Could this be endo?

32 yo female, obese, no major medical probs, no past pregnancies, dependable 28 day cycle.  Gall bladder removed in 2003.

Abnormal discharge started in March, was ignored because kidney stone pain started and required antibiotics and surgery.  Three doses of Diflucan taken afterwards with no effect on original discharge.  No health insurance, so ignored until insurance started in Aug.

August:  Primary doc tested discharge, found only elevated white blood cells.  No bacteria, no yeast, no chlamydia, no thricomoniasis.  Two trials of Flagyl (oral) taken, followed by week of Metrogel Vaginal.  No change.  Referred to GYN.

September:
3 - LMP, more painful than usual and very clotty flow.
13 - Pelvic exam with GYN, painful.  Tests show same as primary doc's findings.  Scheduled ultrasound & blood work.
15 - Symptoms of ovulation on right side.
18 - Sharp pain in lower right quadrant (LRQ) with nausea wakes me up from sleep.  Lasts approximately 30 minutes.
20 - Bloodwork normal.
24 - ER for intense LRQ pain that has been increasing in intensity and now seems chronic.  Pelvic exam still very painful, told right ovary enlarged. CT scan normal.  Given IV antibiotics, Anaprox DS and Doxycycline for possible infection.
27 - Transvag US at GYN office,  2.1cm cyst on right ovary.

October:
5 - LMP late, start Lybrel and Ponstel.
9 - ER again; CT with contrast normal.
19 - Meet with Gastroenterologist, does IBD screening bloodwork that comes back normal.
22 - Trip #3 to ER.  Pain in upper and lower right quad.  No appetite for 3 days.  No fever or vomitting, no changes in bowel, pain chronic and severe with bouts of sharp pain in LRQ.  CT scan normal, again.
24 - Colonoscopy normal, told to follow up with GYN for laparoscopy to evaluate for endometriosis or adhesions.

Is it possible that this is endometriosis?  It seems to me that it would have caused symptoms earlier in my life and not such a sudden and chronic onset.  Any other GYN conditions that should be ruled out?

[John Kim, M.D.]

Yes, it could be endometriosis. Symptoms can vary for it. You should rule out pelvic inflammatory disease ie an infection of your female organ--uterus and tubes. If an infection is ruled out, a gynecologist can perform a laparoscopy or alternatively, attempt a trial of medical treatment with birth control pills, injection of Depo-provera or GnRH agonist for endometriosis. If the pain is resolved with medical treatment and infection was ruled out then it is most likely endometriosis and this is now an acceptable approach to treating endometriosis. However, you would not have an absolute diagnosis unless you have biopsy proven endometriosis during a laparoscopy.  I would recommend that you see an gynecologist.