Do I need a new referral?

[Omieliz]

I am a 37 year old woman and started menstruating when I was 13 years old.  I have have had one pregnancy that was carried to full-term with a live birth fifteen years ago.  Until recently, I have always had regular menstrual cycles every 28 days (except with pregnancy and when I took the Depo Provera shot for three years).  I haven't had a period since July 5, but I have had vaginal discharge with blood and occasional "spotting."  I have been experiencing severe fatigue for since May. I assumed I was starting menopause.  Consequently, my doctor orderd blood work, a pap smear, and ultrasound.  My pap smear was normal.  The full metabolic blood panel was normal.    I am not pregnant (and have been abstinent for almost two years).   Both the pelvic ultrasound and transvaginal ultrasound showed cysts on both ovaries, on the cervix, and in the vaginal wall.  Additionally, my uterus was "large" and had a thick lining with a fluid sac (that is normally associated with early pregnancy, but not in my case, since I haven't had intercourse in nearly two years, I've been told it's just a fluid sac).

My regular doctor referred me to the OBGYN because of the ultrasound and lack of menstruation/irregular bleeding.  The OB checked my hormone levels and insulin levels to see if I had PCOS. My hormone levels are normal. My insulin levels are normal. She has ruled out PCOS. She has ruled out menopause.  I've been taking progesterone for 6 days and nothing has happened. I'm supposed to take it for 10 days.  Other than feeling bloated, fatigue, occasinal lower back pain/and pelvic pain, I have no other symptoms.

I'm not sure if I should get a new referral? Request a biopsy?  Is this normal?   Please advise. Thank you!

[cirella]

Hi Naomi,
I'm glad to read you're getting a 2nd opinion.  If your insurance gives you a difficult time, tell them it's a 2nd opinion.  You are allowed that.

Take care!

[Omieliz]

One last thing...I've been taking medroxyprogesterone, I'm not sure if that makes a difference in the dosage or not, will ask the GYN.

Naomi

[Omieliz]

Thank you, again, all of you.  I will call my insurance provider tomorrow and see if I can get a referral  for a new GYN visit.  I'll keep everyone updated as to the results.

Thanks for caring!
Naomi

[cirella]

oh my goodness....just looked back through my posts to see what the dosage of progesterone was.  It was 400 mg.

[cirella]

Hi Naomi,
I am trying to remember my dosage of progesterone.  I know it was way more than 10 mg.  Something like 200 mg, I think.  I had to take it at night b/c it caused drowsiness.  I think you need to talk directly to the doctor, too.  I don't like the short answers you're getting from the PA and certainly the answers aren't satisfying you.  With all your symptoms you really need the doctor to look through your information and sit with you and talk.  A cyst of either 6 or 8 cm is big, not normal sized.

If your doctor isn't willing to give you the time you need then I'd get a second opinion elsewhere.

Good luck and hang in there.
L

[Sharon2714]

i have advised this before ... do not leave the building until u do see the gyn ... stage a sit in if u have to ... if they try to move u say, "sir unhand me." AND wait ... or get a second referral that will work too ... i am concerned with the size of the cysts if the measuremets were in cm's and also concerned with the ones around the vagina and cervix because thats where some of my sisters cysts were
i am 43 and was premenopausal when my periods stopped ... my ca-125 was 126
post op the path came back 1C serous borderline tumors with noninvasive peritoneal implants (basically a cancer that behaves in both a benign and malignant fashion) ... post op my ca-125 was 18 ... the reason i mention this is that in my case it was a reliable indication of the grade of the tumors and the "surgical cure" of the disease
i pray u the best
love
sharon

[Omieliz]

Hello L,

I'm trying to remember the dimensions of the cysts.  I think one is supposed to be 3 and the other is a 6 or an 8. I'm honestly not sure if it's mm or cm. I'm sorry.  I really feel like an idiot when it comes to my own medical health.   I remember the tech telling me during the transvaginal ultrasound that the one on the left is small, but the one on the left looked "arge" and she asked if I ever felt pain in that area.  I really haven't felt pain, just the symptoms I described earlier.  When I asked the PA about the cysts she says "they're normal size."   I asked her for a CA-125 test and she said that "they're not reliable."

The Progesterone is 10 mg and I just finished day 9...still, absolutely nothing.  I feel and look really bloated (but have been feeling bloated for over a month).  I have an upset tummy, but that's not uncommon for me when I take hormones.

I will let you know when I go back to the GYN.  This time, I'm going to make sure to see the GYN himself.  

I really appreciate your help!
God bless,
Naomi

[cirella]

Hi Naomi,
The way you are describing the pinching feeling was what I would feel when I had the cyst.  Kind of like a pinch/pulling feeling.  I don't remember it while taking the progesterone, sorry.  Do you know how big your cysts are?  It may be that they are hitting a nerve or twisting a bit.  I'd keep track of it.  

I'm surprised she told you that if you don't have a cycle in 3 weeks to call.  I'd think that if you don't start after the progesterone you should call.  That is the reason you're taking it.  What dosage are you on?  I think, b/c you said it's a 10 day rx, that it's a higher dosage to get you going.

I hope that helps.  = )
L

[Omieliz]

Thank you for your responses.  The PA (at the OBGYN) said we're going to "wait and see" what happens.  She told me if I have any severe pelvic pain (from the cysts), to go to the emergency room. She indicated that if I don't have a cycle in three weeks, to contact the office again and they will schedule another transvaginal ultrasound.  

I'm trying not to worry.  Because she has ruled out PCOS and menopause, she thinks my "stressful job" is effecting my cycle.  I'm hoping that's the problem, but I've been under a lot more stress then the present, and I've never had a problem before.

I have a question for Cirella:  When you took progesterone, did you have any quick sharp tingling sensations in your ovaries?  Mine have been feeling kind of achy (like they're ovulating), but then there's a sharp tingly sensation that comes and goes.  It's kind of like a sharp pinch and then it goes away...Did you experience this from the progesterone?

Thank you!
Naomi

[cirella]

Hi, Your doctor may have you on the progesterone so that you can have a cycle and then see what the cysts do.  I had to take progesterone 2 times and the first time I didn't start bleeding until the 7th day and the 2nd time it was after the 10th day.  I have to tell you that you will probably bleed quite heavily and there may be lots of clots.  Be ready.  I just went to bed...no use in wearing pants.  LOL

It's good that your blood work has come back normal.  Have you been scheduled for another transvaginal ultrasound or did they ask you to call to make an appointment when you start bleeding?  I would think this would be the next step.

Try to wait without worrying.  Keep us posted.

[tgal]

I don't have any knowledge with your condition but I can say that if you are not happy with your doctor (specialist or primary care) it is always your right as a patient to request a new specialist. I also know a friend who had extra lining and needed a D and C. Perhaps this could work for your situation if milder treatments do not work first. Good luck and keep us posted. - Tanja