Gynecological Issues: Managing Pain and Treatment Options

Gynecological issues?

Hello, doctor.
I am in so much pain.
I have been seeing doctors every month, but my issues remain unresolved.
Since I had a colonoscopy at the age of 27, I have been visiting doctors every month for problems ranging from my bladder to the left side of my colon, and my entire lower back hurts.
The more I see doctors, the more issues I seem to have, and I don’t know what to say anymore.
I have uterine fibroids, so every time I experience pain, I end up vomiting and cannot drink water.
Could this be causing my recurrent urinary tract infections? However, I did not have any urinary issues before the colonoscopy.
After the procedure, I started feeling discomfort on the left side of my colon, which gradually worsened and eventually led to bleeding.
This helped me understand the cause of my pain, but I still have the same issues now.
Doctor, I am unsure about the antibiotics prescribed by my gynecologist and urologist.
I have taken them for several days, but I still experience pain and backache.
I went without antibiotics for a while, but I still have to visit the clinic every month, and a few days after my menstrual period, I experience bleeding again.
I asked a doctor on this website, and they mentioned it could be ovulation bleeding.
However, my doctor did not explain the cause of my condition; they only mentioned that I have uterine fibroids, but they are unsure about their size or quantity.
Because I am very overweight, they said the imaging was not very clear.
I really want to get better.
I am wondering if I can have surgery to remove the fibroids first, or do I need to lose weight before considering surgery? The doctor has advised me to lose weight, but I feel uncomfortable for half of the month.

Bing hen jiu, 30~39 year old female. Ask Date: 2014/01/17

Dr. Dong Yuhong reply Obstetrics and Gynecology

Hello; chronic pain and abdominal discomfort can cause a lot of psychological stress.
I'm not sure where you sought medical attention before, but based on your description, it seems you have many concerns about your condition.
Since your discomfort involves multiple systems, including gynecological, gastrointestinal, and urinary issues, I recommend establishing care with a medical center to undergo a comprehensive evaluation in the relevant specialties.
This will help clarify the underlying causes of your symptoms, which is essential for making informed decisions about subsequent treatment.
Of course, you will also need to collaborate with your healthcare provider, and it may take some time for follow-up assessments.
Thank you!

Reply Date: 2014/01/17

More Info

Managing gynecological issues, particularly pain associated with menstruation and other reproductive health concerns, can be a complex and frustrating experience. Your situation, characterized by severe menstrual pain, potential endometriosis, and the presence of uterine fibroids, requires a multifaceted approach to treatment and management.

Understanding Your Symptoms
1. Menstrual Pain (Dysmenorrhea): This can be classified into primary and secondary dysmenorrhea. Primary dysmenorrhea is common and usually occurs due to the release of prostaglandins, which cause uterine contractions. Secondary dysmenorrhea, on the other hand, is often related to underlying conditions such as endometriosis or fibroids. Given your history of uterine fibroids and the severe pain you experience, it is essential to consider that your symptoms may be linked to these conditions.

2. Uterine Fibroids: These benign tumors can cause significant discomfort, heavy menstrual bleeding, and even pressure on surrounding organs, leading to urinary symptoms. The size and location of fibroids can greatly influence the symptoms you experience. If your fibroids are large or located in a position that affects your bladder or intestines, they could be contributing to your pain and discomfort.

3. Potential Endometriosis: Although your recent laparoscopic examination did not reveal endometriosis, it is still a possibility, especially if you experience cyclical pain that correlates with your menstrual cycle. Endometriosis can sometimes be difficult to diagnose, as it may not always present visible lesions during surgery.

4. Urinary Symptoms: The discomfort you describe in your bladder area, along with recurrent urinary tract infections (UTIs), could be related to the pressure from fibroids or other pelvic issues. It’s important to differentiate whether these symptoms are due to an infection or the anatomical changes caused by fibroids.

Treatment Options
1. Pain Management: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can be effective for managing menstrual pain. However, if you find that these are not sufficient, your doctor may consider prescribing stronger pain relief or hormonal treatments, such as birth control pills, which can help regulate your cycle and reduce the severity of your symptoms.

2. Surgical Options: If your fibroids are significantly impacting your quality of life, surgical intervention may be warranted. Options include:
- Myomectomy: This procedure involves the removal of fibroids while preserving the uterus, which is ideal for women who wish to maintain their fertility.

- Hysterectomy: In cases where fibroids are large or numerous, and if you do not plan to have children, a hysterectomy may be considered.

3. Lifestyle Modifications: Weight management can play a crucial role in alleviating symptoms. Excess weight can exacerbate hormonal imbalances and increase the severity of fibroid symptoms. A balanced diet, regular exercise, and stress management techniques can contribute to overall well-being.

4. Follow-Up Care: Regular follow-ups with your healthcare provider are essential. If you continue to experience pain and discomfort despite treatment, further evaluation may be necessary. This could include imaging studies or a referral to a specialist in reproductive health.

5. Alternative Therapies: Some patients find relief through complementary therapies such as acupuncture, yoga, or dietary supplements. While these should not replace conventional treatment, they may provide additional support.

Conclusion
Your ongoing symptoms and the complexity of your medical history warrant a thorough and collaborative approach to treatment. It’s important to communicate openly with your healthcare provider about your symptoms, treatment preferences, and any concerns you may have. If you feel that your current treatment plan is not effective, don’t hesitate to seek a second opinion or ask for a referral to a specialist who can provide more targeted care for your specific needs. Remember, managing gynecological issues is often a journey, and finding the right combination of treatments can take time.

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