Sunday, January 24, 2010

Pelvic Pain Proper Diagnosis and Treatment Needed


I have been married almost two years and I have not been able to get pregnant. I have noticed a clear mucus on the tissue when I go to the bathroom. I went to the clinic because of pelvic pain and the nurse told me that she does not see any signs of an infection but gave me doxicyclin and metronodazol for 1 or 2 weeks. She told me that she noticed a lot of cervical mucus. I had also had the same pain issue 5 months prior and was given doxicyclin then by a different doctor whom also said that she did not see an infection but because I recently had an IUD taken out there might be a little bug in there bothering me. I had an IUD removed in Jan/07. I was in for about 3 months. I was not comfortable with the idea of this foreign thing inside me all the time. I feel a sharp pain and discomfort during sex and also I am shocked that I have not been pregnant yet.

I already have one son who was induced a week past due date, and I have been pregnant a few times after but terminated those. I have never seen this heavy clear mucus before. What is it, and why do I keep having this pelvic pain? My weight has also ballooned up 70 pounds in the last 3 years, and I am under a lot of stress. I feel exhausted all of the time and can barely walk up a flight of stairs without taking a break. I am currently at 220pnds and I am 5"8 tall. I hope you can shed some light on my concerns. Thanks.


One of the problems seeing a nurse practitioner is that because they have a limited knowledge base, they treat indiscriminately. As in your example, the nurse practitioner did not detect an infection, yet treated you with two antibiotics. She is essentially covering you for two types of infections. That of course, is improper medical treatment.

I am surprised no one has suggested a pelvic ultrasound. If the pelvic examination was not remarkable, then that would be the next step in your evaluation. You may have a cyst or tumor. Some cysts and tumors express increased amounts of estrogen, which could be why you have an abundance of clear mucous. Clear mucous is usually not due to an infection but due to hormones. I would request a pelvic ultrasound. If the ultrasound does not reveal anything, then you should consider a laparoscopy, which is an outpatient surgery to look into your abdomen and examine the pelvis. Considering your fertile history in the past, and now no pregnancy but pelvic pain, there is a high possibility that you may have developed endometriosis or scar tissue. These entities can cause pain and inhibit fertility.

Finally, your weight is the issue for the remainder of your symptoms. Your ideal weight is 140 lbs. Your are carrying an extra 80 pounds which causes you and your muscles to have to work harder. I would bet that the difficulty going up the stairs is partly due to this and partly due to being out of shape. There have been studies showing that increased weight also decreases fertility, so you may want to use this a a reason to exercise and lose weight.

I hope this answers your questions. Start by insisting on seeing a physician and go from there.

Good luck!

Edward J. Ramirez, M.D.
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program


  1. Hello Edward. I appreciate your guidance to many people who post querry here.I am kavita,28 years old and 5 years married. I tried to conceive after 2 years of my marriage, but baby had no heart beat. I had to abort it. since then I have not been able to coceive. I have gained weight...but doctors think it is because of my job schedule. I work night shifts in a bpo. I get my periods normal, 30 days cycle. ultrasound has recently shown pcod, with no follicles in ovary. My insulin level is 16. I also have tsh(hypo)..that is under control for 2 months now.tsh was 10 but thyronorm daily has helped me.I have been prescribed with formin sr 500mg and pulsonac ,twice a day.
    Do you think I can ever get pregnant? I am scared and need advice. I am 5 fts and 75 kgs. I was 42 kgs when I got married. Are these medicines ok for me? I have got many tests shows normal.

  2. Hello Kavita,

    First, PCO is NOT an ultrasound diagnosis but a clinical diagnosis. One of the requirements for the diagnosis is "irregular" periods so if you have regular cycles, then you don't have PCO.

    Based on the fact that you got pregnant before, I have no doubt that you can get pregnant again. What I don't know is how long it will take to achieve this or what you have to do. If you have been trying for at least one year since your loss (my condolensces), then you should see an infertility specialist to check for other problems. But don't worry, we have lots of options/ solutions for treatment these days.

  3. i am married for 5 problem is i had a regular periods before 3 years and after that due work stress i got pcos and i checked doctor during that time and they said my uterus is good and i am having pcos and gave tablets for getting periods . i took tablets for 5 months and stopped it . after that naturally i got periods on correct dates without any problems .
    Now also am getting in correct time for 4-5 days monthly .i got periods on 18th sep but 3 days before that i had 2 drops of blood in cervical mucas and for next two days it was like in brown colour and then my actual periods started . i want to know is there any problems still exists with me.
    we had IC for many days in this month but still didnt conceived .am really worried what i can do..
    please help.

    1. I'm afraid I can't give you an answer or advice because I'm not sure what you are describing or having a lot of difficulty understanding it. I can provide advice but cannot make a diagnosis in this forum, so there is not way for me to know if any problems exist. I would recommend you see a gynecologist and undergo a thorough evaluation.

  4. My fiance is suffering from hypothyroidism.
    She is not having regular periods after 1 year of thyroid diagnosis.
    It has been 2 years now since her period disorder and now she is diagnosed with pcod.
    We are tensed if she could conceive or not.
    Tell me if this is curable and what are the chances of conceiving.

    1. Hi,
      PCOD is an ovarian dysfunction disorder and in most cases, is not "curable" but it is treatable. In some forms of PCOD, weight is the inciting factor so reducing the weight will return the ovary to normal function. In other forms, an elevated insulin level due to insulin resistance is the inciting factor, so using an insulin reducing medication called Metformin will return the ovarian function. However, in the rest of the cases of PCO not attributed to these problems, it is not curable. The treatment is to cycle with birth control pills if not wanting pregnancy or using ovarian fertility medications if trying for pregnancy. Pregnancy is definitely NOT out of the question. It may be more difficult but NOT impossible. Once the ovary is stimulated to ovulate, thereby making you normal, and assuming that you don't have any other problems, your chances of getting pregnant would be equivalent to your age group. That is, you would have the same chances as someone of your age.

      Good Luck



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