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Endometrial thickening with hemmorhagic cyst

Hi, I am 26 years old and a nullipara, currently working on my nursing degree. I have suffered from back pain for several years and have always had extreme mentrual cramps that exacerbate by back pain 10 fold. In 2004 I had a pelvic laparoscopy done to rule out endometriosis (maternal family history). Incidentally, an infarcted cyst (approx: 2mm x 6 mm) on my fallopian tube was removed. My cramps and periods improved significantly. However, in the last 2 years they have come back with a vengance. I have lost 25 pounds in 1 month putting me at 69" and 120 lbs. I am eating 2500+ calories per day and quit exercising except for mild walking and the weight is falling off. Because of my history of back pain, I have had 11 CT scans as well as numerous xrays and a bone scan trying to discover the cause of my pain. I had an ultrasound performed yesterday which revealed mild thickening of the endometrial stripe and a hemorrhagic cyst approximately 1 cm on my right ovary. My CMP, CBC, and TSH were normal. I have a history of an abnormal PAP with the high risk strains of HPV ID'd 4 years ago. I have since had normal paps after the colpo. I am very concerned about ovarian or uterine cancer (I know its rare in 26 year olds). The doctors working up my back are considering surgery and I do not want to have the wrong thing fixed. If this tiny cyst coudl be a contributing factor I woudl rather fix that. My husband and I both want to try for children in the next year but afraid to due to my pain level and this new development. What are your thoughts? (Sorry so lengthy)
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603463 tn?1220630455
It is actually pretty UNlikely that the cyst is causing the pain.  One way to find out for sure is to have a follow up ultrasound done in 4-6 weeks.  In the vast majority of cases the cysts have resolved by then, and if the pain has not, you know it wasn't the cyst.
You may want to consider repeating the laparoscopy.  It is certainly possible that you had very mild (invisible to the naked eye) endometriosis in 2004 which has since progressed.  If you do have endometriosis, having laser surgery might not only help the pain, but also improve your fertility.  They could double check the ovaries at the same time.  Another option would be an empiric trial of depot Lupron.  This is a GNRH agonist which shuts down your hormone levels (temporarily) and helps "dry up" endometriosis.  With some of my patients who would prefer to avoid surgery, we try the medication to see if it works, and if so, we assume that it is endometriosis.

Long question, long answer!  ;)
Good luck!
Dr B
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