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Having severe pain in pelvis during periods. Hurts to remove or put tampons. On implanon. Suggest relief?

Mar 2013
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Hi, I am having severe pain in what feels like the bottom of my pelvis. It particularly hurts when I squat down. I started my period yesterday and the pain started with it. I have always had very painful cramps with my period, but this feels different than cramps. My last few periods I have had this same feeling but this is the worst. I was bleeding about every two weeks. It also hurts to insert and remove tampons and has been hurting to have sex. I was on Implanon for two years, but had to come off of it because my periods became extremely irregular. Any advice as to what I could do for temporary relief or what may be going on?
Posted Sat, 12 Oct 2013 in Vaginal and Uterus Health
Answered by Dr. Aarti Abraham 37 minutes later
Brief Answer:

Detailed Answer:
Thanks for writing to us.
All the symptoms that you have described strongly point towards the diagnosis of endometriosis.
Endometriosis is a condition where there is presence of ectopic uterine tissue ( the lining of the uterus is made up of a particular type of tissue, in some women this tissue starts growing OUTSIDE the uterus ). Endometriosis is commonly present on the tubes, ovaries, on the rectum and on various surfaces of the pelvis.
This tissue gets congested every month during your periods, as it has good blood supply and responds to hormones the same way as the uterine lining does.
Typically, women with endometriosis have excruciatingly painful periods, because apart from the uterine cramps, the endometriotic spots all over the pelvis also become congested and painful.
ALso, frequently, intercourse is painful, as during the pelvic thrusts, the endometriotic spots are again disturbed and cause pain.
INserting and removing tampons too becomes painful at times.
Endometriosis also causes irregular menstrual bleeding, typically causing spotting before your periods are about to start.
This condition can be confirmed by a gynaecologist by clinical examination ( per vaginum and per rectal ) .
An ultrasound would help to exclude other differential conditions like polyps, fibroids, ovarian cysts, however endometriosis cannot be picked up on ultrasound.
It can be confirmed by a laparoscopy , and certain endometriotic spots can be cauterized, or endometriotic cysts can be removed at the same sitting.
For temporary relief, you can try OTC painkillers like Tylenol.
If the pain is severe and unrelenting, after confirmation of diagnosis, and before opting for surgery, hormonal medications might be tried.
Typically, oral contraceptive pills or progesterone only pills are prescribed for a few months - they generally manage to regulate symptoms. Hormonal injections also can be given.
If these measures fail, then surgery is a last resort.
Please visit a gynecologist to confirm this diagnosis.
I would suspect that your spinal surgeries also would leave residual pain and discomfort in the area, which would be adding to the effects of endometriosis.
All the best.
Please feel free to ask any further follow up questions.
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