Suggest treatment for lower back pain and IBS
Yes there is probably some endometriosis still present
Endometriosis has many different appearances. It can look like powder burn lesions and it can have a tannish or red appearance. Also, the amount of endometriosis that is visible does not always correlate with the patient's level of pain - it can look awful with little pain and vice versa.
It really does not matter in the sense that you have endometriosis and you have pain that is associated with endometriosis. Even though they have treated the obvious lesions, there is almost certainly some left behind.
I tell my patients that 'it is not a curable problem but it is certainly a manageable problem'. You need to followup the diagnosis and treatment with long-term suppression of your cycles. This would include the following options:
1. Birth control pills taken continuously
2. The depo shot
3. Lupron therapy
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Yes it can be nonvisible and yes biopsies can be done
It really can be elusive in terms of where it is and how it appears. It can be as subtle as superficial increased vascularity or as obvious as large burn-like lesions.
Usually we just treat what we can see and then put a patient on long-term suppressive therapy to make them pain free for as long as they can or until they are considering pregnancy.
I would suggest a visit with a Fertility Specialist
If you have a history of endometriosis and are having trouble getting pregnant (usually defined as up to 12 months of attempts without conception) then it would not be unreasonable to consider a visit with a fertility specialist. While your pain may be related to endometriosis, there are also other causes of abdominal and pelvic pain.
This could be scar tissue and endometriosis, but it could also be your bowels (chronic constipation, IBS, inflammatory bowel disease, etc.)
I think that given your goals of pursuing pregnancy, it makes sense to get a second opinion and this seems best with a Fertility Specialist.
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