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Forum Name: Gastroenterology Topics

Question: Pain below sternum during period


 EmilyEm - Sun Feb 28, 2010 1:51 am

I am a healthy 39 year old woman with no underlying health conditions. For the last few months I have had this shooting pain just below my sternum in the upper abdominal area that I also feel in my back. It comes on almost like a contraction. It builds to a peek then subsides. It comes and goes for about week during my period. It's worse when I lie down and the pain wakes me up at night. I do not feel nauseous nor do I have gas. Eating certain foods does not seem to trigger it. It does not bother me when I work out. I have no other symptoms. The only correllation I can think of is that it starts on the first day of my period. This could be a coincidence. I take probiotics, don't smoke or drink.

My doctor ruled out ulcer and thought it was a hiatal hernia; however, it goes away for weeks then returns. Any thoughts as to what this could be?

Regards
Em
 Dr Elias Barrios MD - Wed Mar 10, 2010 5:43 pm

Hi Emily , the way you describe the pain could be intercostal neuritis that sometimes could mimic cardiac pain and is very much related to stress and is treatable with B complex injections .It could also be the sternum cartilage that gets swollen
sometimes. Remember the menstruation is a burden for some women that could lead to stress. Check with your doctor
Dr Elias Barrios MD
 Dr.M.Aroon kamath - Sun Mar 14, 2010 7:15 am

User avatar Hi,
After excluding the commoner causes of retro-sternal pain such as cardiac causes, GERD(gastro-esophageal reflux disease),which usually cause retro-sternal pain unrelated to the menstrual cycles,certain rares causes that can cause 'cyclic' retro-sternal pain (pain related to menstrual cycles) must be entertained.

There are two such conditions that are related to 'Endometriosis'.
- catamenial pneumothorax(associated with or without thoracic endometriosis) &
- catamenial pneumomediastinum.

Catamenial pneumothorax is of obscure etiology.They occur at the time of menstruation(within 2-3 days of the onset of menses),usually on the right side & generally fairly small.Suppression of ovulation and tubal ligation are some modalities that have been reported to be beneficial in some cases.

Catamenial pneumomediastinum due to Thoracic endometriosis may occur with or without an associated pneumothorax.

In thoracic endometriasis,menstrual related
- hemoptysis,
- hemothorax,
- mediastinal bleeding,
- pulmonary nodules,
- bronchiectasis &
- pleural masses
have also been described Thoracic endometriosis.

Endometriosis affects about 5-15% of women in the reproductive age group.Thoracic endometriosis is the most frequent (but rare) extra-pelvic manifestation of endometriosis. Awareness and a high index of suspicion is needed in order to recognize thoracic endometriosis.
Best wishes!

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