Chronic Lower Abdominal Pain: Could It Be Endometriosis?

Persistent lower abdominal pain?

I have given birth to two children, and since having my second child, my menstrual cycle has become irregular.
My periods have not stopped for a whole month, and I experience lower abdominal pain.
After taking medication to regulate my cycle, it became more normal, but once I stop the medication, the irregularity returns.
However, the lower abdominal pain has persisted for three years, which is very distressing for me.
Am I going to have to take medication for the rest of my life? I recently read in a magazine about a condition called endometriosis that seems to match my symptoms.
Could that be the case, or could there be other reasons? How should I get tested?

Wenwen, 20~29 year old female. Ask Date: 2002/09/16

Dr. Lü Lizheng reply Obstetrics and Gynecology

Hello Wenwen!
1.
Menstrual irregularities can be caused by both external and internal factors.
External factors include sleep disturbances, being overweight or underweight, life stress, and a busy work schedule, all of which can disrupt normal menstruation.
Internal factors involve hormonal imbalances that control ovarian ovulation, such as disorders of the pituitary gland, thyroid, and prolactin levels.
Blood tests and ultrasound examinations are necessary to understand the overall hormonal and menstrual status in order to identify the cause and provide thorough treatment.
2.
There are many causes of persistent lower abdominal pain, including chronic uterine inflammation, endometriosis, adhesions of the uterus and ovaries, and even intestinal spasms, constipation, urinary tract stones, muscle contractions, and neuropathic pain, all of which can contribute to chronic lower abdominal pain.
Each potential cause must be investigated and confirmed.
3.
Endometriosis has some characteristic features, such as increased pain before or during menstruation; internal pain during intercourse; and often accompanying diarrhea or constipation during the menstrual period.
During an initial pelvic examination, a sensation of adhesions around the uterus may be felt; however, a definitive diagnosis requires laparoscopic surgery to directly observe whether there are endometrial implants within the abdominal cavity.
Wishing you and your family peace and happiness.

Dr.
Lu Lizheng, Taoyuan Hospital, Department of Health, Executive Yuan.

Reply Date: 2002/09/16

More Info

Chronic lower abdominal pain can indeed be a symptom of endometriosis, especially considering your history of abnormal menstruation and persistent pain following childbirth. Endometriosis is a condition where tissue similar to the lining of the uterus grows outside the uterus, leading to various symptoms, including chronic pelvic pain, painful periods, and pain during intercourse. It can also cause pain during bowel movements or urination, particularly if the endometrial-like tissue is located near the intestines or bladder.

Given your symptoms, it is plausible that endometriosis could be contributing to your chronic lower abdominal pain. The fact that your menstrual cycle has become irregular and that you experience significant pain could indicate that hormonal changes and the presence of endometrial-like tissue are affecting your pelvic region. The pain you describe, which has persisted for three years, is concerning and warrants further investigation.

To diagnose endometriosis, a healthcare provider may recommend several approaches:
1. Pelvic Exam: A thorough pelvic examination can help identify any abnormalities, such as cysts or scars behind the uterus.

2. Imaging Tests: Ultrasound or MRI can be used to visualize any endometriomas (cysts formed from endometriosis) or other abnormalities in the pelvic area. However, these imaging tests may not always detect endometriosis.

3. Laparoscopy: This is a surgical procedure that allows a doctor to look inside the pelvis using a camera. It is considered the gold standard for diagnosing endometriosis, as it can confirm the presence of endometrial-like tissue and allow for biopsy if necessary.

4. Blood Tests: While there is no definitive blood test for endometriosis, tests like CA-125 can be performed. Elevated levels of this protein may indicate endometriosis or other conditions, but it is not specific to endometriosis alone.

In terms of treatment, there are several options available depending on the severity of your symptoms and whether you wish to conceive in the future:
1. Pain Management: Over-the-counter pain relievers such as NSAIDs (e.g., ibuprofen) can help alleviate pain.

2. Hormonal Therapy: Birth control pills, hormonal IUDs, or other hormonal treatments can help regulate your menstrual cycle and reduce or eliminate menstruation, which may alleviate pain.

3. Surgery: If endometriosis is confirmed and causing significant pain or fertility issues, surgical options may be considered to remove endometrial-like tissue or cysts.

4. Lifestyle Changes: Some individuals find relief through dietary changes, exercise, and stress management techniques.

It is understandable to feel concerned about the prospect of needing to take medication indefinitely. However, it is essential to have a thorough discussion with your healthcare provider about your symptoms, treatment options, and any potential side effects of long-term medication use. They can help you develop a personalized treatment plan that addresses your specific needs and concerns.

In conclusion, while your symptoms could suggest endometriosis, a definitive diagnosis requires further evaluation. It is crucial to seek medical advice from a gynecologist who can guide you through the diagnostic process and discuss appropriate treatment options tailored to your situation.

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