chronic abdominal pain

[trina1998]

i am a 29 year old female i have 4 children, i had one abortion in 2005.i got my tubes tied in 2006, a day after my daughter was born.in 2005, i started having severe abdominal pains.ive had laparascopies, ultrasounds and mri done, and they keep saying nothing is wrong. i ahve also been having painful intercourse for 10 years. the pain is always located on the left side in my abdomen. atarting in march 2008, i started to bleed during sex, after sex and me periods atarted to become irregular. iwent from a period every 21 days for 5 days, to only last 3 days.my ob/gyn had put me on depo lupron for the bleeding, i am going to get my 4th shot, because the 1st and 3rd didnt work because i started my period. he has ruled out endometriosis.i am tired of being in chronic pain. he said that if this shot doesn't work his only option will be to do a complete hysterectomy even though nobody can pin point exactly where the pain is and why im having it. he said that many women have experienced their pain going away after hysterectomies even though their is no explanation of where the pain comes from.i would like ot know hwat may be wrong with me before i get a complete hysterectomy and get threw into menopause, and thw pain may still be there after the surgery.thank you

[J T Junig, MD PhD]

My only addition to what Jaybay said  is that it is usually the 'older docs' who do the gyn work-- the idea is that your young patients grow old with you, and then you get to give up the middle of the night OB hours and settle into an easier schedule.

By all means get a second opinion before the hysterectomy.  The attitudes about hysterectomy vary from region to region and from city to the suburbs... I live in a smallish WI town where docs sound like the writer's doc- 'just take the darn thing out' is the usual comment in this 'neck of the woods'!  And I admit to coming across many women over the years who were very grateful for 'the change'.  BUT...  there is something a bit misogynistic about that attitude, and it IS major surgery, and in any major surgery there are a number of things that can go wrong.  

It would at least be nice to have SOME kind of diagnosis, or explanation, for the pain that your surgeon is hoping to eliminate.  Not that MONEY is playing any role... (can't imagine something like THAT happening!)... but hysterectomies pay well too-- especially in non-medicare 29-y-o women.  

I am just realizing that I am taking this more lightly than I should, which is usually a hint for me that I am out of my knowledge area-- and I am.    Please make use of the OB GYN forums, and I hope that they are helpful for you.

[Jaybay]

I'm not the doctor, and I don't know how much Dr. Junig can help you since Pain docs deal with treating pain that has already been diagnosed.  I had endometriosis and ended up having a hysterectromy - kept my ovaries though.  Before you take that drastic step, it might be worth consulting a reproductive endochrinologist to have a thorough look at your hormone levels.  With all the surgeries you've had, I'm surprised no endometriosis was found, but it may be deeply embedded in your uterus (adenomyosis) or deep into the cul-de-sac where it's not easily seen with a laparascope.  I actually had endo embedded deeply in my vagina and it bled a year after my hysterectomy.  Even my doctor was shocked about that!

Have you had any problems with the lupron?  I couldn't take it after two months of injections following an endo cleanout.  The side effects were ruining my life mentally and physically, and it wrecked my short-term memory for nearly a full year.  Since it throws you into immediate medical menopause, I'm not certain a hysterectomy will even help since you continue to bleed.  Don't let surgeons fool you: even though it's a common procedure, a hysterectomy is major surgery and takes easily 8 weeks to start feeling human again - particularly the open procedure.  

If lupron hasn't stopped your periods, then something is seriously whacko with your hormones.  That's why it might be beneficial to see a hormone specialist (endochrinologist).  They can be difficult to find outside a major city, but please think about it before venturing into major surgery.  Even a second opinion from a different gynecologist would be beneficial.  If at all possible, try to find a gyno who does not also have an OB practice.  They are very difficult to find since the OB side of the practice is where the money is, but it's not impossible.

Most of all, don't give up.  Something is obviously not right; you just haven't found the right doctor to help you yet.  That journey can be long and frustrating as I well know. :-)