Right Side Pelvic/Ovary Pain

Hello Dr. Goodman, I am 40 years old, never pregnant. Only history of cancer in my family is my maternal grandmother/breast cancer. I have had right ovary pain for several years. I have been bleeding every 2.5 to 3 weeks and extremely heavy the last 4-6 months. I have been off birth conrol for one year previously took for four years. I was taking BC for ovarian cysts but had to stop as they made me sick. I developed a bladder problem about a week ago and feel like I have to go all the time. Urine test clear and no UTI. My doctor did blood work and a transvaginal/transabdominal ultrasound. Results uterus measures 7.7 cm length, 3.6 cm ap diam, 5.2 cm transverse diam. Right ovary 3.5 x 2.2 x 3.1 cm left ovary 3.2 x 0.9 x 1.8 cm. Within right ovary there is a collapsing 2.3 cm cyst. No significant ovarian abnormality with follicles present bilaterally. No fluid in the pelvic peritoneal space. Uterine fibroids measuring 2.7 cm at the left lateral body of the uterus and 0.7 cm at the posterior upper body of the uterus. Endometrial stripe is 8 mm. Uterine biopsy is set for 12/1. Blood work came back fine but he did not do a CA 125. He said they are not very accurate and since I have no history of OC he felt he did not need to do. I still have low back pain and pelvic pain and feel like my bladder is constantly full. No prior bladder problems. What do these results mean and assuming the biopsy comes back ok where would you recommend I go from here? Thank you so much for your time.

[Annekathryn Goodman, M.D.]

Hi There,
thank you for the complete history. It sounds like you are having a perfect evaluation. The biopsy of the lining of the uterus is important. It most likely will be normal but it is important to check because about 5 percent of all women with a cancer of the uterine lining (endometrial cancer) are younger than age 40 and 25 percent of endometrial cancers occur in premenopausal women. Therefore any abnormal bleeding need to be evaluated by a biopsy.

However, the most common reason for abnormal bleeding is an imbalance of the ovarian hormones, estrogen and progesterone. This is called DUB (dysfunctional uterine bleeding) and is treated by birth control pills, progesterone alone, and sometimes metformin. Metformin is a diabetes drug but some hormonal imbalances are due to a complicated condition called PCOS (polycystic ovarian syndrome)which may have an underlying association with insulin resistance.

Sometimes a well placed fibroid can distort the uterine cavity and cause heavy bleeding. I do not think there is presently any evidence to suggest that your symptoms are from a growth or tumor in your ovaries.
best wishes to you

[lhynce]

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