What tests are needed to check the ovary pain causes at 33?

Question

Hi doctor,

I am a 33-year-old female, and I have had three c-sections and normal, regular periods. My menstrual cycle three months back was short and lighter, and I ovulated about a week early. I noticed some pain, which almost reminded me of implantation pain. This continued on and off with pain and twinges. I thought maybe I was in the early stages of pregnancy. Then I started having pelvic pain and lower left ovary area pain, which continued throughout the week. When I would push to have a bowel movement, it would hurt.

I really thought I was pregnant. The fullness and achiness reminded me of early pregnancy. My most recent period was three days late. I went in and saw my OB yesterday. He did an exam and a transvaginal ultrasound, and he said everything looked fine. He tried to recreate the pain by touching some spots. Ever since then, my left ovary pain has been through the roof. What is going on?

I am terrified I have ovarian cancer.

Would he have been able to tell yesterday?
What else could be going on?

It hurts right around the ovary area and in the groin crease area.

Kindly guide.

Answer 1

Hi,

Welcome to icliniq.com.

After undergoing three cesarean sections, it is quite possible to have intra-abdominal adhesions, which may give rise to intermittent pain associated with bowel movements. The pain that you experienced could be mid-cycle ovulation pain. As you have undergone a transvaginal ultrasound and examination by a gynecologist, and you have been told that everything is fine, that means nothing to worry about.

Whatever pain you are experiencing now after a pelvic examination does not mean you have ovarian cancer. This pain could be just coincidentally happening or may be due to intraperitoneal adhesions, as I mentioned earlier. In my opinion, it will go away with painkillers like tablet Dicyclomine 20 mg and Paracetamol 500 mg, thrice a day for three days.

Hope your bowel habits are regular and you do not have a problem of sticky stools. As there are multiple organs inside an abdomen, other causes of such pain should be ruled out.

I hope this advice helps you.

Take care and get back to me if needed.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

The differential diagnosis would be as follows:

1) Pelvic inflammatory disease.

2) Colitis.

3) Appendicitis.

4) Sprain.

Try taking painkillers; if there is no relief, then you might consider taking an antibiotic course.

I hope this helps.

Thank you.

Answer 3

Hello,

Welcome back to icliniq.com.

From the examination and sonography, your gynecologist would have been able to tell you whether you have any ovarian mass. A cancerous or non-cancerous mass cannot be just predicted from examination and ultrasound. Further blood tests like CA (cancer antigen) 125 and a CT scan of the abdomen and pelvis are required to complement the suspicion of cancer.

In your case, your gynecologist did not find any ovarian mass or swelling. So, he did not ask for any of these tests. Thus, ovarian cancer is unlikely. For your knowledge, ovarian cancer does not give rise to pain. In fact, ovarian cancer causes the ovaries to swell up with a mass and goes unnoticed till the third stage, unless it causes nausea and loss of appetite.

From my clinical acumen, previous surgeries that are cesarean sections might be responsible for intraabdominal adhesions. After exercise, stretching of the abdomen or even after pelvic examination, became a little disturbed and started giving pain. So, I had asked you to take painkillers. Also, try to avoid strenuous activity and exercise at least till pain settles. If a painkiller does not help, then please visit a gynecologist for further evaluation of pain.

Take care.

Feel free to reach out in case of further queries.

Thank you.