Thanks for writing to us with your health concern.
All your symptoms point towards a diagnosis of endometriosis.
This is a condition wherein menstrual blood flows backwards, leading to adhesions on the pelvic walls, over the bladder etc.
Symptoms typically include - painful sex, painful periods, erratic spotting, pain during urination etc.
Yes, the condition does tend to run in families, and is associated with infertility.
What is your age ?
Do you have kids ?
When you said - all tests have come out clean - what all tests have been done so far ?
This is diagnosed by ultrasound / MRI or a laparoscopy.
Also, the treatment includes cyclical progesterone pills, birth control pills, or other higher hormones.
IF all medical treatment fails, surgical intervention is needed.
Please write back wtih more details.
Patient replied :
Dr. Aarti Vazarini,
Thank you for your reply. I am 22 years old patientold, I don't have any kids and we are not planning to have one any time soon.
I have been having annual check-ups for years, and every time I would tell them that there's a pain in my pelvic area. I honestly thought my cousin was just infirtle, I asker her today about her condition. The thing that puzzles me is that her diagnosis is different from mine and like you said, this should be hereditary.
The recent tests I had were the urinalysis, CBC, TVS, lower abnomenal ultrasound. The first doctor I saw said it may just be UTI and the last one said it may be endometriosis (mild) but she didn't explain to me anything about it.
Do I have to get a laparoscopy to confirm it? I have been having sudden pain again but it's not as severe as before, but I'm afraid it could really be an issue in my line of work.
Now that we have been able to spot it early, could we manage it and maybe help me to be able to concieve in the future? I heard this is uncurable but could be controlled, how could we control it? If it is left untreated what would it be deadly?
In terms of laparoscopy, wouldn't I be under general anesthesia, would it affect my memory in any way, or degrate it slightly?
Thank you so much for your fast reply, I really appreciate it.
Thank you for the appreciation.
Now for the rest of your questions.
YOu need a pelvic ultrasound scan ( transvaginal and not abdominal ) and a pelvic and abdominal MRI.
If that fails to pick up anything, and the pain persists as it is, yes a diagnostic laparoscopy is called for.
Yes, it is done under general anesthesia, and it does nothing to impact your memory,or degrade it in the least.
Do not worry on that score.
This COULD be hereditary, but it is not a must.
May I know what was your cousin's diagnosis.
Endometriosis affects fertility, not all women with endometriosis are infertile.
In fact, pregnancy cures endometriosis, atleast for a while !
And yes, if picked up early, it can very much be controlled medically or surgically, and a lot can be done to aid fertility.
It is not curable, as you correctly said, but very much manageable.
Start off with the ultrasound scans suggested and let me know how it goes.
Looking forward to hearing from you.
Patient replied :
Dr. Aarti, I had a transvaginal ultrasound, it came out clean. The doctor asked me to try Visanne, she told me that it will help with the pain. It was hard for her to really distingush what I have when every single tests comes up clean. What other alternatives should I use to treat the problem. Right now I am having mild pain, fullness in my pelvic area especially when I move. I do always have that feeling that there's osmethign leaking out of my genetals, but when I look there's nothing. My cousin told me that the she has a retroverted uterus, that her felopian tube is too thick that the egg couldn't attach itself to it making it hard to concieve. She told me sha has a cyst, and she said it was due to the eggs not detaching itself from the ovaries which becomes a cyst. She didn't tell me what it was called exactly but she said it was not endometriosis. My mother is thinking of letting me have the laparoscopy, I told her to wait for the doctor's orders. It's nice to know that there's a posibility that I wouldn't be infertile, but in your profesional opinon would it be safer to actually start replanning my life? I mean, I was planning to have children when I am about 34? Focus on my career first and then eventually a family, or should I try earlier? I think I may only have one last follow up question after this, so I really thank you for your time. There are a lot of doctors here but I wanted a broader view of the situation, I want to hear a lot of opinions. I guess I may still be in the phase of denial and shock. I only knew I had this three days ago. I don't want to believe something that may not be there, cause I know how powerful the brain is. The problem is, I have been expericing the pain for years old patientand both the intensity and the frequency has been increasing. Do you have any other advice, so I could physically present it to a doctor here? Like some tests or some other alternatives or anything at all. Will the pain intensify even with medication? IS there a posibility of this condition to get worst ovetime even with medication? The doctor here told me I have "mild pelvic endometriosis". Assuming it's mild, it must not be as serious as the others. Will this affect my career? I am a licensed commercial pilot, hopefully by the end of the year I would be teaching future pilots. Best Regards, Nathalie
Firstly this might be your last follow up query, but yes, you can always post a question directly to me on this forum, so no worries.
I am always here.
VIsanne is an excellent drug for this condition, however for immediate pain relief, you can use painkillers, the conventional ones that you would take for pain anywhere in the body, the OTC ones.
Apart from Visanne, there are various therapeautic options, if Visanne does not work , such as - birth control pills, Danazol, Growth hormone analogues and antagonists, Lupride injections.
Surgery is a last resort, and rarely, if ever, needed for mild pelvic endometriosis.
ONly a laparoscopy can assess the grading, however.
Apart from a transvaginal ultrasound scan, you can go for a pelvic MRI.
The condition your cousin has is probably - PCOS ( Polycystic ovarian syndrome ).
It is much better to have a laparoscopy when the doctor thinks you should have one.
If you are symptomatically better with the options discussed, then all is well.
And yes, with a tentative diagnosis of endometriosis, it is not wise to wait until you are 34 to have kids, yes, you should think about it much earlier, if you can.
It is a frank opinion of mine, for an intelligent, perceptive young woman.
Mild degree of endometriosis is unlikely to affect your career or your fertility.
Yes, it CAN worsen with time, even with medications, it is difficult to say how it will behave as it differs with each individual.
And yes, pregnancy and breastfeeding are protective / beneficial for endometriosis, they put the disease back by many years.
Please do not assume you have endometriosis.
I suggested it as a possible diagnosis, unless it is proven, it is again illogical to panic or get worried.
Stay in touch as often as you wish.
Patient replied :
Dear Dr Aarti Vazirani,
I haven't been in touch lately, I would just like to let you know about what has been happening. I started my medication, the first one I tried was Qlaira (estradiol Valerate/Dienogest), a medication (pills) recommended by one of the doctors I consulted.
It is true that most of the pain disappeared but unfortunately there are still that sudden stabbing pain situated around my lower abdominal area going down towards the genitals (and towards the side). I am planning to stop this medication and to go to Vissane (prescribed by the second doctor I consulted). Like I said, for the past few weeks I wasn't convinced at all and wanted multiple diagnosis but all of you have the same diagnosis.
The pills gave me a lot of side effects -- the first week I was so irritable, then I had these mood wings, then there was a week where I just felt so sad, or maybe a little depressed, even if there was no reason to. I also bloated and gained so much weight that was noticable in just a few days.
The doctors told me before that if I started these hormonal treatmeants, or medications the pain would subside, and frankly I am getting scared of when the pain could strike next. The last time was just a couple of days ago, while I was driving -- I can only explain the pain this way, I wanted to drive straight to the hospital because it hurts so much (but, in comparison to the pain before, this is less in frequency and intensity).
If it is not endometriosis, what posible reason or illness do I have explaining all my symptoms?
I have not completely settled in the idea I have endometriosis, but I also have no idea why I am having the pain.
I know that it would be a stupid thing to do to stop the medication and wait and see if a cyst from or not -- even if that's another way of proving if it is endometriosis or not.
I know from the tone of my email you could see that I just really want answers... I just really want the pain gone. No one could explain it before and I had if for years old patientand I thought that maybe, this is what normal should feel like? And I know I am not wrong.
I thought of it being psychological, but being aviator I have passed all my medical and pyschological exam. I have no reason to be unhappy, I have a great family and see a great future ahead. Also, how could I have the same symptoms as my cousin (from five years old patientago till now), when I only knew her condition that last week of June?
I know I am over my qouta and I know that you don't have to reply. Thanks again for yoru help last June.
Hello, glad to hear from you.
Visanne is better suited for endometriosis, please try it.
Also , there is occasional pain, and I admit it can get bad, but you have admitted that the pain has significantly gone after starting the hormones.
So please switch to Visanne, give yourself a month or two, before deciding whether it is working, and also, if the side effects have levelled out.
Frankly I cannot think of any other condition that explains your symptoms.
I do not think it is psychological, since you are quite intelligent, happy and an achieve.
The only option is to actually have a diagnostic laparoscopy that will go inside and see what is going on.
That maybe an option if you do not want to blindly take hormones.
Hope this helps ?