Should I get a laparoscopy?

[tfc123]

Hi I'm debating whether I should ask for a laparoscopy.

I have had debilitating period pain for several years now. It started when I was about 18 and the general trend is it's got progressively worse. The pain is so severe it leaves me screaming and rolling on the floor with intense nausea.The pain is like an intense burning right through my lower abdomen. When I get an episode they are incredibly traumatic. I cannot stand up or do anything useful until I have taken several painkillers. I usually end up taking too many during my period and I am worried that longterm overuse has caused me other health problems like acid reflux and stomach pain afer eating.

I have been seeing a gynecologist about the pain since last year. She suspected that I might have insulin resistance, and speculated that poor metabolism of sugar and carbs were causing general inflammation in my body, explaining my intense period pains. She gave me metformin because I have slightly polycystic ovaries (about 8-10 follicular cysts) even though I don't have any symptoms of PCOS apart from that; I have no weight problems or excessive hair growth and I don't get intense cravings for sugary food. I tried the metformin while also reducing carbs and increasing the protein in my diet for a year with no real impact ony my pain (although I did manage to have one or two periods with reduced pain). I have also been taking supplements which are supposed to help reduce pain and inflammation like omega-3 fish oil and magnesium. But despite this I just had my worst episode of pain recently.

I'm thinking that the next step should be a proper investigation to see if I have endometriosis. How people describe their pain with endo it sounds incredibly familiar to me. But I've had two transvaginal ultrasounds and nothing abnormal showed up? How common is it for nothing to show up in an ultrasound but be found in a laparoscopy? My gynecologist never suggested my pain could be caused by endometriosis or ever brought up laparoscopy so , I don't know. Not knowing the causse is so frustrating. I am also concerned about my fertility being affected.

[RES159]

Hi,

Sorry to hear you are going through such a difficult time at the moment. Think I'm in a similar position to you, both in terms of symptoms and that, until recently, I've been on the fence about the need for a laparoscopy.

Transvaginal ultrasounds, even internal ones, do not always show endometriosis and a laparoscopy is the only real way of securing a medical diagnosis of the condition. Having said that, if you do have an insulin resistance as your doctor suggested, I'm not sure how/if it will affect things, so it might be worth looking into this in more depth before making any big decisions about the medical direction you wish to take.

Choosing to undergo surgery is a big decision for anyone to make and, depending on your level of concern/the severity of your symptoms, it may be worth discussing endometriosis as an option with your gynecologist and get their read on the situation.

While fertility can be affected by endometriosis, many women with varying stages of the condition have had children and from what I've read there is no clear outcome either way. People sometimes say that fertility is most likely in the year following endometriosis surgery, but don't quote me on that one!

With regards to your pain killers, it is always good to check the box/with your doctor about the number of pills you are able to take safely and try not to exceed the advised amount. Taking pain killers with/after eating food can really help to line and settle your stomach which should also help to minimise the harsh impact on your digestive system. If your pain is so bad that ordinary pain killers do not sufficiently ease your symptoms, definitely discuss this with you doctor as you may need to take stronger prescription pain killers such as Mefanamic Acid (which is the only thing that touches the sides of my pain!)

My experience

A year-and-a-half ago I began to get an unprecedentedly agonising intense burning pain in my lower abdomen on day three of my period, which have become progressively worse over the course of the year and now occur both on day one and day three of the period. Other symptoms, including the aura (flashing lights) of a migraine, ears ringing, sudden fever, sweating and dehydration also occur without warning during the painful episodes.

Having experienced very heavy but otherwise 'normal' period periods until I was 23, the new agonising period pain marked a definite change in my body's routine. It was me that mentioned endometriosis to my GP and pushed to see a gynaecologist after doing a bit of research.

Prescribed Mefanamic Acid is my absolute saviour as it knocks out the pain and symptoms entirely. The fact my symptoms were easily managed put me off the idea of having a laparoscopy. My inclination was to think 'why should I put my body through an operation that will cause scarring and possibly worsen the situation if I can get away with effective pain killers.'

After two external ultrasounds that showed a large and quickly growing cyst on my left ovary, my gynaecologist advised a diagnostic laparoscopy to remove the cysts (and possibly my ovary) and explore/laser away any endometriosis cells in the process.

In this respect, my hand has been played for me on whether or not to have surgery! I'm due to have my first (hopefully last... :/) laparoscopy on 3 October, so we'll see how that goes..! Genuinely terrified, but if it will answer my questions, explain my symptoms and remove the cyst - it is (hopefully?) worth the fear and uncomfortable recovery process ahead?!

Think if anything has come from reading the posts on this site, it's that every case is different and, what is the right course of action for one person may be the wrong course for another. It is definitely a good idea to read up as much as you can and have an open and honest conversation with your doctor and gynaecologist to discuss the options/risks/benefits in detail to gain a clear picture of what you want to achieve.

There is a lot of support around and the more questions you ask, the less you have to go through on your own Hope you are feeling okay and really hope this has helped slightly!

RES159

[Shelly92 in reply to RES159]

Hello RES

I had pain on my third day as well.

It was way different than cramps I would get. Felt like something was inside twisting and pulling me apart.

Finally one dr explained it.

He was the one who said it sounds like endo to me and it

Makes sense to have more pain in the latter part of your period.

This is when I learned of how endo acts.

He said

Endo is caused by escaped blood from your period.

It travels out your tubes into surrounding areas where it attaches and gets worse.

He did say that there was no real answer as to how this blood got there.

Some say it backs up into your tubes and goes up .

Some say you are born with it inside your body and it takes years to start having pain.

We really don't know how it's started. But as your period proceeds you can get worse pain in the middle or end of your period .

The pain is the tissue trying to escape because your brain has given the signal to leave your body cause conception did not happen.

So that blood is trying its hardest to leave to but there is nowhere it can escape from.

As your period keeps going your brain is sending out more signals for it to leave now .

So it attaches and causes pain as it can't get out .

That's why I would have pain on the third day .

Pulling stretching pain

And I was so sore it hurt to touch or bend over .

So I hope that that made sense but it sure fit the description of what I was feeling.

Thus starting my journey with endo.

A road I would be walking for years .

[tfc123 in reply to RES159]

Good luck with your surgery!

Thank you, it puts it in more perspective for me. I understand that the benefits of having the surgery don't often outweigh the drawbacks, if they even find endo in me it might not make any difference to the pain.

About painkillers: I used to take Mefenamic acid but I can't get it prescribed to me anymore. It was a very effective painkiller, but I didn't always take it correctly because it works best when you begin before your period starts.

[Shelly92]

It is very possible not an ultra sound would not pick it up and a lap is needed .

This Endo stuff is tricky .

And it really makes no sense .

I think it could show up on an ultra sound if you had Endo right in the right spot .

But then you'd still need more testing to see how far it has gone