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Which route to take for endo diagnosis ?

Hi, 6 years ago I started getting worse abdmonial pain and nausea. After couple of Ultrasounds they diagnosed appendicitis and removed it. Following month itself I had the recurring pain. Later went to GI and after U/S the results were normal. One fine day of the same year had severe vomiting and pain in abdomen resulted ER visit. CT, U/S were done and found 4cm haemorrhagic ovarian cyst on left. No medication prescribed so far.

3 years ago, again had the pain which usually starts a week before the period and stays until the end of period. Mood swings, depression and anxiety are in addition to the constant shooting pain. My PAC ordered for U/S and found no cyst on both sides.

2year ago, moved to new state and followed up with new PAC for the abdominal pain. She suspected gallstone and ordered CT abdomen & pelvis, Xray and found no abnormality. She referred to GI and he ordered for Hida scan(Liver, Gallbladder) and Endoscopy both came out normal.

1 year ago, switched to acupuncture for the pain management, it helped only for couple of days after the session. After 3 or 4 months, she recommended to visit Ob/gyn to rule out any internal issues for the unmanageble pain. Again Ob/Gyn ordered for U/S and found a cysts(under 3cm) in the Ovary. She asked us to take another u/s after 3 months to check their growth. We did that and found they were waxing cysts. No medications prescribed and recommended to have Birth control pills. Owing to their side effects we refused it. She therapy sessions to cope up the pain.

Early this year, changed the PAC and she prescribed Amitryptiline and Buspirone to manage the anxiety and depression. After many months also there was no significant improvement in the life style. Each cycle the pain starts by 21st day and lasts until 7th day. 50% of life is getting lost without able to do anything.

Couple of months ago had severe pain in the abodmen and had ER visit. U/S was performed and found a cyst(under 2cm) in right ovary.

Followed up with a general physician and she ordered for MRI Pelvis as we suspected endometriosis. Last week MRI was done and found 2 cm, intermediate T2 signal,
minimally T1 hyperintense, uncertain etiology. Differential considerations include evolving hemorrhagic cyst or
endometrioma.

My general physician referred to a Ob/gyn who got the next opening only by Jan.

Now, please suggest what would be best route to identify the root cause. Is it through Ob/gyn or Gyn/Oncology or Reproductive Endocrinology or any other ?

I have met the out of pocket maximum this year(owing to ER visit). Prefer to have it diagnosed and get the remedy at the earliest in South Bay Area, California. Please help. Thanks

  1. Thank you for sharing your story. First I want to acknowledge what a journey you've been on! This is a lot of time spent getting tests and seeing doctors and I can only imagine how frustrating it is to still be dealing with pain.
    I'm not a doctor, but it does seem like OB/Gyn is a good route to go. I've had recurring endometriomas and they are often a sign of more advanced disease. If you do, indeed, have endometriomas, it's a good idea to connect with a gynecology surgeon who is highly skilled with performing surgery and has experience with stage 3/state 4 and deep infiltrating endometriosis. It is in your best interest to have a MIGS trained surgeon who has performed many excisions.
    You can use this tool to find endometriosis experts near you: https://icarebetter.com/
    I wish you luck with the next steps and please keep us posted.

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