Managing Severe Menstrual Pain: Options for Endometriosis and Surgery

Menstrual pain

Hello Dr.
Lu,
I have endometriosis and have undergone an ovarian removal surgery, leaving only one-third of my right ovary, while my left ovary was completely removed.
Later, I successfully underwent in vitro fertilization at your hospital and had a cesarean section to deliver triplets.
However, it has been nearly 10 years, and my menstrual pain continues to accompany me and is increasing day by day.
I have seen many doctors and taken numerous medications, which have led to a gastric ulcer.
Now, I experience pain from the start to the end of my menstrual cycle (approximately 20 days), leaving me with only a few days of relief each month.
This severely impacts my work and daily life.
Therefore, I would like to ask if there is a definitive solution, such as a hysterectomy.
I am unsure if there are specific regulations regarding this surgery, as well as any potential side effects and how long I would need to rest post-surgery.
Thank you!

lynn, 30~39 year old female. Ask Date: 2003/06/14

Dr. Lü Lizheng reply Obstetrics and Gynecology

Hello! 1.
If medication treatment is ineffective, surgical treatment is recommended.
2.
A hysterectomy is suggested; if the ovaries are also affected, consideration should be given to their removal as well; if not, they can be preserved.
3.
Health insurance coverage is available.
4.
Side effects: a small number of individuals may experience intestinal adhesions, and those with severe adhesions may have intermittent discomfort or pain.
5.
Postoperative recovery: if an open abdominal surgery is performed, a five-day hospital stay is required; if laparoscopic surgery is performed, only a three-day hospital stay is necessary.
Best wishes for health from Dr.
Lu Li-Cheng, Department of Obstetrics and Gynecology, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2003/06/14

More Info

Managing severe menstrual pain, especially in the context of endometriosis, can be a complex and challenging issue. Your situation, having undergone ovarian surgery and experiencing persistent and debilitating menstrual pain for nearly a decade, is not uncommon among women with endometriosis. The pain you describe, which lasts throughout your menstrual cycle and significantly impacts your daily life, is a serious concern that warrants a thorough discussion of potential treatment options.

Endometriosis is a condition where tissue similar to the lining of the uterus grows outside the uterus, leading to inflammation, pain, and sometimes the formation of adhesions. Surgical intervention, such as laparoscopic surgery, is often employed to remove endometrial tissue and adhesions. However, as you've experienced, surgery does not always provide lasting relief, and pain can persist or even worsen over time.

Given your history and the severity of your symptoms, it is understandable that you are considering a hysterectomy (removal of the uterus) as a potential solution. A hysterectomy can indeed provide relief from endometriosis-related pain, particularly if the uterus is a significant source of pain. However, it is important to note that this procedure is typically considered a last resort, especially for women who wish to retain their fertility. In your case, since you have already had children, this option may be more viable.

Before proceeding with a hysterectomy, several factors should be considered:
1. Evaluation of Symptoms: A comprehensive evaluation by a gynecologist specializing in endometriosis is crucial. They can assess the extent of your condition and determine if other treatments might be effective before resorting to surgery.

2. Medical Management: There are various medical treatments available for endometriosis, including hormonal therapies such as birth control pills, progestins, and GnRH agonists. These medications can help manage pain by suppressing menstruation and reducing the growth of endometrial tissue. However, as you've noted, some treatments can have side effects, such as gastrointestinal issues or other complications.

3. Surgical Considerations: If a hysterectomy is deemed appropriate, your doctor will discuss the specifics of the procedure, including the type (total vs. subtotal), potential risks, and recovery time. Generally, recovery from a hysterectomy can take several weeks, and you may experience hormonal changes if your ovaries are also removed.

4. Post-Surgical Care: After a hysterectomy, it is essential to have a plan for managing any potential hormonal changes, especially if the ovaries are removed. Hormone replacement therapy (HRT) may be necessary to alleviate symptoms of menopause.

5. Long-Term Outlook: While a hysterectomy can provide significant relief from endometriosis-related pain, it is not a guaranteed solution for all patients. Some women may still experience pain or develop other complications post-surgery.

In conclusion, while a hysterectomy may offer a potential solution for managing your severe menstrual pain due to endometriosis, it is essential to have a thorough discussion with your healthcare provider about all available options, including medical management and the implications of surgery. Each case is unique, and a tailored approach considering your specific circumstances, health history, and personal preferences is crucial for achieving the best possible outcome.

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