Why is this happening
At the moment of ovulation, the wall of the follicle ruptures to release the egg, and in its place a corpus luteum with a rich vascular network is formed. This is a physiological process, and a small amount of fluid in the pelvis after ovulation is normal.
Apoplexy occurs when the rupture affects a larger vessel. Blood flows into the ovarian tissue and into the abdominal cavity. The amount of blood loss can range from insignificant to massive, and it is this that determines the severity of the condition and tactics.
- Ovulation is the main background against which a gap occurs
- Corpus luteum cyst
- Physical activity, heavy lifting, sudden movements
- Sexual intercourse
- Abdominal injury
- Inflammatory diseases of the pelvic organs that change ovarian tissue
- Adhesive process
- Taking anticoagulants and bleeding disorders
- Ovulation stimulation
- Sometimes - without any obvious provoking reason, at rest
Symptoms
- Sudden sharp pain in the lower abdomen, usually on the right
- Pain in the middle of the cycle or in the second half
- Irradiation of pain to the rectum, lower back, leg
- Nausea, sometimes vomiting
- Weakness, dizziness
- With significant blood loss: pallor, cold sweat, rapid pulse, decreased blood pressure, fainting
- Shoulder pain due to massive bleeding - irritation of the diaphragm
- Urge to defecate
- Bloody discharge from the genital tract is an optional sign
- The temperature is usually normal - an important difference from inflammation
What can be confused with
- Ectopic pregnancy - must be excluded by a hCG test
- Torsion of the pedicle of an ovarian cyst
- Acute appendicitis - pain often begins in the navel and moves to the right, the temperature rises
- Adnexitis - gradual onset, temperature, discharge
- Renal colic - lower back pain radiating to the groin, changes in urine
- Ovarian cyst rupture
- Intestinal pathology
It is because of this diversity that sudden pain in the lower abdomen requires a doctor, and not self-diagnosis. A pregnancy test, ultrasound and blood test quickly put everything in place.
Diagnostics
- Examination by a gynecologist - severe pain in the appendage area
- Pregnancy test and hCG are mandatory to exclude ectopic pregnancy
- Ultrasound of the pelvic organs - formation in the ovary, free fluid in the pelvis
- General blood test over time - assessment of blood loss by hemoglobin and hematocrit
- Hemodynamic assessment: pressure, pulse
- Puncture of the posterior vaginal fornix for suspected bleeding into the abdominal cavity
- Diagnostic laparoscopy - if the picture is unclear and bleeding continues
- Blood type and Rh factor
Treatment
- Conservative observation in the hospital - with minor blood loss, stable condition and no signs of ongoing bleeding
- Rest, cold on the lower abdomen, pain relief
- Hemoglobin monitoring and ultrasound in dynamics
- Laparoscopy - with significant or ongoing bleeding, deterioration of condition, unclear diagnosis
- Stop bleeding with maximum preservation of ovarian tissue
- Ovarian resection for extensive damage
- Removal of clots and sanitation of the abdominal cavity
- Replenishment of blood loss if necessary
- Removal of the ovary is extremely rare, only if it is completely destroyed
After treatment and prevention
- Limiting physical activity for a period determined by your doctor
- Control ultrasound
- Treatment of anemia with significant blood loss
- Hormonal contraception to suppress ovulation—considered for recurrent episodes
- Treatment of chronic inflammatory diseases of the pelvic organs
- Be careful with physical activity and sexual activity during the period of ovulation if you are prone to relapse
- Correction of anticoagulant therapy together with the attending physician
- Observation by a gynecologist
Where to contact in Tashkent
We need a 24-hour examination by a gynecologist, ultrasound, laboratory and readiness for emergency laparoscopy.
In Tashkent, such care is provided at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic.
If there is a sudden sharp pain in the lower abdomen, especially with dizziness and weakness, do not take painkillers and do not wait until the morning: the painkiller blurs the picture, and bleeding may continue. Clinic contacts are below.
