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Having abdominal pain. Diagnosed with severe endometriosis. Should I take a second opinion before proceeding with the treatment?

Apr 2013
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General Surgeon
Practicing since : 2009
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I am a 45 year old mother of two. I have been dealing with a chronic left-side, abdominal pain for over two years. Once I even went to the emergency room, and was told that my "left-side" pain might be referred to my right side, and removed my surpise-to-me-but-enlarged appendix. My gynecologist at the time eventually performed a laparoscopy after which I was told "everything looked fine" and that my "ovaries looked healthy, and at least ten years from menopause XXXXXXX He prescribed birth control to help relieve control my severe PMS and attempt to ease my left-side pain and began prescribing various depression medications which did nothing for the pain. We have recently moved, and my current doctor --who has a reputation for finding things other doctors miss--diagnosed me with severe endometriosis and scarred ovaries, after reviewing a sonogram and recent blood work. His plan is to put me in medically induced menopause, then perform a complete hysterectomy (including ovary removal). Part of me thinks this makes sense as the next step, but part of me questions why the doctor that performed my laparoscopy last year said everything looked "fine". My new doctor said that endometriosis can be hard to detect without the appropriate training and even can changes colors during the month, but I am very puzzled by the two completely different diagnoses. Should I get a third opinion before proceeding with my current doctor's plans? I am very confused, and would appreciate any advice.
Posted Sat, 24 Aug 2013 in Women's Health
Answered by Dr. Ivan R. Rommstein 33 minutes later
Hi and welcome to XXXXXXX Thanks for the query.

Yes, endometriosis can change color and intensity during the cycle and can be hard to detect,but endometriosis which requires total hysterectomy is detectable by laparoscopy even by medical student. I dont see how can someone detect severe endometriosis by ultrasound and blood tests. Or ovarian scarring as well. Ovarian cysts and shape disorders may be seen,but there is no way that US can verify endometriosis better then direct laparoscopical visualisation.
Endometriosis is common cause of chronic pelvic pain and it is possible that it wasnt seen on laparoscopy,but I dont think it can be indication for hysterectomy at this point. There should be clear indication for it.If your doctor has doubts,he should do laparoscopy around the ovulation time.
I suggest to check your hormonal levels and perform CT abdominal and pelvic scan. Your pain can be caused by adhesions, diverticulitis, or some digestion disorder(IBD, pancreatic or somach issue).
Induced menopause is one of the options if your symptoms are considered to be caused by gynaecological disease. YOu can start with this,but without hysterectomy and see the improvement. If there is no pain regression after medically induced MP then you dont need to expect the improvement after hysterectomy unless there is some specific ovarian pathology.

So before any treatment, I think that,if you have enough patience, your second doctor should peform laparoscopy if he is sure about the endometriosis based on US finding. Just to make clear, hysterecomy or medical MP wont have some significant consequances and it is common treatment modality, but why would you have unneccesary surgical procedure without confirmed diagnosis.

Wish you good health.If you have any question I ll be glad to help. Regards
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