Endometriosis or something else?


Q: I am trying to figure out if there is any reason for me to go to a doctor and have more expensive tests run. I have been having left lower quadrant pain since fall 2013. I went to my OB/GYN at the time and she did a series of sonograms that showed small cysts on my ovaries that would resolve by the next sono, each time the cyst would be on a different ovary, which indicated normal ovulatory cysts. She concluded that because of family history, I likely had endometriosis and that the cysts were not causing the pain (while I had cysts on both ovaries, I only had pain on the left.) She offered to do exploratory surgery to diagnose endometriosis, but this procedure caused scar tissue with my sister, which caused more pain, and I was hoping to avoid that. The pain had great subsided over this past summer and I have been pain free for the fall. The pain returned today and it is quite uncomfortable. Is this still likely a symptom of endometriosis, or could it be something else, maybe intestinally related? I am 35 with three living children, one early miscarriage 10 years ago.

Symptoms:  Pain in left lower quadrant

A:   Hello,
Thanks for the query to ATD.
The presentation of pain restricted to left iliac fossa and pain not being associated with menses and usually inter menstrual, with no history of deep pain during intercourse and then pain getting relieved on its own for a period more than 6 months and then recurring now again , all goes against the diagnosis of endometriosis at all.
Endometriosis pain should be worse during menses and should be relieved after the end. Also intercourse should be painful. it is usually not relieved for months together unless you have become amenorrhoeic or if your menses have stopped by medication or menopause.
This is unlikely to be ovary either as the size of left ovary is normal and not causing any pressure symptoms anywhere. Neither you have been experiencing any dragging sensation in the pelvis in the centre indicating a possible uterine prolapse which can cause stretch of uterosacral or mackenrodt's ligaments. So it is unlikely to be a gynaecological cause, this seems to be more of dyspepsia or gastroenteritis causing a dull aching pain constantly which comes and goes. It is suggested that you may get a stool test done to look for any infection and if required may opt for deworming and a empirical course of treatment with gut antibiotics for a week to cover any infection be it pelvic or gastrointestinal if present.
I hope i have answered your query in detail,
wishing you good health,

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