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What Causes Pelvic Pain And Pain During Sexual Intercourse?
Question: I have been having pelvic pain that is increasing as time goes on. I have pain with intercourse and with bowel movements, and my cervix is painful upon examination. I also have extremely painful periods, but no bleeding in between. They are increasingly heavier than I have had before. I have had a history of endometriosis at 21, and am now 43. I had an ultrasound which showed: an anteverted uterus measuring 8.2x4.5x4.4cm. The endometrial echo is homogeneous measuring 9.1 transversely. No mass, no collection of fluid and ovaries fine. One follicle measures 1.2cm. (I should be ovulating in a few days.)
My family history is that my mother had adenomyosis, but it was not found until she had a hysterectomy. She had pain and bleeding after I was born. I have had 2 children and my pain started worsening after my son was born 2 years ago.
The NP I saw today said everything was normal and is going to speak with the MD at the office, since she does not know what can be causing this?? I am so tired of the pain! Any idea what is going on?
My family history is that my mother had adenomyosis, but it was not found until she had a hysterectomy. She had pain and bleeding after I was born. I have had 2 children and my pain started worsening after my son was born 2 years ago.
The NP I saw today said everything was normal and is going to speak with the MD at the office, since she does not know what can be causing this?? I am so tired of the pain! Any idea what is going on?
Brief Answer:
Yes I have an idea. Endometriosis is acting up.
Detailed Answer:
The pain that you're describing is classic for endometriosis. Adenomyosis is a variation of endometriosis. The glandular tissue is percolated into the muscle rather than the pelvic slippery surfaces. There are several treatment options. You could consider the Quadriphasic birth control pill Natazia which is been shown to be effective in the treatment of secondary dysmenorrhea such as pelvic pain caused by endometriosis. There's also a potent progestin IUD called Mirena that also relieve endometriosis symptoms. Finally you'll not be surprised to hear that there is a surgical option of hysterectomy. If at the time of hysterectomy endometriosis is confirmed then you should only consider hormone replacement that includes a progestin in order to not spread the endometriosis after surgery. I would suggest medical therapy first. There are very few contraindications to the IUD. It should be very effective if you can put up with the initial side effects of irregular bleeding. It will diminish overtime. Each year you have the IUD in place you're more likely to have no periods at all. I hope you feel better soon.
Yes I have an idea. Endometriosis is acting up.
Detailed Answer:
The pain that you're describing is classic for endometriosis. Adenomyosis is a variation of endometriosis. The glandular tissue is percolated into the muscle rather than the pelvic slippery surfaces. There are several treatment options. You could consider the Quadriphasic birth control pill Natazia which is been shown to be effective in the treatment of secondary dysmenorrhea such as pelvic pain caused by endometriosis. There's also a potent progestin IUD called Mirena that also relieve endometriosis symptoms. Finally you'll not be surprised to hear that there is a surgical option of hysterectomy. If at the time of hysterectomy endometriosis is confirmed then you should only consider hormone replacement that includes a progestin in order to not spread the endometriosis after surgery. I would suggest medical therapy first. There are very few contraindications to the IUD. It should be very effective if you can put up with the initial side effects of irregular bleeding. It will diminish overtime. Each year you have the IUD in place you're more likely to have no periods at all. I hope you feel better soon.
Above answer was peer-reviewed by :
Dr. Yogesh D
Thank you so much! I really had no idea that adenomyosis was related to endometriosis. That would explain a lot. A couple of more questions:
-If the radiologist suspected adenomyosis, would he/she have stated it on the report?
-Is that why my report said "homogeneous"? Also, is the measurement showing that the uterus is thick? I don't know what normal is...
My only other problem is that I don't think I am a candidate for hormones at all. I was positive for a phospholipid antibody in the past, but they are running it again. I also have Bipolar and the birth control pills I have used in the past cause me to cycle pretty severely. To top it off, my mother had an ER/PR + breast cancer (but she was older and did not have the BRCA gene.) I wasn't tested.
Considering all that, would hysterectomy probably be my option? And would I need my ovaries removed also?
Thank you again-
-If the radiologist suspected adenomyosis, would he/she have stated it on the report?
-Is that why my report said "homogeneous"? Also, is the measurement showing that the uterus is thick? I don't know what normal is...
My only other problem is that I don't think I am a candidate for hormones at all. I was positive for a phospholipid antibody in the past, but they are running it again. I also have Bipolar and the birth control pills I have used in the past cause me to cycle pretty severely. To top it off, my mother had an ER/PR + breast cancer (but she was older and did not have the BRCA gene.) I wasn't tested.
Considering all that, would hysterectomy probably be my option? And would I need my ovaries removed also?
Thank you again-
Brief Answer:
Endometrial thickness is not abnl while cycling.
Detailed Answer:
This is a lot more than one question. I will try to work my way through it.
1)The endometrial thickness would only be abnormal if you were postmenopausal. The ultrasound was done for pain not abnormal cycles. If your cycles were abnormal I would repeated after a menses & perform an office endometrial biopsy if it was thicker then .5 cm or 5 mm.
2) Adenomyosis is a pathology diagnosis of a surgical specimen. It is not usually detected on ultrasound. It is a diagnosis of exclusion. Homogeneous means that everything looks pretty much like everything else.
3) Antiphospholipid anybody can indicate that you are more susceptible to forming blood clots if exposed to high levels of estrogen such as in birth control pills. Postmenopausal levels of hormones are usually less than you make it the menstrual cycle. if you undergo hysterectomy and removal of your ovaries for pain my guess especially given your psychiatric history is that you will need some. Estrogen replacement. This can be done with a live this transdermal patch. There is no data to indicate that a .375 mg estradiol patch elevates the risk of clotting.
If you undergo surgery for pelvic pain and endometriosis is diagnosed and is severe enough you may wish to avoid estrogen for that reason. Hormone replacement with oral progesterone consisting of 5 mg of northindrone daily often is enough to control most of the hot flashes and will counteract endometriosis without increasing the risk of blood clotting.
4.All women are susceptible to breast-cancer if they live long enough. Most breast cancers are estrogen and progesterone positive even in women who have never taken post menopausal hormonal therapy. 5 to 10 years of treatment should not elevate your risk above baseline even with the hx you give.
5. Mirena IUD is not contraindicated by any of the history you have given. You can always progress to surgery. Surgery however you reversible. The Mirena IUD can be removed if it doesn't work out. It is very effective for the treatment of adenomyosis and endometriosis. It can take six months to a year to achieve maximum effect. One may have several months of irregular bleeding initially that will diminish over time. The IUD is as effective as inducing medical menopause in the treatment of endometriosis.
6) if you do undergo surgery for endometriosis and the ovaries should be removed. If only adenomyosis is present at the time the surgery then retaining the ovaries would be advised. The explanation behind that decision is too lengthy to discuss further at this time, but we are here for you if we can be helpful in the future.
Endometrial thickness is not abnl while cycling.
Detailed Answer:
This is a lot more than one question. I will try to work my way through it.
1)The endometrial thickness would only be abnormal if you were postmenopausal. The ultrasound was done for pain not abnormal cycles. If your cycles were abnormal I would repeated after a menses & perform an office endometrial biopsy if it was thicker then .5 cm or 5 mm.
2) Adenomyosis is a pathology diagnosis of a surgical specimen. It is not usually detected on ultrasound. It is a diagnosis of exclusion. Homogeneous means that everything looks pretty much like everything else.
3) Antiphospholipid anybody can indicate that you are more susceptible to forming blood clots if exposed to high levels of estrogen such as in birth control pills. Postmenopausal levels of hormones are usually less than you make it the menstrual cycle. if you undergo hysterectomy and removal of your ovaries for pain my guess especially given your psychiatric history is that you will need some. Estrogen replacement. This can be done with a live this transdermal patch. There is no data to indicate that a .375 mg estradiol patch elevates the risk of clotting.
If you undergo surgery for pelvic pain and endometriosis is diagnosed and is severe enough you may wish to avoid estrogen for that reason. Hormone replacement with oral progesterone consisting of 5 mg of northindrone daily often is enough to control most of the hot flashes and will counteract endometriosis without increasing the risk of blood clotting.
4.All women are susceptible to breast-cancer if they live long enough. Most breast cancers are estrogen and progesterone positive even in women who have never taken post menopausal hormonal therapy. 5 to 10 years of treatment should not elevate your risk above baseline even with the hx you give.
5. Mirena IUD is not contraindicated by any of the history you have given. You can always progress to surgery. Surgery however you reversible. The Mirena IUD can be removed if it doesn't work out. It is very effective for the treatment of adenomyosis and endometriosis. It can take six months to a year to achieve maximum effect. One may have several months of irregular bleeding initially that will diminish over time. The IUD is as effective as inducing medical menopause in the treatment of endometriosis.
6) if you do undergo surgery for endometriosis and the ovaries should be removed. If only adenomyosis is present at the time the surgery then retaining the ovaries would be advised. The explanation behind that decision is too lengthy to discuss further at this time, but we are here for you if we can be helpful in the future.
Note: Revert back with your gynae reports to get a clear medical analysis by our expert Gynecologic Oncologist. Click here.
Above answer was peer-reviewed by :
Dr. Prasad
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