Q: I am a 26 years old woman who underwent surgery few months back because of cysts in both my fallopian tubes, which were diagnosed on ultrasonography (USG). This was done as I had disturbed periods for the last one year with pain inside vagina and the belly despite taking medicines prescribed by the doctor for infection. Now it has been 3 months following surgery but still I have the infection as per the USG. I had been consistently taking antibiotics for infection but I still have pain. Further my periods are not regular and the pain still persists inside the vagina and in my belly. The pain becomes severe during periods. The doctor tried different medications starting from jelly and antibiotics but the pain still persists. Why I am still suffering from infection and why are my periods not regular? Is there any need to change the medication? How will I overcome my menstrual problem?

A:It looks like you have been receiving treatment without any evidence of pelvic infection. I would strongly recommend stopping all antibiotics, as it is very clear from your history that infection is not the underlying cause for your symptoms.

I am not clear what kind of cysts you had removed from your fallopian tubes. Cysts in fallopian tubes causing symptoms and needing surgical removal are extremely rare, in fact non-existent. I am therefore not surprised that you symptoms have persisted even after removal of the cysts. Could you please chase the histology (pathology) reports of the cysts, which were removed to see what it suggests?

Your symptoms suggest two different sets of problems:

1. Pain in your belly (lower abdomen) especially during periods could be either because of conditions such as endometriosis, adenomyosis or more commonly hormonal causes. Unfortunately, I cannot go into details of each of these conditions in my mail but the best treatment at this stage could be taking combined oral contraceptive pills. These pills have both oestrogen and progestogens in them. I am not aware of the brand names in India so I cannot recommend any - but if you take these cyclically (every month) it should be very effective both in controlling your pains and also regularise your cycles. If this does not work, there are other ways to deal with the problem – but I would suggest try this first.
2. Pain in vagina is commonly seen either because of dry vagina (due to hormone deficiency) or due to a condition called candidiasis. Use of hormonal (oestrogen) preparations vaginally in the form of pessary or gel could be helpful. If you have facility to have vaginal swabs taken to screen for infection such as Chlamydia or candida, I would recommend it especially if you are sexually active. If pain in the vagina is similar in pattern and nature to that in your belly, it may be because of vaginal endometriosis, which can be diagnosed by a simple examination in the OPD with the help of a speculum (which is available in all gynaecological clinics).