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"ACOG [american College of Obstetricians & Gynecologists] developed a Practice Bulletin on Use of Hormonal Contraception in Women With Coexisting Medical Conditions that allows the use of COCs in women with migraine only if they do not have focal neurological signs, do not smoke, are otherwise healthy and are aged younger than 35 years."
"In light of all these facts, we must always bear in mind that POPs [progestin only pills] are not contraindicated in patients with MO [migraine without aura] at any age, even if it is a pre-existing condition (WHO Category 1), or if it develops during POP use (WHO Category 2). Women suffering from MA [migraine with aura] can start to use POPs (WHO Category 2), but if MA starts during the use of POPs, they should generally be suspended, unless other more appropriate methods are not available."
Things to consider:
The primary concern is the elevated risk of stroke in people with migraine, which may be increased with hormone use.
The increased risk appears to be greater with migraine with aura, and it appears to be greater with combined (estrogen & progestin) pills.
Other factors may also increase stroke risk, including smoking and high blood pressure, and age (over 35 for pill users),
You are over 35 and have a history of migraine with aura.
You would, by the criteria in the link, be eligible for use of the progestin only pill, but should avoid the combined pill because you are over 35 years old.
That assumes that you do not smoke or have high blood pressure or uncontrolled cholesterol abnormalities.
In addition, there are some genetic blood clotting abnormalities, called thrombophilias, that may increase the risk of stroke. There are blood tests that can tell if you have one of those. If your primary care doctor is not comfortable ordering those, a hematologist would be the one to consult.
However, I am not sure that the cause of your pain has been identified for sure. It would be unusual to have a ruptured corpus luteum cyst with severe pain every month. Cyclic pain could be due to recurrence of the endometriosis, or it could be due to scarring around the remaining ovary. Development of a normal corpus luteum with stretching of the scar tissue could produce pain, without a true ruptured hemorrhagic corpus luteum.
It might be helpful to ask your gynecologist to do an ultrasound just prior to the time when you would predict the pain to begin again. If there is a cyst, it should be visible. It could be a corpus luteum or it could be an endometriotic cyst.
Of course, definitive confirmation of the diagnosis would require another laparoscopy, at which time a decision would have to be made concerning removal of the remaining ovary. Despite the previous surgery, laparoscopy could be performed by someone with skill and experience, preferably someone with a special interest in endometriosis. It might be possible to remove any scar tissue, treat any endometriosis, and leave the ovary, with the understanding that new scar tissue might form.
Removing the ovary has the disadvantage that you might have severe menopause symptoms and run smack against the problems of taking hormone replacement that exist with the birth control pills.
So, an option would be to try the progestin only pill and see what happens with the pain and the headaches. That is an inexpensive option, and it is easy to stop it if the headaches worsen.
If that does not produce satisfactory results, ask your gynecologist about a trial of Lupron or a similar medication. Did you take it at any point for the endometriosis? It temporarily suppresses endometriosis, prevents ovulation, and has actually been used to treat women who have migraine associated with their menstrual periods. Three to six months on Lupron should confirm that the ovary is the problem, and you could then decide whether to proceed with surgery, if symptoms return when the Lupron is stopped. Lupron does tend to cause hot flashes, since it reduces natural estrogen levels. Sometimes it is given with a small dose of progestin to help with those, but the combination of the two can increase migraine, so you should probably not do that.
After the Lupron is stopped, it might take a while for endometriosis symptoms to come back, since the medication is not curative. Due to its expense and the risk of osteoporosis from long term suppression of estrogen, Lupron is not used long term, though it is possible to give another 6 month treatment if needed and monitor bone density.
If you have frequent migraines, an option is to consider preventative treatment for them. There would be no contraindication to taking such medication and a progestin only pill together.
I'm sorry to hear about all these horror stories. I've been having vaginal sonograms the last couple of months - I go for another one in August because I have a cyst filled with fluid that my OB is keeping an eye on. I'm no sure what "fluid" means exactly but now I'm more frightened if they have to go in and remove it. It sounds like a pretty invasive procedure.
Red Rose,
I too had a full hysterectomy in Dec. of 2010. A couple months ago I had an abdominal ultrasound for abdominal pain and they found a mass on my left side. They thougt it was an overy that may have gotten left behind. After another vaginal ultrasound they determined it was a fluid filled (no fibroids) ovarian cyst. At this point they say there is no concern, but they are keeping an eye on it to make sure no fibroids form.
This is directed to lakerchick34 and anyone in the same boat as us. I am in the same boat right now as lakerchick34 and I thought I was the only one but in a sense I am relieved that I am not the only one. I just had my CT scan and they said I have a 2cm mass that they are calling an ovarian cyst, but I DO NOT have any ovaries! I had a full hysterectomy in June of 2011 and Iam experiencing intense pain that begain in my lower left area of my abdominal area and I was admitted for 3 days and they did a CT scan and said they found this mass and they told me to follow up with my gyn and I did and she set up a trans vag ultrasound because she said she knows for sure I don't have any ovaries because she did the surgery and there has to be a mistake so she set up the ultrasound for today and I am in so much pain I cannot even get out of bed so I didn't make it and now my primary wants me to go TO the er and check in but I cant move when the pain medicine I have is strong and isn't working then how can i possibly get to the er when they'll just drug me up and tell me I have to follow up with my dr to see what is going on, I feel like im on a never ending carosel from hell that is no fun and its beginning to feel llike no one knows what the hell they are doing! Im scared and fell like I KEEP hitting a brick wall. now the suggestion of visiting a gastro dr is in the air and I feel like I am beginning to live what all of you have been going through how do I get it to stop and make them just fix me? HELP!
I had a complete hysterectomy 7 years with the removal of both the overies and tubes. i was on HRT for 7 years and doing fine. I was having severe abdominal pain and they found out I have a cyst in the vaginal vault and now they say I have got a small unilocular cyst on the posterior wall of the rectum. This scares me to death. Anybody has such experience after a complete hysterectomy. I am confused. Please help me
I had a complete hysterectomy 7 years with the removal of both the overies and tubes. i was on HRT for 7 years and doing fine. I was having severe abdominal pain and they found out I have a cyst in the vaginal vault and now they say I have got a small unilocular cyst on the posterior wall of the rectum. This scares me to death. Anybody has such experience after a complete hysterectomy. I am confused. Please help me
What was the indication for your hysterectomy and how was it performed?
What size is the cyst? Do you have pain with intercourse? Can your doctor feel the cyst on physical exam? If so, does pressure on the cyst reproduce the pain you are having?
I am 33 years old and I have always had terrible periods. The moment that I started my period, I dealt with intense cramping, ovarian cysts, and incredibly heavy bleeding. I always figured that that was normal, until I realized that it wasn't. About 7 years ago, everything intensified. My periods were crazy. I was bleeding so heavy that I was changing every 30 minutes to 2 days and then every 2 hours for another 5-7 days. Because I was certain that I was finished having babies, November 2011, I underwent an endometrial ablation. This helped with the bleeding, but didn't touch the pain. I was dealing with cysts rupturing fairly frequently and I was undergoing regular ultrasounds.
March 2012, I went to the emergency room doubled over in pain. After an ultrasound and a CT with contrast, I was diagnosed with multiple cysts. One of which, was the size of a tennis ball and another was the size of a golf ball. We again played with meds. We quickly decided after having a crazy amount of side effects, to go ahead with the hysterectomy. So after years of pain and discomfort, lots of experimenting with hormone injections, IUD, endometrial ablation, I underwent a hysterectomy on June 4, 2012. The surgery was much more complicated than expected. You would think that after dozens of ultrasounds, you would know what is going on with your anatomy, but when my doctor opened me up (laparascopically) he saw an incredible amount of endometriosis. I had it on the front and back of my uterus, my bladder, intestines, rectum, and it had completely infiltrated my ovaries. After a couple of hours of cleaning up and excising the endometriosis, my doctor began my hysterectomy. I had a Total Laparascopic Hysterectomy with Bilateral Salpingo Oopherectomy.
Here we are now 10 months later. We played with my hormone levels a lot following my hysterectomy because of abdominal pain. My doctor put me on the lowest Vivelle patch possible. He was certain that the Vivelle patch was causing any residual endometriosis to regrow. After lots of frustration, I just stopped the patches. 6 months later, I am again doubled over with abdominal pain, again. I am so fatigued and my joints hurt. I know that's because of the lack of estrogen in my body, but I'm afraid to "feed" the endometriosis. I called my doctor, he put me on a progestin pill. This one makes me a little nervous too because we tried this one prior to my hysterectomy and I had EVERY side effect....lightheaded, dizzy, nauseous, fatigue....
I feel lost. I don't know what to do. I started this new pill, but then what? Any suggestions?
Hi, I too had a hysterectomy back in 1999, a year later they removed my right overy, all due to endometriosis . Off an on for ALL these years I have had right sided pain, painful, but I'd take meds. Yesterday , I woke, pain began , I took my meds, within an hour I was on the floor curled up in THE worst pain of my life , yes worse than child birth, my husband called an ambulance , at the hospital after asking me about 7 times, my history, it took over an hour for them to give me something for the pain. I truly wanted to die. I'm not the type of person to bring attention to myself, but I was screaming out in pain, it seemed as tho sense I have had a hysterectomy , appendix removed, overy removed, the felt there was nothing serious. The nurse even told me" we Handle the emergency, it's cheaper to have your primary run tests" UNBELIEVABLE!!!! Well after being there for 10 hours, they finally did do an ultra sound, they thought maybe I had kidney stones. The ultra sound showed nothing. And they sent me on my way.
I'm frustrated, my husband is frustrated, I'm soooo sick of Drs looking at me as " a flake" " a drug seeker" , I just want to know WTF is going on.
Anyone here have advice??
Hi, I too had a hysterectomy back in 1999, a year later they removed my right overy, all due to endometriosis . Off an on for ALL these years I have had right sided pain, painful, but I'd take meds. Yesterday , I woke, pain began , I took my meds, within an hour I was on the floor curled up in THE worst pain of my life , yes worse than child birth, my husband called an ambulance , at the hospital after asking me about 7 times, my history, it took over an hour for them to give me something for the pain. I truly wanted to die. I'm not the type of person to bring attention to myself, but I was screaming out in pain, it seemed as tho sense I have had a hysterectomy , appendix removed, overy removed, the felt there was nothing serious. The nurse even told me" we Handle the emergency, it's cheaper to have your primary run tests" UNBELIEVABLE!!!! Well after being there for 10 hours, they finally did do an ultra sound, they thought maybe I had kidney stones. The ultra sound showed nothing. And they sent me on my way.
I'm frustrated, my husband is frustrated, I'm soooo sick of Drs looking at me as " a flake" " a drug seeker" , I just want to know WTF is going on.
Anyone here have advice??
See a gynecologist with experience in treating endometriosis and pelvic pain. You do not say how old you are. I assume you still have your left ovary. If you are not postmenopausal, you could have recurrent endometriosis. If you are postmenopausal and taking estrogen, you could have endometriosis. If you are not either producing natural estrogen or taking it as a supplement, you could just have scar tissue. An ultrasound is not a reliable way to diagnose these problems. If you had a cyst that ruptured, the only thing an ultrasound might show would be some fluid in the pelvis.
When you see the gynecologist, make a strong case for having a laparoscopy performed. That can help determine the cause of the pain or rule out a gynecologic source.
I am 45 and just had a total hysterectomy in Oct of 2012. after about 3 months I started feeling severe pain on my left side and very painful to have sex or bowel movements, even hurt sometimes to urinate. I have gained like 20 lbs in a short period of time and looks like its coming from my stomach and bloating. I went back to by GYN and he did a vaginal ultrasound which he said I have a cyst on my left ovary. At that time I told him "no I don't have any ovaries" He immediately called the specialist that I was sent to in the first place to consult with him since he is the one that done the surgery. I made appt with him and he said I was full of scar tissue and my surgery was very difficult when he did it but he was sure that he had removed every piece of ovary. He then asked for a CT scan and then concluded well yea maybe some was left behind. at that time the cyst was only 0.8 x 0.6cm. He said well I think you probably need to go to a GI doctor because surgery is just to risky. It has been 5months since I seen him and my pain as of last night has become unbearable. I went to the ER and they did another CT scan and of course came back saying that I have cyst on my ovary which is now 2.8 x 1.6 in size so its not getting smaller and that I had vaginal cuff thickening and I have no idea what that means. He stated I needed surgery and for me to go back to my GYN/ONcologist first thing Monday morning. This all is such a mess to me and the pain is affecting my whole life!!!!!!
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Fluid filled ovarian cyst
