Endometriosis: CA-125 Levels and Treatment Options Explained

Endometriosis

Hello, Doctor: Since the onset of my menstrual period, it has been irregular, and I experience menstrual pain every time.
Therefore, I went to a large hospital for an examination.
My attending physician ordered a CA-125 blood test, but on that day, my menstrual period was at its most painful point.
I asked the doctor if it was okay to have the blood test during my period, and she said that some tests are meaningful when done during menstruation.
Later, during my follow-up appointment, my CA-125 level was 35.1.
The doctor mentioned that there were no structural issues with my uterus on the ultrasound, but my blood test result was already slightly elevated, which could indicate endometriosis due to retrograde menstruation.
I then started taking medication for treatment.

I would like to ask, I have heard that CA-125 levels can be elevated during menstruation, and since my level is not significantly above the normal range, how can it be determined that I have endometriosis? Given that the treatment with medication lasts for six months, I am confused about whether I should continue the treatment or if it would be better to seek a second opinion at another hospital.
I would appreciate Dr.
Lu's advice.
Thank you!

Niming, 20~29 year old female. Ask Date: 2015/09/13

Dr. Lü Lizheng reply Obstetrics and Gynecology

There are many causes of dysmenorrhea, and endometriosis is one possible reason.
However, it is not easy to confirm clinically.
Measuring the Ca125 level through a blood test can provide some reference, but it is not definitive; it may be necessary to retest during a non-menstrual period if needed.
There are various options for managing dysmenorrhea, including simply taking pain relievers or using hormonal contraceptives (not for contraception, but to utilize the progesterone in the contraceptives to regulate and reduce menstrual flow, which can also alleviate menstrual pain).
The advantage of using hormonal contraceptives is convenience, as they can be taken every three days, although there may be side effects.
Some individuals improve without medication by increasing physical activity and ensuring adequate sleep.
If there are plans for pregnancy, it may also be worth considering starting earlier, as many people find that their dysmenorrhea resolves after childbirth.
As for whether to consult other physicians, that is also an option.
Sincerely, Dr.
Li-Cheng Lu, Taoyuan Hospital.

Reply Date: 2015/09/13

More Info

Understanding endometriosis and the role of CA-125 levels in diagnosis and treatment is crucial for managing this condition effectively. CA-125, or cancer antigen 125, is a protein that is often elevated in women with endometriosis, ovarian cancer, and other conditions. However, it is important to note that CA-125 is not a definitive marker for endometriosis, and its levels can fluctuate due to various factors, including the menstrual cycle.

In your case, your CA-125 level of 35.1 is indeed above the normal range, which is typically considered to be less than 35 U/mL. However, it is essential to understand that CA-125 levels can be influenced by several factors, including menstruation, pregnancy, pelvic inflammatory disease, and benign conditions like fibroids or cysts. Since you mentioned that your blood test was conducted during a particularly painful phase of your menstrual cycle, it is possible that the elevated CA-125 level could be attributed to the hormonal changes and inflammation associated with menstruation.

The suggestion from your physician that the elevated CA-125 could be related to retrograde menstruation leading to endometriosis is a common hypothesis. Retrograde menstruation occurs when menstrual blood flows backward through the fallopian tubes into the pelvic cavity instead of leaving the body. This can lead to the development of endometrial tissue outside the uterus, which is characteristic of endometriosis.

Regarding your treatment with "佑汝" (likely a reference to a hormonal treatment), it is essential to follow your physician's guidance. Hormonal therapies, such as birth control pills or progestins, can help manage symptoms by reducing menstrual flow and suppressing the growth of endometrial tissue. The typical duration for such treatments is around six months, and many patients experience significant relief from symptoms during this time.

If you are feeling uncertain about the necessity of continuing treatment, it is entirely reasonable to seek a second opinion. Consulting another healthcare provider can provide you with additional insights and help you feel more confident in your treatment plan. It is also beneficial to discuss any concerns you have about the side effects of the medication or the effectiveness of the treatment with your current physician.

In summary, while your CA-125 level is elevated, it is not solely indicative of endometriosis, and the context of your menstrual cycle must be considered. Continuing treatment under the guidance of your healthcare provider is advisable, but do not hesitate to seek further evaluations if you have lingering doubts. Endometriosis can be a complex condition, and a multidisciplinary approach involving gynecologists, pain specialists, and possibly reproductive endocrinologists may be beneficial in managing your symptoms and addressing your concerns about fertility and overall health.

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