help with pcos and possible endometriosis
help with pcos/ possible endo
hi so i went to a new obgyn today. i’ve moved around a lot and have disjointed care over the past 10 years. i have a history of multiple ovarian cysts rupturing and a 11cm dermoid cyst on my left ovary. i have a family history of women in my family having pcos and endometriosis also history of ovarian cancer and breast cancer. i have never had a normal period in my life. birth control pills gave me migraines or eczema/skin issues. i’m on the nuva ring and it’s still not enough. the notes from the obgyn i saw today were insane and i would like any guidance or advice PLEASE.
**CC:** Concern for ovarian cyst
**HPI:**
24 y.o. who presents for evaluation for possible ovarian cyst. She states that approximately 2 weeks ago she was having significant lower abdominal pain. She has a history of ovarian cyst in the past and states that the pain felt similar. The pain has improved since that time.
Also complaining of burning in the vagina. Not currently sexually active. Using NuvaRing for birth control.
History of ovarian cyst in the past. Had a dermoid cyst removed 10 years ago. This was performed laparoscopically on the left.
She is obese. She was prescribed Zepbound by her family medicine doctor but insurance did not cover it. She is unsure if that was the only diagnosis that was provided.
She does have a history of rib pain that was believed to be scar tissue. She saw a chiropractor in the past and had what sounds like maybe was ultrasound therapy that improved her pain.
She does have chronic back and joint pain. She works as a dental hygienist.
She previously had a diagnosis of PCOS that was given to her by a gynecologist that she saw out of state. Unclear if she had blood work done. However, she does report that her menses are never regular, she is not on birth control, and she reports ultrasounds in the past that showed multiple ovarian cysts. Denies hirsutism.
**REVIEW OF SYSTEMS:**
General: no fevers, chills, unexplained weight loss
HEENT: no sore throat, neck adenopathy, dysphagia
Respiratory: no shortness of breath, dyspnea, hemoptysis
Cardiac: no palpitations, chest pain or tightness
Gastrointestinal: no nausea, vomiting or abdominal pain; normal BMs
GU: Denies abnormal vaginal bleeding, discharge or pelvic pain
Musculoskeletal: no range of motion limitations, joint or muscle pain
Extremities: no leg swelling or edema; no claudication symptoms
Neurologic: no numbness, tingling, peripheral neuropathy, motor weakness
Psychiatric: +anxiety
**PHYSICAL EXAM:**
BP: 120/70 (Left arm, sitting)
Height: 167.6 cm (5’6”)
Weight: 95.3 kg (210 lb)
LMP: 05/02/2026
BMI: 33.89 kg/m²
**General Appearance:** alert and oriented, no acute distress, well nourished.
**ASESSMENT PLAN:**
24 y.o. who presents for lower abdominal pain, vaginal burning with urination, questions about obesity/PCOS and joint pain.
Transvaginal ultrasound ordered
Referral to genetic counseling due to family history of ovarian cancer and BRCA positive both on maternal side.
Vaginal burning/burning with urination
Urinalysis negative for UTI
NuSwab collected today
Obesity: Recommended that she speak with her primary care doctor about Zepbound and make sure PCOS and hypercholesterolemia were included is diagnosis codes as that may change may change insurance coverage.
Discussed the diagnosis of PCOS is a diagnosis of exclusion although it does typically include blood work she is on the NuvaRing right now and therefore serum testing would not be accurate. That being said, it would not change her current management which would include hormonal management to regulate menses and weight loss