OpenHealth Q&A

Could Severe Pain Really Just Be Period Issues or PCOS?

**THE ISSUE:** As a 30-year-old female, I am grappling with intense pain that seems to be linked to my menstrual cycle and possibly my digestive system. Historically, I’ve dealt with uncomfortable cramps during my periods, but the severity has notably increased over the past five years. I’ve hesitated to confront this problem, but the intensity of the pain has reached a level that cannot be ignored; it feels like something is seriously wrong with my body. Finding a diagnosis has proven to be quite challenging. Every general practitioner I’ve consulted and all tests I’ve undergone offer little clarity, and I worry I haven’t adequately conveyed the severity of my situation to them. While I intend to secure another GP appointment shortly, I’m seeking insights from the community to assist me and the doctors. What could be the potential causes of my discomfort? I’d characterize the pain as a “cramping pain”—a medium to high level of consistent discomfort with sharp spikes in intensity. At its peak, the pain can reach an 8.5 on a scale where 8 signifies groaning, 9 equates to screaming, and 10 means extreme agony. If I were to unexpectedly experience such a pain, I would likely rush to the hospital. The pain is concentrated in the area between my belly button and vulva, primarily towards the center and right side, sparing the left. When it intensifies, it radiates to my hips, upper thighs, and especially affects the muscles connecting my vulva to my legs. Occasionally, about every two months, a sharp, electric-like pain jolts down my vagina. **TIMING OF THE PAIN:** This discomfort typically arises during my menstrual period or up to two weeks afterward, but its timing is unpredictable. It seems to be less tethered specifically to my period than it used to be, making it increasingly difficult to anticipate. The pain generally escalates within 15 to 30 minutes and can last anywhere from 30 minutes to a couple of hours before subsiding. It has never persisted throughout the entire day and does not occur in the morning, only appearing between midday and night, sometimes awakening me from sleep around 2:00 AM. I’ve observed that it often starts about two hours after eating, yet it can also strike randomly. Furthermore, if the discomfort is already present, eating—especially a substantial meal—tends to exacerbate the pain. **MY MEDICAL HISTORY:** For the past 8 to 9 years, I have been using a ParaGard copper IUD for birth control. While it significantly worsened my cramps during my period initially, those symptoms had been confined to specific times at the start. I would have considered alternative birth control methods without hormones, as I prefer to avoid altering my hormonal balance unnecessarily. My menstrual cycle usually averages around 27 days, although it varies greatly between 22 and 33 days, with no missed periods to date. A recent blood test showed low levels of MCV, MCH, neutrophils, lymphocytes, and basophils, while my ferritin was moderately low and SHBG level moderately high. I take iron and sometimes multivitamins, and I apply EpiDuo cream to manage acne, which I believe predominantly relates to hormonal factors and partly to oiliness. Physically, I am of average height, Caucasian, and generally lean. My mother has developed Ehlers-Danlos Syndrome as she aged and has also been diagnosed with PCOS. I suspect several of her sisters may have PCOS as well. Considering that PCOS seems likely to be the underlying issue for my pain, I want to highlight that: - I have an inherited tendency to grow excess body hair, including noticeable chin hair that began appearing in my mid-to-late 20s. - My hair is thick, but I notice significant shedding and a receding hairline. (If my pain is indeed solely attributable to PCOS, then it is certainly the most severe case I’ve ever heard of.) I find it relatively easy to gain weight when I overeat, but I can also shed pounds reasonably quickly by eating healthily and staying active. My profession involves a lot of sedentary work. I consume alcohol socially, less than three times a month, and have never experienced blackouts. Furthermore, I do not smoke, vape, or use recreational drugs. I have never been pregnant or attempted to conceive, and I have no known allergies. My surgical history is limited to mole excisions for skin cancer prevention, and I have never been hospitalized. Other symptoms that may be connected, though they could be entirely separate, include: - A consistently slightly bloated abdomen relative to the rest of my frame. - A mild increase in gas compared to the past. - A tendency to feel full more quickly than is typical but also to get hungry soon after. - Occasional spotting between periods, which began about five or six years ago, marked by old-looking blood. - An increase in vaginal discharge over the years and a notable uptick recently. - Experiencing thrush for the first time less than a year ago due to a damp environment from sports training, which I successfully treated with a doctor’s prescription. It has recurred mildly a couple of times since, but I managed to resolve it after a week of treatment. **EXPERIMENTS AND TESTS CONDUCTED:** When the pain peaks, I find myself immobilized momentarily until it subsides. Curling up in a fetal position tends to worsen the sensation rather than alleviate it. Heat packs can be somewhat soothing, and occasionally cold packs help, but neither approach provides significant immediate relief. If I respond promptly with three ibuprofen pills as soon as the first pang hits, I find relief; however, two pills do not suffice, and Ponstan (mefenamic acid) has been ineffective. A general practitioner once suggested that the discomfort might stem from inflammation associated with my menstrual cycle and prescribed Ponstan to be taken six times daily starting seven days prior to my period until a couple of days into it. However, due to the unpredictable nature of my cycle, I often start Ponstan late and sometimes forget to take it three times a day. Although I believed Ponstan might help initially, it is difficult to determine its actual efficacy, especially with the pain continuing even post-period. About three years ago, I underwent a blood test for PCOS, but the results were inconclusive. I had an ultrasound a couple of years back, aimed at checking for potential endometriosis; however, nothing significant was detected—though I was informed that this does not rule it out entirely, which was frustrating, especially after a $400 expense. I have also completed STD screenings (for HIV, syphilis, and hepatitis B/C) to eliminate those possibilities, but nothing unusual presented itself, partly because my partner and I maintain a monogamous relationship. Furthermore, my thyroid (TSH) levels came back normal. With all this background in mind, I would greatly appreciate any assistance or insights from others regarding possible diagnoses. Thank you for your input!

Answers (1)

2/10/2026, 12:01:20 AM

OpenHealth AI

It sounds like you're experiencing significant and debilitating pain, particularly related to your menstrual cycle, and you're understandably seeking answers. Your symptoms suggest a complex interplay between potential gynecological and gastrointestinal issues, and it’s great that you’re planning to discuss these challenges further with a healthcare provider.

Main Points

1. Possible Causes: Your symptoms could be linked to conditions like endometriosis, PCOS, or gastrointestinal issues such as irritable bowel syndrome (IBS).
2. Diagnosis Steps: It's important for you to keep tracking your symptoms closely to provide detailed information to your next healthcare provider.
3. Immediate Self-Care: You might benefit from keeping a symptom diary, managing diet, and considering a more consistent pain management plan.

Explanation

The pain you're experiencing, particularly the cramping and the location you describe, could be indicative of several conditions often encountered in women, especially those related to reproductive health like endometriosis and polycystic ovary syndrome (PCOS).

• Endometriosis: This condition involves tissue that behaves like the endometrial tissue growing outside the uterus, leading to severe pain, especially during menstruation. It's possible to have endometriosis without visible signs on an ultrasound.

• PCOS: Characterized by hormonal imbalances, PCOS can lead to irregular periods, weight gain, and sometimes pain related to ovarian function or inflammation.

• Gastrointestinal Factors: Symptoms such as bloating, gas, and changes in appetite could suggest issues like IBS, which can coincide with menstrual cycles.

Next Steps

1. Symptom Diary: Document your symptoms meticulously, noting the timing, intensity, and any associated dietary intake. Include any patterns you observe, like the connection between eating and pain onset. This information can be invaluable during your next appointment.

2. Dietary Adjustments: Consider tracking foods that might exacerbate your discomfort (e.g., dairy, gluten, heavy meals), particularly around your menstrual cycle. Eating smaller, more frequent meals might also help in managing your symptoms.

3. Pain Management Strategy: Since ibuprofen is somewhat effective for you, try establishing a routine that incorporates it at the first sign of pain. You might also consider alternative pain relief strategies, like acupuncture or certain relaxation techniques like deep breathing or meditation to help manage pain during flare-ups.

4. Follow-Up on Tests: When you visit your healthcare provider, discuss your symptom diary and the ongoing pain. You may inquire about additional assessments for endometriosis (such as a laparoscopy) or further testing for PCOS markers.

5. Consider a Specialist: If you haven't already, think about seeking an appointment with a gynecologist specializing in reproductive health issues or a pain management specialist to explore other options beyond general practitioner visits.

Taking proactive steps with the documentation and dietary management will be empowering for you and can provide clearer insights for your healthcare providers. Remember, your concerns are valid, and pursuing the right care is crucial. Please reach out if you need more support or have further questions.