Endometriosis: Key Questions and Concerns Addressed

Endometriosis!

Hello Dr.
Hsu,
I have been undergoing blood tests for the CA-125 tumor marker for three consecutive years, with values ranging from 49 to 72.
In 2003, my test result was #72.
When I asked the doctor about it, he couldn't find a reason.
A year passed, and this year my result was #71.
The doctor then diagnosed me with endometriosis and prescribed Danazol (200 mg) for me to take continuously for six months, with monthly follow-up appointments for monitoring.

I would like to ask:
1.
Can this condition be detected through ultrasound?
2.
Are these test values considered severe, or do they indicate other possible diseases?
3.
Is it possible to avoid taking medication?
4.
If I take the medication, what side effects might it have? (For example: nausea, dizziness, weight gain, acne, etc.) I have previously taken menstrual induction medication and contraceptives, which caused severe dizziness and vomiting.
5.
Should I seek a second opinion from another gynecologist?
Thank you, Dr.
Hsu!
Best regards,
Xiao You from Taichung

Xiao You, 30~39 year old female. Ask Date: 2005/10/14

Dr. Xu Junzheng reply Obstetrics and Gynecology

1.
It is difficult to diagnose via ultrasound if there are no lesions formed in the ovaries or uterus.
2.
CA-125 can be elevated in many conditions, but your situation does resemble endometriosis, and a level of 71 is not considered too high.
3.
Some believe that medication may not be very effective.
4.
Danazol is an androgen that can indeed cause side effects such as nausea, dizziness, weight gain, and acne.
5.
You may consider seeking a second opinion from another obstetrician-gynecologist.
Thank you for using "Taiwan e-Hospital" to ask your questions; "Taiwan e-Hospital" cares about your health.
Hsu Jun-Cheng

Reply Date: 2005/10/14

More Info

Hello, 小憂. Thank you for your questions regarding endometriosis and your health concerns. I understand that you have been experiencing elevated CA-125 levels and have been diagnosed with endometriosis. Let’s address your questions one by one.

1. Can ultrasound detect endometriosis?
Ultrasound can be a useful tool in identifying certain types of endometriosis, particularly ovarian endometriomas (often referred to as "chocolate cysts"). However, it is not always definitive. Endometriosis can also occur in locations that are not easily visualized with ultrasound, such as the pelvic lining or deeper structures. Therefore, while ultrasound can provide valuable information, it may not detect all cases of endometriosis.

2. Are CA-125 levels of 49-72 considered serious, or could they indicate other diseases?
CA-125 is a tumor marker that can be elevated in various conditions, not just endometriosis. While levels above 35 U/mL are considered elevated, your values in the range of 49-72 are not extraordinarily high but do warrant monitoring. Elevated CA-125 levels can also be associated with other conditions such as ovarian cysts, pelvic inflammatory disease, and even benign tumors. It is essential to interpret these levels in conjunction with clinical findings and imaging studies.

3. Is it possible to avoid medication?
The decision to take medication for endometriosis depends on the severity of your symptoms and the impact on your quality of life. Some women may choose to manage mild symptoms with lifestyle changes, dietary adjustments, or alternative therapies. However, if your symptoms are significant, medication may be necessary to help manage pain and prevent the progression of the disease.

4. What are the side effects of the medication (Danonice cap)?
Danonice, which contains dienogest, is a hormonal treatment used for endometriosis. Common side effects can include nausea, headaches, mood changes, weight gain, and acne. Since you have previously experienced significant side effects from other hormonal treatments, it is crucial to discuss these concerns with your doctor. They may be able to adjust the dosage or suggest alternative treatments that might be better tolerated.

5. Should I seek a second opinion from another gynecologist?
If you feel uncertain about your diagnosis or treatment plan, seeking a second opinion can be beneficial. Different specialists may have varying approaches to managing endometriosis, and a fresh perspective might provide you with additional options or reassurance. It’s essential to feel comfortable and confident in your treatment plan.

In summary, endometriosis is a complex condition that can significantly impact your life. Continuous monitoring of your CA-125 levels and regular follow-ups with your healthcare provider are essential. If you have concerns about the proposed treatment or side effects, don’t hesitate to communicate openly with your doctor. They can help tailor a management plan that suits your needs and preferences. Remember, you are not alone in this journey, and there are resources and support available to help you navigate your health concerns. Wishing you the best of health!

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