Could This Indicate Endometriosis?
Greetings! I’m a 36-year-old woman seeking clarity regarding some ongoing health issues. Below, I’ve summarized my medical history and included my questions at the end. I would appreciate any insights into potential next steps. For years, I have been on a quest for answers concerning persistent pain, and I have undergone numerous tests with only a handful of significant findings. **MEDICAL BACKGROUND** - Diagnosed with endometriosis at age 16, underwent laparoscopic surgery, and evidence of endometriosis was observed again during an emergency surgery for a ruptured ectopic pregnancy in July 2021. - In 2018, an HSG test revealed a blocked fallopian tube, which was subsequently unblocked and allowed me to conceive; however, I did have an ectopic pregnancy in that tube which ruptured in July 2021. I have been able to conceive again. - Diagnosed with asthma, thyroid cancer (2024), and unexplained tachycardia (currently consulting with a cardiologist). - Since giving birth to my first child nearly six years ago, I’ve experienced chronic pain primarily on my right side—focusing on the shoulder, neck, lower back, and hip. This pain has intensified over time and now manifests regularly, sometimes exacerbated by my menstrual cycle (which tends to be irregular or around 45 days apart). Initially, it started as shoulder discomfort, but it has now progressed to involve my entire right side. The pain can become severe, described as a burning sensation affecting my whole right side, accompanied by knots in my back and discomfort in my neck, jaw, and even behind my eyeball. Additionally, I’ve had flare-ups in my lower back and right hip, leading to issues like constipation, fatigue, and night chills. While I can manage some discomfort through physical therapy, yoga, stretching, breathing exercises, and medication, I am still looking for the underlying issue. **CURRENT MEDICATIONS** - Norethindrone (until a few months ago due to heavy bleeding), metoprolol, asthma inhaler as necessary, magnesium supplements. **LATEST TEST RESULTS** - No physical abnormalities detected in my spine, shoulder, or neck. - Thyroid cancer was removed through partial thyroidectomy; currently, I do not require supplemental medication. - Recent blood tests returned normal results. - In April 2024, I underwent an MRI of the abdomen and pelvis with and without contrast. The radiologist's report stated: * "No definitive evidence of pelvic or abdominal endometriosis. * Mild thickening of the torus uterinus and dorsal uterine serosa, accompanied by a retroflexed uterus and medialization of the left ovary—these findings may be non-specific, either normal for the patient or indicative of mild fibrosis from earlier surgeries. However, superficial fibrotic endometriosis could also be a consideration." - In March 2025, a colonoscopy and endoscopy were performed, and a medium submucosal nodule was discovered at the appendiceal orifice, potentially indicating a mucocele. - A subsequent CAT scan was conducted due to findings related to the appendix, which returned normal results except for a complex left adnexal mass measuring 5 cm, suggesting the presence of fluid levels. **SUMMARY** Historically, I have dealt with endometriosis affecting my bowels, had laparoscopic surgery years back, and during surgery in 2024, more endometriosis was identified on the uterus. Currently, I have a complex left adnexal mass which has raised concerns. **QUESTIONS FOR DISCUSSION** 1) Considering my medical history, how probable is it that the mass is related to endometriosis? 2) What additional insights might a follow-up ultrasound provide that the CAT scan did not? 3) Given that this area corresponds with both my blocked tube in 2018 and the ruptured ectopic pregnancy in 2021, could this mass be associated? 4) Based on your experience, what recommendations would you make for further actions regarding these results? Note that I have a consultation scheduled with an OBGYN as well as a follow-up with my endo surgeon, who also performed the MRI in 2024. I look forward to your feedback!
Answers (1)
3/30/2025, 10:10:46 PM
OpenHealth AI
Thank you for sharing your detailed medical history and concerns. Understanding the complexity of your situation is important, and I'm here to provide clarity on your questions about the potential connection of your symptoms and findings to endometriosis, as well as next steps for managing your health.
Summary of Main Points
- Complex adnexal mass: Could potentially relate to endometriosis but requires thorough assessment.
- Ultrasound benefits: It can provide better visualization of soft tissues compared to a CAT scan.
- Connection to past medical issues: Yes, there may be a connection, but only further evaluation can clarify this.
- Next steps: Prepare for upcoming consultations and consider managing pain effectively in the meantime.
Detailed Explanation
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Probability of the mass being related to endometriosis: Given your history and symptoms, particularly previous surgeries and the nature of endometriosis, there is a possibility that the complex left adnexal mass could be related to endometriosis. The characteristics of this mass – especially its complexity and the presence of fluid levels – warrant further investigation to understand its origins.
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Insights from a follow-up ultrasound: An ultrasound can offer real-time images of the pelvic region and is particularly useful in evaluating ovarian masses. It can differentiate between solid and cystic structures, assess the blood flow in these areas using Doppler ultrasound, and help determine the nature of the adnexal mass more clearly than a CAT scan might have. This can guide potential next steps, including monitoring or intervention.
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Association with past medical issues: The mass could be linked to past complications such as the blocked tube and your history of ectopic pregnancy. Previous surgeries can lead to adhesions or new areas of endometriosis, which may contribute to the formation of cystic structures or masses.
Recommended Next Steps
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Prepare for your upcoming OBGYN and endo surgeon consultations:
- List your symptoms clearly, including the nature and patterns of your pain.
- Discuss the significance of the complex adnexal mass, the possible need for a follow-up ultrasound, and any concerns about your menstrual cycle.
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Consider a pain management strategy:
- Continue utilizing physical therapy, yoga, and stretching as these can be beneficial for managing chronic pain.
- Discuss adjustments to any medications you may require for pain, especially at times when menstrual cycles exacerbate your symptoms.
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Monitor symptoms: Keep a diary of your symptoms, noting their severity and any triggers or patterns, as this can help facilitate discussions with your healthcare providers.
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Stay proactive about managing your overall health:
- Follow up on any recommendations from your specialists regarding your thyroid condition and tachycardia.
- Ensure you maintain open communication with your healthcare team regarding any changes in your health status.
Your concerns are valid, and it's essential to remain informed and engaged in your care process. If you have additional questions or need further guidance, feel free to ask.
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