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Painful periods, constipation, pain in pelvic region. Have endometriosis. Taking Provera, norethisterone. Advise

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Practicing since : 1997
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I am having poor tolerance of both oral Provera and norethisterone. It is hormone therapy for suspected endometriosis ( I have had laproscopic surgery that confirmed endometriosis in the past but one six years ago to remove my intra uterine nerves (pretty sure that what is was) showed no endometriosis. My pain is far worse in the days leading up to and especially the first three days of a period. I am always constipated in the days leading up to a bleed, and it is sore when I move my bowel. This time however, I also get pain at the same time as in the pelvic area, in my appendix area, and some times to the left of my navel - all cyclical. I am on a 12 week waiting list to be seen for an initial consultation with gynae at the Public Hospital. I have not been eligible to be seen sooner because I hadn't been on hormone therapy for 6 months. So since late November I have not had day with no pain (it started out lighter and has progressed to the level now where I am on daily opiates). I think the ?endo symptoms emerged because I ceased taking amitriptylline in September 2012 that I was prescribed for post-concussion syndrome in 2011. Are there natural forms of progesterone that can be reliably used? I do not drink, I have gone gluten free, I take evening primrose oil 3000mg od, , and I am getting counseling (for this and and other life issues). I am in New Zealand, so not everything you recommend I may not have access to
Posted Mon, 29 Apr 2013 in Women's Health
Answered by Dr. Kulsoom Qureshi 3 hours later
Thanks for discussing your problems with us.
After reading your question I have an impression that your endometriosis is quite advanced & that at present you are concerned about the relief of your symptoms & not your fertility which may also be affected by this disease. All form of medical treatments like progestogins, birth control pills & GnRH analogues are temporary treatments & there is a 50 % recurrence rate with each modality after cessation of treatment.
Yes, there are natural progesterones but there effect is probably not superior to the synthetic forms you have tried but side effects have been claimed to be less. You will have to check availability in your area. Please remember if you are using provera or norethisterone you should take it in the prescribed dose which should be preferably continuous for three months at least, without any break & without any periods. As long as you are having periods your symptoms will not go away if endometriosis is the cause of your pain.
If you are not tolerant to progetogins you may have GnRH analogues for a limited time. These are very expensive & also have side effects but may suppress your disease for sometimes.
If you are really exhausted by your disease & side effects of your treatment then you may opt for a surgical treatment. Please discuss this issue with your doctor at the next meeting.
Wish you best of luck & good health.
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