Every month for the last three months, I have had one excruciating pain in my extreme lower abdomen. It seems to come about 10 days before my period. The first two times it lasted about 20 minutes, and the last one about 40 minutes. It is so severe that I perspire, feel nauseated, can't catch my breath, and can't get in a comfortable position. I think a weaker person would faint. I am 42 and have never had any health problems. Could this have anything to do with ovulating? I am afraid this will happen again next month, maybe at work or in a store or something. Can you give me an idea what this might be just so I'll be more prepared?

M.

The type of pain, as well as its timing, is certainly suggestive of an ovarian cyst. Sometimes, in the process of an egg developing and growing in preparation for ovulation, a fluid-filled cyst can form on the ovary. This cyst may leak, rupture or twist -- and pain is the result. Some women also experience pain midcycle, around ovulation; this sharp but short- lived pain is called mittelschmerz. This is another possibility.

You should see your gynecologist for an examination, preferably timed for the middle of your cycle. If a cyst is present, it can be detected on exam or ultrasound. Sometimes cysts are observed to see if they improve or worsen; sometimes birth control pills are given to hasten their resolution. If a cyst is large, has solid components, or is causing significant pain, then a laparoscopy may be recommended to further evaluate and treat the cyst. Your doctor, after examining you, will have better idea of the cause of your pain and the best approach to rid you of it.