Dear Kennie: Given what you have shared, my best GUESS is that you do have a swollen right inguinal lymph node. The lymph nodes in the groin serve to fight infections in the pelvis and external genitals. Here is a direct quote of some causes of enlarged lymph nodes in the groin:
"Inguinal lymphadenopathy: this group of lymph nodes drains the lower abdomen, external genitalia (skin), anal canal, lower third of the vagina and lower extremities. Enlargement of inguinal lymph nodes up to 1 to 2 cm in size can be found in healthy adults. [2> In a diagnostic work-up, biopsy of inguinal lymph nodes has been shown to offer the lowest diagnostic yield. [16> Causes of inguinal lymphadenopathy include:
Cellulitis [skin infection--JHH>
Squamous cell carcinoma (metastatic from the penile or vulvar regions)."
Kennie, this quote is from a group associated with the British Medical Journal (BMJ). While the following link is targeted at healthcare providers, this BMJ article is a very thorough discussion of swollen lymph nodes:
As you can read in the article, most swollen lymph nodes in younger persons are NOT a sign of cancer. Given that your node is painful, I would urge you to see your MD or clinic so an exam can be done. They may want to do some basic blood work to rule out an infection as the cause.
The second approach would be to find a specialist in pelvic floor surgery. Another specialty group that does this are uro-gynecologists. This next link is to the American Urogynecologic Society which also has a "find a provider" feature: http://www.augs.org/
Finally here is a Cleveland Clinic site which features good over view information:
Dear missjennifer: Got it! In terms of medication approaches, you options might be: Mirena IUD with synthetic progesterone, DepoProvera injection, Provera pills taken continuously, progestin only mini-pill, and Implanon. An endometrial ablation (lining of the uterus is removed so hormones stay the same but there is little to no lining to respond with a flow) is a procedure that might be discussed.
Dang, it should be so much easier to get your BP down so you could continue with the NuvaRing that you are using successfully.
Dear An: Love your picturesque turn of phrase; are you a novelist or writer? Alas, breakthrough bleeding (BTB) can be a common side effect of most types of hormonal birth control (eg pills/patch/ring/DepoProvera shot/Mirena IUD). More remotely, BTB in a pill user can arise if she has gotten a chlamydia infection. Yet, if you both are monogamous this is not going to apply.
When a woman uses hormonal birth control it can make the lining of the uterus more unstable--so it is easier to have some of it begin to shed and continue to shed. Sometimes the lining is less stable because the hormones make the lining much thinner (actually this is good as a thin lining is a healthy lining). Sometimes the lining is unstable because the hormones can make parts of the lining out of synch. Depo does make the lining of the uterus thinner over time. Yet your BTB appeared rapidly so my best GUESS is that part of the lining is out of phase as the lining is "getting used to" the medication.
Bottom line, BTB on hormonal methods of birth control is a nuisance side effect. The protection from pregnancy is still in effect. Because you have been bleeding heavily for eleven days you should return to your GYN or clinic.Often a change in the type of contraception will fix the problem. With Depo specifically, BTB can sometimes get a temporary "fix" by giving a short course of low dose estrogen. I'm really sorry this happened to you. Sometimes Depo Provera will work perfectly and just eliminate periods---other times erratic bleeding will ensure.
Dear saltina: Once pregnancy is ruled out there are several POSSIBLE explanations for a "too-light" flow" in a woman not using hormonal forms of birth control:
1. Lowered estrogen levels--this is more likely to be the case in a woman around the time of menopause.
2. Elevated prolactin levels---prolactin is produced from the pituitary gland. Levels can be elevated from a benign pituitary adenoma or from certain psychiatric medications. Often women will notice nipple discharge along with too light flows--or missed flows.
3. Missed ovulations--with a missed ovulation the lining of the uterus does not shed all at once. This can result in a missed flow, a too-light flow (just part of the top layer is shed), or even prolonged/erratic flows. This is the most common cause. In your specific case, given the unusual cramping, an ovarian cyst MIGHT be the culprit.
Most important would be to rule out an undetected pregnancy (eg a tubal or ectopic pregnancy) with a very sensitive pregnancy test. If you can get test with a GYN or clinic they can also evaluate you for other causes of your too-light flow (eg ovarian cyst).
Dear minniemol/An_250615: Yes, this does not fit with the usual patterns. It would be interesting to know if the symptoms occurred while she was still on the BCP, or about 72 hours after taking the last active pill. It generally takes about 72 hours for the hormone levels from the BCPs to drop enough to trigger a withdrawal bleed ("pill period"). Surprisingly, even when she was using the progestin-only "minipill,"where active pills are taken continuously, the GERD ensued. What would happen if your daughter takes regular combined BCPs every day without a break so a period is avoided?
Dear An: Lets take each of your concerns in order, OK?
1. An IUD is a very reliable method of birth control, consequently miscarriages are infrequent. Even if one conceives with an IUD it will not always cause a miscarriage. In this scenario we usually recommend IUD removal to decrease any chances of a miscarriage accompanied by infection.
2. IUDs, even the infamous Dalkon Shield from the 1970's, do not cause infertility per se. If a woman has risks for a sexual infection (eg chlamydia or gonorrhea) the untreated infection can cause tubal scarring which can decrease fertility. This is why IUDs are suggested for women in monogamous relationships (low risk for sexual infections).
It has been calculated that perhaps 1,000,000 women per year will get a severe pelvic infection ("PID") of some type. Of those, an estimated 10% will develop infertility. One landmark study followed almost 1,500 women, of whom about 2/3 had confirmed PID as documented by a laproscope. Among the women with a PID history 7.8% had tubal occlusion where the tube was scarred closed. By contrast, a comparison group without PID had less than 1% tubal occlusions.
3. Given that an IUD is within the uterine cavity, it is not impacted by pressure on the abdomen. You also mentioned positional pain with intercourse. This MIGHT mean that your uterus is "tipped" slightly more forward or more to the back. Both positions are normal, but may have positional pain with certain intercourse positions. In terms of IUD use, a severely "tipped" uterus can sometimes make for a more difficult insertion procedure, but most GYNs are very competent to handle these normal variations in uterine position.
4. Gosh, you did not specify your four prescription medications. Most medications would not impact use of a Paragard IUD. The few exceptions I can think of would be blood thinners.
Given what you have shared, the most concerning elements of your history would be the abdominal pain issues. Some of this might be bowel related--or even bladder. Whilst an IUD should not directly impact these, if an IUD triggered worsened menstrual cramps, that could be perceived as worsened abdominal pains. I would urge you to take your important questions to your GYN or clinic. You are asking all the right questions, but the most "for sure" answer will come from someone who knows your entire health history. Fortunately there are many birth control methods from which to choose so if you decide the IUD is not for you, there are other options.
Deare amymo: Excellent question! A woman can have apparently regular flows and yet still not be having regular ovulations. How can this happen? In a cycle without an ovulation, estrogen stimulation (assisted by the hormone FSH ) will continue to make the lining of the uterus grow thicker and thicker. In the absence of a LH surge, no ovulation will occur. The progesterone level will not rise. When the follicle that contains the un-ovulated egg involutes the woman's blood estrogen level will drop. This triggers much of the lining to be shed. Thus if it takes two to three weeks for the follicle and un-ovulated egg to regress, the woman may have somewhat regular bleeds.
How often does this happen? In the first year after menstrual periods begin up to 55% of the cycles may occur without ovulations (Mansfield & Emans, 1984). In a study of 20-35 year old women who were had regular cycles but were infertile, an average of 30% of women were not ovulating. Among these 123 women with regular cycles the highest incidence of not ovulating was 41%. This highest incidence occurred among women who had never had a conception. Women who had at least one documented pregnancy had a lower incidence of non-ovulation despite regular periods (Hegab, 1987).
Lastly, the presence of very regular periods, accompanied by common premenstrual symptoms ("molimena") suggests an ovulatory cycle—especially when there are menstrual cramps. Yet this may not always be the case. In as many as 5% of these "classic for ovulation" cycles, ovulation may not have occurred (Speroff, 1999).
Bottom line amymo, other than a confirmed pregnancy the only other ways to document an ovulation are to do blood progesterone levels on cycle day 21, or to use ovulation predictor kits which measures for the LH surge. Even basal body temperature charting or watching for cervical mucus changes can have results thrown off by other physical issues (eg viral infection or elevated estrogen levels from PCOS).
Dear An: The bad reflux pain did not begin until she had been on a birth control pill (BCP) for "a couple of months". Since that time the pain and vomiting have been escalating and have historically occurred during her flow--especially the first day of flow. This pattern persisted even during treatment with a synthetic progestin only BCP which is taken every day without a break for inactive placebo pills. Hope I am tracking correctly.
IF the above is true then I would likely concur with her MD that synthetic progesterone is not the most probable culprit. She has been exposed to some type of synthetic progesterone ever since starting BCPs (except when she was taking placebo pills). In terms of a low dose progesterone BCP, the progestin only "mini-pills" typically have about one third the amount of synthetic progesterone found in "regular" BCPs.
It is compelling that this seems to be triggered by the onset of her flow. The GI symptoms might be related to prostaglandins. Prostaglandin release may start prior to the onset of flow and usually last 72 hours. There are also receptor sites for prostaglandins in the bowel and central nervous system. Thus prostaglandins can produce not just cramps but also nausea/vomiting, diarrhea, headaches, and other "flu-like" symptoms. Ways to block prostaglandins can include BCPs, or anti-prostaglandin drugs (eg ibuprofen, naproxen sodium, ketoprofen, etc.)..It is odd that her symptoms have apparently been worsened, not improved with BCPs.
Multiple lit searches at the National Library of Medicine site yielded one citation about GERD and hormones:
Gastroenterology. 2008 Apr;134(4):921-8.
Postmenopausal hormone therapy as a risk factor for gastroesophageal reflux symptoms among female twins. Nordenstedt H, Zheng Z, Cameron AJ, Ye W, Pedersen NL, Lagergren J. Source
Unit of Esophageal and Gastric Research (ESOGAR), Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. firstname.lastname@example.org
Female sex hormones have been suggested to increase the risk of gastroesophageal reflux symptoms via a relaxing effect on the lower esophageal sphincter. We investigated the relationship of oral contraceptives and postmenopausal hormone therapy (HT) to risk of reflux symptoms, controlling for genetic factors and body mass. METHODS:
Information on exposures and reflux symptoms was obtained by telephone interviews conducted in 1998-2002 among women in the Swedish Twin Registry. Use of oral contraceptives was also assessed in 1973 by questionnaires. Both cross-sectional and prospective nested case-control designs were used, each with external control analysis. The cross-sectional design was further submitted to monozygotic co-twin control analysis. RESULTS:
The cross-sectional study design comprised 4365 twins with reflux and 17,321 without. In ever users of estrogen HT, the risk of reflux symptoms was increased by 32% (odds ratio, 1.32; 95% confidence interval, 1.18-1.47). This association remained in the nested case-control analyses and increased slightly with higher body mass index. A similar pattern was observed for the use of progestin in the cross-sectional design, but no association remained in the nested case-control analysis. Use of oral contraceptives was not associated with an increased risk of reflux symptoms. Generally, the risk estimates remained virtually unchanged after adjustments for potential confounding factors, including genetic factors. CONCLUSIONS:
This population-based twin study indicates that estrogen HT is an independent risk factor for reflux symptoms, while the influence of progestin HT and oral contraceptives is less consistent.
An_ 250615, it sounds like her MD is taking the symptoms seriously (eg ruling out gall stones). Your daughter may even need a GI MD referral for a second opinion.
Dear An: I would agree with your conclusion, a vaginal infection that comes from an STD is extremely unlikely. Vaginal secretions are composed of cells shed from the vaginal walls, cervical secretions/mucus, and bacterial inhabitants of the vagina.
Changes in discharge can be prompted by the phase of your monthly cycle (eg increased clear, stretchy "egg white" cervical mucus around the time of the midcycle ovulation or thick, library paste discharge in the 7-10 days before flow).
Vaginal pH can help determine which bacteria grow to predominate the vaginal eco-system. There are more than 30 types of bacteria which can be found in the vagina. When a certain type overgrows, changes in color, odor, and consistency may appear. Most of us are familiar with the symptoms of an overgrowth of yeast. Symptoms may include vaginal itching, burning, discomfort with intercourse, clumpy "cottage cheese" discharge and even pain when the urine stream touches irritated tissues. Even an overgrowth of the "beneficial" vaginal bacteria, ( hydrogen peroxide producing lactobacilli), can prompt symptoms of burning, stinging, or irritation.
Based upon what you have shared, my best GUESS would be either a temporary overgrowth of normal bacteria or even low grade yeast. However, for the most "for sure" answer you should see a GYN or your local family planning clinic. They can take a swab of the secretions and look at the sample under a microscope. That is the best way to get an accurate diagnosis. Then too, if a treatment were to be needed, it would be the right one.