Endometriosis pain/bleeding

I was diagnosed with endometriosis April 2008, at the age of 22. It was quite devastating, but a relief after having to consult a few GYNs before one listed to my complaints. I had surgery in April of 08, which was successful in removing multiple cysts, scar tissue, adhesions. Post surgery i felt fine, my dr put me on a 6 month treatment of lupron, which was non the less, horrible. After the 6 month treatment he put me on a mini pill, which i took for about 4-6 months, and towards the later part of treament i started to either bleed too much, too little or none at all. He had since switched me to seasonal, and the first month was fine, besides 2 days of spotting toward the end of that month, and a 9 pound gain weight. The beginning of the 5th week i started t ospot and have been non stop since then. Ive been spotting for 6 weeks now, and actually cramping. I consulted with my dr yesterday, and he told me to begin taking 2 pills a day, as opposed to 1 and the bleeding should stop.....and it hasnt. Is this normal? What are my options? He tested my CA125 and it is a normal of 13, compared to 122 before the surgery. I hate being in pain every day from the cramping, and especially hate that i spot on a daily basis...please help.

[Elaine Brown, MD]

HI!
Your doctor is probably correct in thinking that the spotting is due to atrophy (thinning) of the lining of your uterus.  When the lining gets too thick or too thin this type of bleeding can occur.  Given your history, it is most likely that your lining is too thin.  Taking two pills a day will eventually thicken up the lining and stop the spotting, but it will take some time--usually two to three days or even a little longer.  Once the lining is stabilized, the bleeding should subside.  When the bleeding stops, the cramping very likely will too. In the mean time you could use anti-inflammatories such as Motrin or Aleve.  Once the bleeding stops, call your doctor back to see if he wants you to go back to one pill per day.
Good luck!
Dr B