I am 37 years old. For the last year and half I have been experienceing debilatating pain in my pelvic region during my cycle and sometimes when its not my cycle. My cycle is moderate to heavy and lasts 6 days and the pain is there the whole 6 days. No OTC meds help with the pain. My lower back hurts as well. I have had two sets of ultrasounds internal and external in the last year and nothing there. My pap was normal. I have been pregnant 4 times with 3 births and 1 miscarriage. The births were all vaginal and full term no complications. Had tubal ligation after my last child in 2002. Please can you offer your advice. Thank You
Dear An: Your pain history sounds like classical endometriosis. Some GYN's would try empiric treatment for endometriosis ("endo') given your symptoms. You see, endo is rarely visualized on ultrasound. The most reliable diagnosis is made after a laparosope is done to look inside the abdomen, and samples of tissue are removed to be sent to the pathologist. This requires a sugical procedure, so if endo is suspected sometimes a GYN will prescribe hormonal treatments known to dampen down the growth of endo. Most commonly prescribed are birth control pills or a synthetic progesterone type of medication (eg Provera, DepoProvera). Then, if the hormones stop the menstrual pain, an inference might be drawn that endo was the culprit.
Some other possible causes of the pain pattern you have described might also include: adenomyosis (endometriosis grown into the muscular wall of the uterus), fibroids (these would have been seen on ultrasound), an ovarian mass (should be seen with ultrasound), or a pelvic infection (unlikely if you are monogamous). It is also possible that you are having the heavier flows typical of our late 30's through 40's. In this scenario, the heavier flows release more prostaglandins leading to increased cramps. Yet this would not prompt pain during the rest of your menstrual month.
Bottom line, I would urge you to return to your GYN or clinic--or if you do not have a GYN ask your primary care MD to refer you to one. You deserve a more "for sure" diagnosis and a discussion of treatment options.
Thank You and I did see a GYN the one who did my mom's hysterectomy and delivred my third child. She felt maybe I had a case of celiac but I dont was tested in January for that. So she said she felt it was unnessecary to start hormones because she tied my tubes after my third child and the family history so the plan is to wait til March and track everything going on and then most likely plan on a partial hysterectomy consisitng of the uterus and maybe ovaries depending on what they see when in there. Little nervous but if thats my only option of relief then it's a done deal. Thank you again.
Endometriosis can be tough to manage. And hysterectomy isn't a cure because endo can usually be found throughout the pelvis including in the bowels and it's difficult to remove it all. I've connected with a number of women who had hysterectomies for endo and for most, it didn't end the pain for very long. Most of these women had pain since menarche; development of endo many years after menarche doesn't seem nearly as common. However, I've read that c-section can cause it - not sure about tubal ligation.
Did you have any of these symptoms prior to your tubal ligation? TL can cause some of these same symptoms. Google it.
The removal of ovaries has been shown in medical studies to increase risk for a number of health problems. Google "oophorectomy mortality increased risk." If I'd received all the necessary information, I wouldn't have allowed any of my organs to be removed. Not only were my ovaries doing a lot more than I realized, so was my uterus.
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