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Gynecology

Menstrual cycle and chest pain

08/01/2006

Question:

when I start my menstrual cycle I develop right upper chest pains. It only last about the first 24 hours. I have had a lung x-ray, upper GI, gallbladder ultrasound and a whole cardiology work up. There is nothing wrong there. I was put on two different types of birth control pills, hormones, to try to stop the pains and they still occur. I have been to the Emergency Room twice because the pains are so bad. Breathing is NOT a problem. The two gynocologist I have gone to do not seem to have any idea what is causing this. The last one now wants to do a hysterectomy. He basically has only given me the reason, "if you don`t bleed, you won`t have the chest pains." I am 38 yrs old and do not plan to have anymore children. The problem is I want a "name" for what is causing the chest pain. No one else I know has ever had this.

Answer:

It sounds like your condition is very puzzling even after all the 
evaluations.  You should consider the diagnosis of endometriosis 
(EM).  EM is when the tissue that lines the uterus is growing and 
shedding in a place it shouldn't.  It is usually in the pelvis and 
causes pain prior to and often times during menses.  It has been 
found in areas outside the pelvis such as the lung, nose, etc.  Women with these symptoms complain of pain in these areas with menses along with coughing up blood or nosebleeds.  In these circumstances, a hysterectomy wouldn't help since you would still continue to have growth from these areas even if the uterus was gone.  Removing the ovaries would stop the cyclical hormone changes that cause the growth and shedding of the endometriosis.  There is medicine that shuts down the ovaries which is similar to removing them.  If your pain was caused by EM, this should take care of it.  It is worth a try rather than doing a hysterectomy (and removal of the ovaries) to see if it will work.  I agree with you, hysterectomy to improve chest pain without knowing the cause may be a bit drastic at this point.

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Response by:

Thomas  A deHoop, MD Thomas A deHoop, MD
Formerly Associate Professor of Clinical Obstetrics and Gynecology
Director, Medical Student Education
No longer associated