Post-Miscarriage Pain and Ovarian Cysts: Seeking Answers and Relief

After a miscarriage, pain, ovarian cysts?

Hello, doctor.
I would like to ask you a question.
When I was 12 years old, I underwent surgery for an ovarian chocolate cyst, and my right ovary was removed.
At the same time, I also had a uterine suturing procedure due to uterine fibroids.
Last year, I finally managed to get pregnant, but I unfortunately miscarried at just over six weeks, experiencing an incomplete miscarriage with heavy bleeding, infection, and fever.
Initially, I had continuous bleeding and was in severe pain despite taking uterotonics, which caused excessive sweating.
I went to the emergency room, where the doctors suggested considering traditional Chinese medicine to help with uterine contractions due to my adverse reactions to the medications.
After switching to Chinese medicine, I had my first menstrual period about a month later.
However, this menstrual cycle lasted around 12 days, and while I was relieved it finally stopped, I started experiencing lower back pain that affected my mobility, along with pain in my lower abdomen and belly.
I returned to the obstetrics and gynecology department for a follow-up, and the doctor found a 2.5 cm cyst on my ovary.
Will this cyst affect my chances of conceiving next time? The doctor also mentioned that my endometrium is still too thick.
After all this time and bleeding, how can my endometrium still be too thick? I am quite puzzled.
The doctor later suggested that there might be some infection or inflammation causing my lower abdominal pain and prescribed me antibiotics, stating that I need to be monitored for three months and to return if I have any issues.
However, after taking the medication, I developed a fever again three days later.
I consulted an infectious disease specialist, and after blood and urine tests, they found no signs of infection.
Yet, I still experience persistent pain in my abdomen and lower back (the pain seems to shift around my lower abdomen, sides, lower back, buttocks, and upper back).
The doctor suggested arranging for an abdominal ultrasound, but I noticed that sneezing still causes pain in my lower abdomen.
The tests have not revealed any clear cause, and the pain persists.
Is this related to the infection that occurred after the miscarriage? Do you have any suggestions, doctor? I am very distressed as I have not found relief.

JJ, 30~39 year old female. Ask Date: 2016/03/24

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, it is likely not closely related to last year's miscarriage; it may still be due to inflammation.
If you continue to feel unwell, I recommend visiting a hospital to see an obstetrician-gynecologist.
Wishing you good health.

Reply Date: 2016/03/24

More Info

I'm sorry to hear about the challenges you're facing after your miscarriage and the subsequent health issues. It sounds like you've been through a lot, and it's understandable to feel frustrated and concerned about your health.

Based on your description, it seems that you are experiencing a combination of symptoms that could be related to several factors, including your previous surgeries, the miscarriage, and the potential development of ovarian cysts. Here’s a breakdown of the issues you mentioned and some insights that may help you understand your situation better.

1. Ovarian Cysts: The 2.5 cm cyst on your remaining ovary could be a functional cyst, which is common and often resolves on its own. Functional cysts typically do not affect fertility unless they are large or cause significant pain. However, if the cyst is persistent or growing, further evaluation may be necessary. It's essential to follow up with your gynecologist for monitoring and to discuss any concerns regarding how this might affect future pregnancies.

2. Thick Endometrial Lining: A thickened endometrial lining can occur after a miscarriage, especially if there was retained tissue. This could lead to prolonged bleeding or irregular menstrual cycles. Your doctor may recommend a follow-up ultrasound to assess the endometrial lining and ensure that it is returning to normal. In some cases, a procedure called dilation and curettage (D&C) may be necessary to remove any remaining tissue.

3. Post-Miscarriage Pain: The pain you are experiencing could be multifactorial. It may be related to inflammation or infection following the miscarriage, especially if you had a retained product of conception. The fact that you experienced fever and ongoing pain suggests that there might have been some inflammatory response. Even if tests for infection came back negative, inflammation can still cause significant discomfort.

4. Chronic Pain: The "shifting" nature of your pain—moving from the lower abdomen to the back and sides—can be indicative of several conditions, including pelvic inflammatory disease (PID), endometriosis, or even referred pain from gastrointestinal issues. It’s crucial to communicate these symptoms to your healthcare provider, as they may warrant further investigation.

5. Follow-Up Care: Since you are still experiencing pain and discomfort, it is essential to keep an open line of communication with your healthcare providers. If your symptoms persist or worsen, consider seeking a second opinion or asking for a referral to a specialist, such as a reproductive endocrinologist or a pain management specialist.

6. Lifestyle and Support: Managing stress and ensuring you have a support system in place can also be beneficial during this challenging time. Consider discussing your symptoms with a mental health professional, as emotional well-being is closely tied to physical health.

In conclusion, while some of your symptoms may be related to the aftermath of your miscarriage and the surgeries you've had, it is essential to continue working with your healthcare team to monitor your condition. Regular follow-ups, imaging studies, and possibly further diagnostic procedures will help clarify the situation and guide appropriate treatment. Remember, you are not alone in this, and seeking help is a vital step toward recovery.

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