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Women's Health

Recurrent pelvic pain

07/10/2006

Question:

I have had endometriosis for 4 years. I am 26, and have had two laproscopies, the last one in Feb 06. I had the Lupron Depot shot last year and been on continuous birth control, getting a cycle only 4 times a year for 4 years. The last surgery found major adhesions affecting the bowel, uterus, ovary and fallopian tubes. They removed the scar tissue and adhesions, removed the unnatural connection of my organs, and opened my tubes, and lasered off the peritoneum. The pain is back again, just as bad if not worse than ever. I am at a total loss. My GYN is on maternity leave till September, a Primary Care Physician isn't skilled in this area, and all anyone can tell me to do is take NSAIDS. I went to the ER once. They give you pain medication, and sure it helps - Dilaudid will help almost anything. But like all medications it wears off. I had a CT scan that was negative (of course). I need to be able to have kids, and not only that I need to be out of pain. Any advice would be appreciated.

Answer:

Endometriosis and pelvic pain have a wide spectrum of presentations; your case sounds quite severe, and I understand that you are very frustrated and upset by this very problematic disease.

This site of general information is perhaps not the best forum to give specific recommendations, but I can make a few observations.  You have tried some very appropriate and usually effective therapies, but I am unclear what results you obtained from them in the past.  If the Depot Lupron or the continuous pill were helpful treatments, you may consider another course of one of those options. 

Sometimes the pain becomes chronic because of persistent inflammation of pain-sensing nerve fibers, and treatment of neurogenic pain with a non-narcotic such as gabapentin or amitryptiline is also helpful.  A chronic pain specialist may help with prescribing one of these medications or managing other pain medications. 

If you are interested in conceiving right away, you should probably consult with an infertility specialist.  Most of these specialists are also experts in the management of endometriosis, and if you can get pregnant, this will often help the endometriosis to regress.   Good luck!

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Response by:

Jonathan  A Schaffir, MD Jonathan A Schaffir, MD
Clnical Assistant Professor of Obstetrics & Gynecology
College of Medicine
The Ohio State University