I was diagnosed with endo via laparoscopic surgery in 2003,

Patient

Q: I was diagnosed with endo via laparoscopic surgery in 2003, it was pretty extensive. In 2003 I also had my thyroid removed due to cancer. Prior to 2003, I was diagnosed with PCOS and I bled for 3 months after I had my first child. My period was always irregular until I went on synthroid in 2003, now it's regular. Over the past few years my periods have gotten worse. I get horrible PMS symptoms as well as lots of clots during my period. Cramping after my period is worse than during and ovulation is awful. Over the past few years I've had new pain on my left side. It's getting worse. It's in what I would assume to be my kidney/intestines and spreads to lower back but also under and on top of my ribs. Sometimes it's so bad under the ribs it feels like a pulled muscle or Charlie horse and I have to reposition myself for it to stop. I feel like my whole left side is swollen and sore to touch. I've had multiple CT, blood work, colonoscopy, endoscopy and a vaginal ultrasound that showed a small chocolate cyst. I'm scheduled for another laparoscopic surgery next month. I'm driving myself crazy. Diagnosing myself with cancer, pancreatitis, diverticulitis, IBS, I think maybe an autoimmune ??!

Doctor

A:   Hello,
Thanks for the query to askthedoctor.com for an opinion.

Firstly let me put your anxiety to rest that this is not a cancer presentation. The typical severe pain during menses or dysmenorrhoea and during ovulation time with spread to lower back and abdomen, with a history of diagnosed endometriosis and also a chocolate cyst seen on ultrasound indicates that your endometriosis has worsened and formed extensive adhesions with the surrounding adnexal structures. The pain is typically increased during your menses when the endometriotic patches inside the abdomen also proliferate and extending to different organ structures. Ideally you should have been placed on GnRH analogues if pregnancy was not a concern again so that endometriosis could have been controlled or continuous progesterone pills to avoid menses or cause amenorrhoea.

A second look laparoscopy is an ideal mode of diagnostic surgical modality which can estimate the extent of endometriotic spread and along with adhesiolysis and fulguration of endometriotic patches can be performed, which shall give you relief. Following the surgery you should be placed on GnRh analogue if you desire to retain your uterus else hysterectomy would be best advised for you,if you have completed your family.

I hope i have answered your query in detail,
Wishing you good health,
Regards

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