Brief Answer:
Laparoscopy will make the picture clear. For pain, pain killers

Detailed Answer:
Dear Madam Kumavat,

I have gone through your message. I felt that you may be thinking that this is one query, however, I feel these are number of queries you are having. Let me handle them one by one.

You have taken ipill after 24 hours of the unprotected sex. Ipill is a very good post-coital birth control pill with good success rate. So the chances of your pregnancy are very remote. Moreover, you had bleeding after 5-6 days which rules out the possibility of you being pregnant from that sexual incidence. Negative pregnancy tests confirms that you are not pregnant.

Ipill is a pill which contains Oestrogen and Progesterone components in higher dose. Hence, it is likely that after these tablets, the regularity of the menses may get disturbed. If you have taken the pill in later half of the period, you my get withdrawal bleeding after 4-7 days, which you have. You need not be bothered about it.

The concerning issue is pain in your abdomen. USG has shown a haemorrhagic cyst (cyst with blood in it) in your left ovary. There could be number of reasons for such haemorrhagic cyst; however, considering your age, I would think of following conditions:
1. Corpus luteum cyst: After the egg is released, the remnant tissue of the follicle is called as corpus luteum. If the blood gets collected in it is called as corpus luteum haemorrhagic cyst. Usually, it gets resolved by itself.
2. Chocolate cyst of the ovary: If uterine lining (endometrium) is present in the ovary, then during menstruation it bleeds causing a cyst in the ovary with blood in it. This is also known as ovarian endometriosis. This leads to painful menses. It usually needs surgical treatment, though a small one may be tried with hormones.
3. Ectopic pregnancy in the ovary: However, negative pregnancy test rules this out.
4. Cancer of the ovary: I feel this possibility rather rare.

I feel you should repeat the ultrasonography after few weeks. The corpus luteum cyst might subside. Chocolate cyst will remain. Then laparoscopy will make the picture more clear. You may bypass second ultrasonography and straight a way opt for laparoscopy. Some small haemorrhagic cysts can be managed by laparoscopy.

Please report to your Gynaecologist without delay. The severe pain can be managed by potent pain killers. However, it will be only symptomatic treatment you will have to go to the root of it and get rid of the underlying disease.

And I would like to ask you one question, how did you came to know about me and feel like asking me direct question? Anyway, you are from XXXXXXX and so you can even directly call me up.

I feel this information should guide you for the initial and immediate steps. Please upload your ultrasonography images with the report for me to view. Also, please inform me the reports of laparoscopy.

If you want any more information, I am always available for you Mrs. Kumavat.

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Brief Answer:
Reports and images are missing

Detailed Answer:
Dear Mrs. Kumavat,

I am indeed confused about your intention about the pregnancy.

Since you consumed Ipill after unprotected intercourse, I had an understanding that you are trying to postpone the pregnancy. Then why Ovacare tablets? These tablets help conception, particularly in patients with Polycystic Ovarian Syndrome (PCOS). Are you looking for some treatment for becoming pregnant? In that case why are you taking Ipill? Ipill is an emergency birth control pill.

Please clarify your intentions about pregnancy.

You are having agonizing pain in the abdomen for four years. You are very much uncomfortable due to this pain. Your ultrasonography has revealed a haemorrhagic cyst. This is more suggestive of Chocoloate cyst of the ovary.

I feel Mrs. Kumavat, you should concentrate on the treatment of ovarian endometriosis. Please get the diagnosis confirmed by laparoscopy. If needed, let the Gynaecologist remove the Chocolate cyst(s). The laparoscopy also will show directly whether there are any other endometriotic lesions present any where else in side or outside the pelvis.

The women with endometriosis are advised to go for the pregnancy as early as possible as pregnancy itself is one of the treatments for endometriosis.

I tried to locate your reports; however, you seem to have forgotten to upload them. Will you please upload them and inform me accordingly? After seeing the images and reports, I may form my opinion regarding further mode of action.

Also, please inform me about the pattern your menstruation - periodicity, the days and amount of bleeding and regularity. I know they are very painful.

Please furnish me the required information and the reports to carry on this consultation further.

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Brief Answer:
Surgical treatment needed.

Detailed Answer:
Dear Mrs. Kumavat,

I have gone through your reports. Now I got the picture rather clear. You seem to have Chocolate cyst of the ovary (Ovarian endometriosis). Let us discuss one by one.

You are having left ovarian haemorrhagic cyst which most probably appears to be Chocolate cyst of the ovary. It has to be treated surgically. Either it can be enucleated by opening the abdomen or it can be fulgurated by Laparoscopy. Now a days, most Gynaecologists prefer the later mode of treatment though enucleation is more scientific mode. Surgical treatment will give you relief from the monthly pain you are experiencing during menstruation.

I do not feel Ovacare can help you. That tablet is better for conception in cases of PCOS.

I feel I have now given you clear guidelines. If you are satisfied with the information, you may post your review with 5 starts rating for me. If you want any more information, I am always available for you, Mrs. Kumavat.

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