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What treatment and tests are recommended for constant abdominal pain due to endometriosis?

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General & Family Physician
Practicing since : 2009
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I am a 19-year-old college student suffering with constant lower right abdominal pain since one week after college began last year. At first, I thought it was college anxiety, but after feeling really bad and going to the ER and being thoroughly checked out, appendicitis was ruled out. Throughout the year, I've seen my regular doc, a gastro doc, and my GYN. I even had a normal colonoscopy and a diagnostic laparoscopy, during which they did remove my unaffected appendix (just for safe measure) and also 4 lesions, so apparently I do have endometriosis. However, I never felt any relief from the removal of the very small/thin lesions she found in there. Any suggestions about who to turn to next? I do not feel I can live with this makes me nauseous a few times/week and it has completely limited me in my usual physical activity. It hurts tremendously when I run or engage my core muscles in any way! Thanks for any suggestions. I will come home in a few weeks and revisit my GYN doc (maybe change birth control pills?). Should I go to another type of doc, return to the Gastro doc, or insist on having an MRI, the one test no one has ordered. All other tests and ultrasounds appear to be normal.
Posted Wed, 25 Dec 2013 in Abdominal Pain
Answered by Dr. Shoaib Khan 2 hours later
Brief Answer: Gynecologist; MRI or CT abdomen good Detailed Answer: Hello ma'am and welcome. Thank you for writing to us. I am sorry to learn about the extreme pain and discomfort you are experiencing. But from the investigations conducted and the provided information, your presentation seems to be caused almost entirely by the endometriosis. I have seen numerous patients who suffer from endometriosis-related pain, saldy even with no presenting lesions at the time of the pain. I would recommend a CT scan or a transvaginal ultrasound before the MRI ma'am. And it would be best to visit a gynecologist for your condition. Once the endometriosis is being addressed, then an abdominal and pelvic CT or MRI scan would be beneficial in ruling out any other causes for a presentation similar to yours. I hope you found my response helpful and informative. Please feel free to write to me about any further clarifications, I would be more than happy to help guide you ti good health. In the meantime, application of a hot compress on the abdominal or pelvic region would provide temporary relief ma'am. Best wishes.
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Follow-up: What treatment and tests are recommended for constant abdominal pain due to endometriosis? 8 hours later
Do different birth control pills/methods ever help to alleviate pain? I know they are supposed to "hinder" the process of blood formation so that it won't leak out of the fallopian tubes and cause adhesions, but if I am still getting a period while on the birth control pill, is this not enough? Since I am many years away from child-bearing, should I take a more "semi-permanent" approach to stopping my periods? I think the GYN suggested something implanted in my arm -- but it releases hormones, so I worried about how those constant hormones would affect me in other ways aside from the you know anything about this? Also, what pain medications seem to work best for alleviating this type of pain -- or are you saying that heat is really the only thing that truly works? And it does help, but I can't walk around all day long with a heating pad on! Would a capsacin patch of some type help?
Answered by Dr. Shoaib Khan 27 minutes later
Brief Answer: All queries addressed ma'am Detailed Answer: Hello once again ma'am. Well birth control pills help in regulation of hormone levels and to help with your menstrual cycle, by regulating your normal period; but it does not contribute to pain relief. No ma'am, although the birth control pills are part of the treatment for endometriosis, unfortunately it only provides temporary relief. The only documented completely effective treatment option of endometriosis is a hysterectomy (removal of the uterus). All other treatment options are provided to those patients who cannot go ahead with a hysterectomy (eg. young females like yourself, women who have not completed their family, etc.). A semi-permanent approach to stopping or temporarily inhibiting your menstrual cycle is not a very healthy option as this can result in some undesired effects like menstrual irregularities, weight gain, infertility (rare), etc. i would not advise the same for you ma'am. Yes I do ma'am, the implant in your arm (eg. norplant; which you can google and read up on), are implants that regularly release hormones that will help in regulating your periods. The only side effects would be breast tenderness and/or enlargement, menstrual irregularities, weight gain, etc; which are usually seen with hormonal imbalances. Pain management is supposed to be a temporary option, but in your case, as long as you have the endometriosis, you will require pain management; which could be until you complete your family. I would not advise such long-term pain management for you ma'am, as you are too young for me to advise you on pain killers. I would suggest something mild (eg. paracetamol) along with the hot compress. But in patients with endometriosis ibuprofen and naproxen are usually advised. As for the capsaicin patch should provide temporary relief, but is usually helpful only for locally affected regions (eg. if you have muscular or joint pain around the knee, it should help relieve that). But your source is internal, so I doubt it would provide much relief. I really hope I have succeeded in providing you with as much information as you were seeking. If you have anymore clarifications, or if I have not answered any of your queries clearly enough, please feel free to write back to me. I would be more than happy to help you. Best wishes.
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Follow-up: What treatment and tests are recommended for constant abdominal pain due to endometriosis? 2 days later
The thing that confuses me the most is that having had the lesions REMOVED in July 2013, I should have felt some relief and I have never felt ANY relief! (And she removed 4 lesions, one of which could only be seen with the special Firefly luminescence detection system she is one of the few people who knows how to use!!!). This is why I am fearful of something more serious being wrong! Is there any chance I could have a cancer of some type in the soft tissue and/or organs in that area that has not been detected and how WOULD it be detected? Would blood tests DEFINITELY show something or does some kind of imaging actually have to "see" a tumor or growth? If so, can I/should I insist on a more extensive imaging of my abdominal area where the pain ALWAYS is -- I've only had ultrasounds, vaginal ultrasounds, and a CT Scan, but no PET Scan or MRI; I realize these are expensive tests, but how much constant pain must I endure before they are warranted? Finally, is there ANY chance, do you think, that this could be damage from a vaccine? In 2007 or 2008, I got the series of Gardasil vaccines -- and, interestingly, shortly after that, I did experience severe knee pain. Could the vaccine have "given" me the HPV virus and that is what is causing the pain? I have tried to research that, but it is very confusing. Most of all, I just want to know how I can "get on with my life" without so much worrying and, obviously, pain! I will continue with the acupuncture and some diet changes -- and maybe look into biofeedback -- but nothing really seems to be working!!! If it were a few days each month, I could tolerate this, but this is pretty much DAILY!!! Thanks for trying to help, but please advise me what direction you would go in for someone who has a hard time believing this is ALL endometriosis pain. Mayo Clinic? Duke University? Any other tests? Thanks!
Answered by Dr. Shoaib Khan 12 hours later
Brief Answer: All queries addressed; and apologies for delay Detailed Answer: Hello ma'am and my sincere apologies for the delay as I was assigned to a few urgent surgeries and had to get them done at the earliest. As for the pain, unfortunately many individuals experience such intense pain with endometriosis even when their lesions have been removed. I would not worry about this having another cause, but sadly the pain in youe case is very intense and appears too often (almosr always). A PET scan would help in ruling out all other causes, including tumors or cancer, and you could request for the same ma'am. As for the vaccines, they do cause a lowered immunity and can make an individual susceptible to infections, which could have cause the HPV or any other infection. If you have been diagnosed with HPV or any other infection in the past, I would suggest a repeat confirmation of the infection and treatment accordingly as these infections may also be causing the pain. Next, I would recommend a diagnostic hysteroscopy to visualize the interior of your reproductive tract and find any other causes/conditions possible, and confirm them with a spot biopsy. I understand this condition is getting the best of you and is restricting the normal way of life, and I would recommend you to go about all the above investigations; but sadly if everything else returns normal, then the only effectuve treatment for endometriosis is hysterectomy and you are way too young to undergo this. If endometriosis is the only cause then I would recommend you to try all the possible treatment options available for suppressing the symptoms. Hope this helps. Please feel free to write back to me for any further clarifications. Best wishes.
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