Lower Abdominal Pain and Bloating: Possible Causes and Concerns

Lower abdominal swelling and pain, concerns regarding pregnancy and discharge?

From late February to mid-April, I had several instances of unprotected sexual intercourse with withdrawal.
A few times, I later realized it was during my fertile period (confirmed on March 25, during which unprotected withdrawal occurred).
My usual menstrual cycle is 34 days, but in April, it suddenly changed to 31 days.
A few days after it ended, I noticed abnormal spotting.
From late April to early May, I used a pregnancy test twice, both of which were negative.
My period also arrived, but in July, I frequently experienced pain in the lower left abdomen and the upper middle abdomen, along with abdominal distension.
My cycle suddenly became delayed, extending to 36 days.
From February to July, my weight remained between 43-45 kg (my lower abdomen is quite protruded, feels somewhat hard when standing straight but can be pulled in; when bending over, it becomes soft and appears as three layers of fat).
I visited a gynecologist for a pregnancy test, which was negative, and a transvaginal ultrasound revealed adenomyosis, with my uterus being larger than that of someone who has not given birth (I had a dilation and curettage in late February 2016; could this have caused the enlarged uterus?).
I also found some cervical erosion.
Do I need to have a Pap smear? I tend to have a lot of discharge and have frequently experienced itching in the genital area due to Candida albicans causing inflammation.
This recurred during the period from February to April.
On July 23, a urinalysis indicated a urinary tract infection.
After completing antibiotics, my lower abdomen remains distended and painful.
I want to know if I can be certain that I am not pregnant.
I have seen doctors multiple times, and they all suggested that the abdominal pain and distension might be due to a urinary tract infection.
However, after finishing the antibiotics, my lower abdomen is still distended and painful (I have also consulted a gastroenterologist with no issues found).
They advised me to return if I still feel unwell after my next period.
I would like to ask if the abdominal distension and pain are related to adenomyosis, inflammation caused by Candida albicans, and cervical erosion.

Niming, 20~29 year old female. Ask Date: 2018/08/13

Dr. Huang Jianzhong reply Obstetrics and Gynecology

From late February to mid-April, I had several instances of unprotected sexual intercourse with withdrawal.
A few times, I later realized it was during my fertile period (confirmed on March 25, during which unprotected withdrawal occurred).
My usual menstrual cycle is 34 days, but in April, it suddenly changed to 31 days.
A few days after it ended, I noticed abnormal spotting.
From late April to early May, I used a pregnancy test twice, both of which were negative.
My period also came, but in July, I frequently experienced pain in the lower left abdomen and the middle upper abdomen, along with abdominal distension.
My cycle unexpectedly became 36 days.
From February to July, my weight remained between 43-45 kg (my lower abdomen is quite protruded, feels somewhat hard when standing straight, but I can engage my core; when bending over, it becomes soft and appears as three layers of fat).
I visited a gynecologist for a pregnancy test, which was negative, and a transvaginal ultrasound revealed adenomyosis, with my uterus being larger than that of someone who has not given birth (I had a miscarriage at the end of February 2016; could this have caused my uterus to be enlarged?).

Answer: A history of miscarriage does not cause uterine enlargement.
It was also found that I have mild cervical erosion.
Do I need to have a Pap smear?
Answer: Given that you have had several instances of sexual intercourse, a Pap smear is recommended.
I tend to have a lot of discharge; last year, I frequently experienced itching in the genital area due to a Candida infection.
This recurred during the period from February to April.
On July 23, a urine test indicated a urinary tract infection.
After completing antibiotics, I still have abdominal distension and pain.
I want to know if I can be certain that I am not pregnant.

Answer: From late February to mid-April, you had several instances of sexual intercourse, and you tested for pregnancy at the end of April to early May, with both tests returning negative, and your period also arrived.
This confirms that you are not pregnant.
I have consulted with doctors multiple times, and they have indicated that the abdominal pain and distension may be caused by a urinary tract infection.
However, after completing antibiotics, I still have abdominal distension and pain (I also consulted a gastroenterologist, and there were no issues).
They advised me to return if I still feel unwell after my next period.
I want to ask if the abdominal distension and pain are related to adenomyosis, the inflammation caused by Candida, and cervical erosion.
Answer: The abdominal distension and pain are related to adenomyosis.

Reply Date: 2018/08/13

More Info

Understanding lower abdominal pain and bloating can be quite complex, especially when various factors such as menstrual cycles, potential infections, and underlying conditions like adenomyosis come into play. Based on your detailed description, it seems that you have been experiencing a range of symptoms that could be interconnected.

Firstly, let's address the potential causes of your lower abdominal pain and bloating. Adenomyosis, which you mentioned was diagnosed through a transvaginal ultrasound, occurs when the tissue that normally lines the uterus (the endometrium) grows into the muscular wall of the uterus. This condition can lead to symptoms such as painful periods, chronic pelvic pain, and bloating. The enlargement of the uterus associated with adenomyosis can also contribute to a feeling of fullness or pressure in the lower abdomen.

The irregularities in your menstrual cycle, such as the sudden change from a 34-day cycle to a 31-day cycle, followed by a 36-day cycle, can also be indicative of hormonal fluctuations. These fluctuations can be influenced by various factors, including stress, changes in weight, and underlying health conditions. It is not uncommon for women to experience changes in their menstrual cycles after a significant event, such as a pregnancy termination, which you mentioned occurred in 2016. This could potentially have long-term effects on your menstrual health.

Regarding the presence of abnormal bleeding or spotting, this could be related to several factors, including hormonal imbalances, the presence of adenomyosis, or even cervical issues such as cervical erosion (cervical ectropion). Cervical ectropion can lead to increased discharge and bleeding, especially after intercourse or during menstruation. It is advisable to follow up with your healthcare provider regarding the need for a Pap smear, especially given your history of increased discharge and previous yeast infections.

Your history of recurrent yeast infections and the recent urinary tract infection (UTI) could also contribute to your symptoms. UTIs can cause lower abdominal pain and discomfort, and if the infection persists or is recurrent, it may require further investigation. It is essential to ensure that the antibiotic treatment was effective and that the infection has cleared. If symptoms persist, further evaluation may be warranted, including a repeat urinalysis or imaging studies.

Given that you have been experiencing persistent symptoms despite treatment, it is crucial to maintain open communication with your healthcare provider. They may recommend additional tests, such as a pelvic ultrasound or even a hysteroscopy, to evaluate the uterine cavity and rule out any other potential issues.
In summary, your lower abdominal pain and bloating could be related to adenomyosis, hormonal changes, cervical issues, or recurrent infections. It is essential to continue monitoring your symptoms and to seek further evaluation if they persist or worsen. Keeping a symptom diary, noting the timing of your menstrual cycle, and any associated symptoms can be helpful for your healthcare provider in diagnosing and managing your condition effectively.

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