Ultrasound and CA125 Results in Endometriosis Diagnosis

Regarding the results of ultrasound and CA-125 tests?

Hello Doctor, I apologize for the lengthy message, and thank you for your response.
(I have not had sexual intercourse yet.) I have been experiencing chronic menstrual pain for a long time, which I used to endure, but over the past six months, the pain has become increasingly severe (I wake up in the middle of the night due to pain during the first two days of my period).
It is accompanied by pain in the rectum and coccyx, as well as lower back discomfort.
Pain relievers have not been effective.
Recently, I consulted with Dr.
A, a gynecologist, who diagnosed me with endometriosis.
Dr.
B (the deputy director) said the ultrasound was normal and advised me to wait for the CA125 report.
Dr.
C stated that I have endometriosis and suspected adenomyosis, and my CA125 level was 440, which is abnormal, and advised me to test again (the second test result was 493).
However, since Dr.
C and Dr.
B are from the same hospital, I was instructed to return to Dr.
B for follow-up.
It has been over a week since my period ended, and although the discomfort has become milder, it still persists.
When I returned to see Dr.
B, he responded that the initial tests were conducted while I was still in pain, so those results were not significant, and advised me to wait until I am not in pain to undergo testing.
Regarding the endometriosis, I can choose to take medication or pay out-of-pocket for menopause injections.
I would like to ask the doctor: (1) Is Dr.
B's statement accurate? If so, why were the tests arranged at that time? (2) For the discomfort in the lower abdomen, near the vaginal opening, rectum, coccyx, and lower back, do I just have to wait until the pain subsides? (Especially the frequent sharp pain in the rectum and coccyx.) (3) Besides medication and paying for injections, are there any other treatment options available?

A Fang, 30~39 year old female. Ask Date: 2021/01/17

Dr. Huang Yuande reply Obstetrics and Gynecology

1.
Dr.
B's statement is correct, but testing can serve as a reference for the severity of symptoms and is not excessive.
2.
These pain points are essentially common sites for endometriosis; therefore, in addition to symptomatic treatment, management should be tailored to address endometriosis based on its severity.
3.
The treatment trilogy: (1) medication to relieve pain, (2) hormonal suppression therapy (which can be administered via injection or oral medication), and (3) surgical intervention.

Reply Date: 2021/01/17

More Info

Understanding the results of ultrasound and CA-125 tests in the context of endometriosis can be quite complex, especially when dealing with symptoms that significantly affect your quality of life. Let's break down your concerns and questions regarding the diagnosis and management of endometriosis.

1. Understanding CA-125 and Its Implications
CA-125 is a protein that is often elevated in women with endometriosis, ovarian cancer, and other conditions. In your case, the CA-125 levels of 440 and then 493 are significantly above the normal threshold (which is typically less than 35 U/mL). Elevated CA-125 levels can indicate the presence of endometriosis, particularly when accompanied by symptoms like severe menstrual pain and discomfort in the pelvic region. However, it is important to note that CA-125 is not a definitive diagnostic tool for endometriosis. Other conditions, such as pelvic inflammatory disease or even benign ovarian cysts, can also cause elevated levels.

Regarding Dr. B's comment about the relevance of your CA-125 results while you were experiencing pain, it is somewhat valid. Elevated CA-125 levels can fluctuate based on various factors, including the presence of inflammation or other underlying conditions. However, the decision to test CA-125 should still be based on clinical suspicion of endometriosis or other conditions, regardless of whether you were in pain at the time of testing.

2. Managing Symptoms and Discomfort
Your symptoms, including pain in the lower abdomen, rectum, tailbone, and lower back, are indeed concerning and warrant attention. While waiting for the pain to subside before further testing may seem reasonable, it is crucial to address your discomfort actively. Pain management strategies can include:
- Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) can help alleviate pain, but if they are ineffective, discussing alternative pain relief options with your healthcare provider is essential.

- Hormonal Treatments: Hormonal therapies, such as birth control pills or GnRH agonists, can help manage endometriosis symptoms by suppressing menstruation and reducing the growth of endometrial tissue.

- Lifestyle Modifications: Regular exercise, dietary changes, and stress management techniques can also play a role in managing symptoms.

If your pain persists or worsens, it is crucial to communicate this to your healthcare provider. They may recommend further imaging studies or even a laparoscopy, which is a surgical procedure that allows direct visualization of the pelvic organs and can confirm the diagnosis of endometriosis.

3. Exploring Treatment Options Beyond Medications
In addition to medications and hormonal treatments, there are other management strategies for endometriosis:
- Surgery: If conservative treatments fail and your symptoms are debilitating, surgical intervention may be necessary. This could involve the removal of endometriosis lesions, cysts, or even a hysterectomy in severe cases.

- Physical Therapy: Pelvic floor physical therapy can help alleviate pain and improve function, especially if there is pelvic floor dysfunction associated with endometriosis.

- Alternative Therapies: Some patients find relief through acupuncture, chiropractic care, or dietary supplements, although these should be discussed with your healthcare provider to ensure they are safe and appropriate for your situation.

Conclusion
In summary, understanding your ultrasound and CA-125 results is essential in managing endometriosis. While elevated CA-125 levels can indicate endometriosis, they are not definitive on their own. It is vital to address your symptoms actively and explore various treatment options with your healthcare provider. If you feel that your concerns are not being adequately addressed, seeking a second opinion from another specialist may provide additional insights and treatment options. Your health and comfort are paramount, and you deserve a comprehensive approach to managing your condition.

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