient, I would want to rule out some type of obstruction to the outlet of the menstrual blood.  I would do this by performing an ultrasound during one of the painful episodes to determine whether there is any fluid collection within the uterus.  If this is not what is happening, then it is quite possible that you have adenomyosis.  This is a form of endometriosis that occurs within the wall of the uterus, especially in areas of scarring.
The first line of therapy would be anti-inflammatory medications such as Ibuprofen or Aleve.
If that doesn't help, the next thing to try is oral contraceptives.  They work quite well sometimes.  If those are not helpful, there are some medications such as Lupron (GnRH agonists) that may do the trick.  Finally of course, there is always the option of surgery.
Hysterectomy is usually definitive, although should not be done unless you've completed your family.
Hope this helps!
dr B