Managing Endometriosis and Menstrual Pain After Uterine Surgery

Menstrual period post-surgery?

Hello doctor, last year I underwent surgery for uterine fibroids.
After the surgery, my attending physician informed me that I have endometriosis, and I have been on medication for over six months to induce menopause.
Blood tests have shown that my hormone levels have been consistently high, possibly related to the fibroids.
Is there a chance they will grow back? If they do, could it lead to a hysterectomy or another surgery to address the fibroids? I am unmarried, and my parents wish for me to keep my uterus, but I often experience severe pain that feels unbearable.
Recently, my doctor prescribed pain medication and ergotamine, and I stopped taking the endometriosis medication.
After that, my first menstrual cycle in the following month was delayed for a few days before starting again, with dark blood, clots, and a foul odor.
Is this normal or abnormal? Now, in the second month, the first day had less bleeding, but it increased afterward.
By the fifth day, there were large blood clots.
This time, I feel very uncomfortable and nauseous.
Even with pain medication, I still feel pain radiating from my lower back and from the left side of my uterus down to my intestines.
During the surgery, it was mentioned that my intestines were adhered to my fallopian tubes.
I read that ergotamine can cause nausea and vomiting, and I'm unclear on how to take it—should I take it for the first three days or continue until the end of my cycle? I used to experience menstrual pain that lasted several days, making it impossible to eat or even drink water.
It feels like I'm back to that time.
After my surgery, I had very few dietary restrictions, and I'm not sure what I should or shouldn't eat, as I am overweight.
My attending physician mentioned follow-up appointments every three months.

Zhenzi, 30~39 year old female. Ask Date: 2015/01/21

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, your symptoms may be due to endometriosis, which has caused uterine fibroids and pelvic adhesions, leading to heavy menstrual bleeding and pain.
The discomfort you experience from taking ergotamine is a side effect of the medication.
It is recommended that you discuss treatment options with a gynecologist.
If you live near our hospital, you are welcome to come for a consultation.
Wishing you good health.

Reply Date: 2015/01/21

More Info

Managing endometriosis and menstrual pain after uterine surgery can be quite challenging, especially when considering the complexities of the condition and the surgical history involved. It sounds like you have been through a lot with your health, and it’s understandable to have concerns about your symptoms and treatment options.

Endometriosis is a condition where tissue similar to the lining of the uterus grows outside the uterus, which can lead to significant pain, especially during menstruation. The pain you are experiencing, particularly in your lower abdomen and back, is not uncommon for those with endometriosis, especially after surgery. Surgical interventions, while often necessary, can sometimes lead to complications such as adhesions (scar tissue) that can cause ongoing pain and discomfort.

Given your situation, it’s important to address a few key points:
1. Post-Surgical Pain Management: After surgery for endometriosis or fibroids, it is common to experience pain as your body heals. However, if the pain is severe or worsening, it’s crucial to communicate this to your healthcare provider. They may need to adjust your pain management plan or investigate further for any complications such as adhesions or new growths.

2. Menstrual Changes: The changes in your menstrual cycle, including the presence of dark blood and clots, can be concerning. While some variation can be normal, especially after surgery or hormonal treatment, significant changes should be evaluated by your doctor. The odor you mentioned could indicate an infection or other issues that should be assessed.

3. Medication Management: You mentioned being prescribed pain medications and ergot alkaloids (like methylergometrine). It’s essential to follow your doctor’s instructions on how to take these medications. Typically, ergot alkaloids are used to manage bleeding and may be taken during your menstrual period. However, they can have side effects, including nausea, which you are experiencing. If the side effects are intolerable, discuss alternative medications with your doctor.

4. Diet and Lifestyle: While there is no specific diet that universally alleviates endometriosis symptoms, maintaining a balanced diet rich in fruits, vegetables, whole grains, and lean proteins can support overall health. Some women find relief by avoiding inflammatory foods, such as processed foods, sugars, and excessive caffeine. Staying hydrated and maintaining a healthy weight can also help manage symptoms.

5. Follow-Up Care: Regular follow-up with your healthcare provider is crucial. Since your doctor has suggested returning every three months, ensure you keep these appointments. They can monitor your condition, adjust treatments as necessary, and provide support for managing your symptoms.

6. Alternative Therapies: Some patients find relief through complementary therapies such as acupuncture, physical therapy, or mindfulness practices. These can help manage pain and improve quality of life.

7. Consideration of Future Treatments: If your symptoms persist or worsen, it may be necessary to discuss further treatment options with your doctor. This could include hormonal therapies, additional surgeries, or even discussions about the possibility of a hysterectomy if other treatments fail and if you feel that is the right choice for you.

In conclusion, managing endometriosis and menstrual pain after surgery requires a comprehensive approach that includes effective pain management, regular monitoring, and lifestyle adjustments. Open communication with your healthcare provider is key to finding the best strategies for your individual situation. Don’t hesitate to reach out for support and to advocate for your health needs.

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