Endometriosis

Realizing that endometriosis can only be diagnosed by laparoscopy, I was just wondering what the other differential diagnoses would be for someone who gets left sided groin pain monthly for 3-4 days around ovulation and then also for 3-4 days around the period, no spotting or heavy periods.  The pain only occurs when I am sitting which is strange to me, and resolves if I stand or lie down and was wondering if this can occur with endo.  Can other things beside endo cause the pain at the time of ovulation and menses?  I have an appt to have this evaluated further but wanted to see what else I could find out in the meantime.  Thank you.

[Shayne Plosker, MD]

The pain you are experiencing could be endometriosis, or could also be due to what is called primary dysmenorrhea, which is period pain or discomfort due to a group of hormones in the reproductive tract called prostaglandins. Cysts and adhesions are scar tissue are uncommon causes. You are correct that endometriosis can only be diagnosed by laparoscopy, but if the endometriosis is moderate or severe there can be suspicious findings on ultrasound. The question of whether or not you need a laparoscopy is not so straightforward. For women trying to get pregnant and having difficulty doing so, laparoscopy is probably helpful for moderate or severe endometriosis, but of only some benefit if minimal or mild. Even if a laparoscopy is done and endometriosis is found and treated, we estimate that at best one out of eight women who have minimal or mild endometriosis treated at laparoscopy will get pregnant as a result of the laparoscopy. For women bothered by pain, laparoscopic treatment can help most of the time, but the alleviation of pain is not always permanent, and not always complete. Thus, if the pain is something you can tolerate, and if ultrasound does not suggest moderate or severe endometriosis, then it is not clear whether or not you would benefit that much from laparoscopy, even if endometriosis is found and treated. A very important part of the decision is how you feel. If you feel that you need to know the answer, even if surgery will not greatly improve chances of getting pregnant, then that too is a consideration for laparoscopy. Finally, painful periods or pain around ovulation can of course often be treated with great effect by the birth control pill, but if you are trying to get pregnant that is obviously not an option. I hope  this helps.