fluid in pelvic area

[mariemomof4]

My daughter is 16, not sexually active, very athletic and in good health.  Approx 2 1/2 months ago she started complaining of "cramps",  I brushed it off thinking menstrual cramps.  After her period was over she continued to complain of cramps and stated they were getting worse.  When her period came the following month she was in severe pain, (lower abdomen/pelvic area) period was heavy, lasted 10 days, and she complained of increased urination.  I made an appt with gyn and she ordered urinalysis and ultrasound (I suspected a cyst on her ovary).  Was told that both tests were normal.  My daughter continued to complain of pain stating it was getting worse.  I took her to another dr who ordered CT scan of abd adn pelvis.  This came back showing fluid in pelvic area. Dr referred us to GI specialist who performed colonoscopy. To make an extremely long story short.  My daughter has been complaining of this lower abd pain for almost 3 months now.  She says is ranges to mild cramping to sever stabbing pain and it is there on a daily basis.  She has increased urination, decreased appetite, fever off and on, bouts of nausea, abnormal periods (last one was 2 weeks late, lasted over 10 days, passing lg clots).  If she had a cyst on her ovary wouldn't it have shown on the US and CT scan?  If it ruptured causing the fluid that was shown on CT scan wouldn't the pain have gone away?  She is going through test after test and everything is coming back  'normal'  I'm at a loss as to what to do.  She has tried Tylenol, ibuprofen, Bentyl, levsin, warm cloths to abdomen.  Nothing is helping.  Can you offer some insight?  Thank you in advance.

[Keith Downing, MD]

Hello,

I'm sorry your daughter has been having such a difficult time.  It sounds like your daughter has had a thorough work up.  One thing I have to mention is that despite your belief that she is not sexually active I'd make sure a pregnancy test (urine or blood) has been performed.

One thing you haven't mentioned is adolescent endometriosis (a condition that occurs when tissue similar to the inner lining of the uterus is found in the pelvis).  This can result in pelvic pain, including bladder symptoms and pain with bowel movements (you and your daughter can visit www.youngwomenshealth.org for more info).  

I suggest you have your daughter see (if she hasn't already) someone who specializes in adolescent gynecology.  If it turns out the origin of her symptoms are gynecologic in nature, a trial of the birth control pill will likely be helpful (and can be helpful for endometriosis).

Lastly, I want to encourage the both of you to have patience.  Pelvic pain can be a very challenging condition to diagnose and adequately treat.  Try to stay encouraged.

Best regards,

Dr. Downing

[mariemomof4]

Thank you for your response.  I followed up with another gynecologist and took all of my daughters records with us.  It appears that on her very first US it shoed she had several lg cysts adn follicles on both ovaries.  The doctor put her on darvocet for the pain and a high estrogen bc pill.  My question now is how long will it take the bc to work for the pain?  My daughter is absolutely miserarble.  She is usually very energetic and active in sports but doesn't want to do anything because she states she's not feeling well.  She said the pain pill just numbs the pain to make it tolerable but doesn't take it away completly and around 1-2 hours before she is allowed to have another one she complains of severe pain. She quit running (she was an avid runner and went to state for the past 2 years and colleges are looking at her for scholarships) she says that running makes it hurt more.  All she want to do is lay around the house.  Would it be reasonable for me to request her dr do a laparoscopy now to remove the cysts and explore to make sure there is nothing more or should I wait out the bc cycle?  Thank you so much for your guidance and information.