OpenHealth Q&A

Long-Term Consequences of Using Ketorolac Trometamol

Greetings, I'm a 29-year-old assigned female at birth (AFAB) and I'm currently undergoing gender-affirming treatment with Testosterone Undecanoate, which I've been on for two and a half months. I have been diagnosed with ADHD, although I'm not currently receiving treatment for it, and I was diagnosed with polycystic ovary syndrome (PCOS) in 2019. I have a suspicion that I might have endometriosis alongside my PCOS, but I am uncertain if this is a local issue (as I reside in Brazil) or part of a broader problem with women's healthcare here. I have struggled to find a doctor willing to test me for endometriosis. Since my initial menstrual cycle began at age 11, I have consistently endured severe cramps both before and during my periods, often resulting in vomiting due to the intensity of the pain, as well as experiencing diarrhea, fainting, and experiencing extremely heavy menstrual flow. My cycles were irregular during my teenage years but have stabilized somewhat in adulthood. This condition has significantly affected my daily life by making it nearly impossible to study or work effectively during my cycle. Consequently, I’ve been forced to pursue remote work, as I typically experience debilitating pain for at least three days each month, making it exhausting to even leave my home. I have visited the emergency room multiple times due to these symptoms when my periods began and throughout my early adulthood, largely because they impacted my work ability. However, physicians have frequently dismissed my concerns as "normal," suggesting I simply take ibuprofen, despite the fact that I have been unable to keep food down, leading to vomiting in hospital waiting rooms. I relied on ibuprofen for years until it ceased to alleviate my pain. I then transitioned to nimesulide, which was effective for a time, but its efficacy also faded. Eventually, I tried diclofenac and similar medications, but this pattern repeated: effective at first but losing potency with continued use. I often resorted to self-medicating because doctors would continue to recommend ibuprofen, which had become ineffective by the time I was 16. I have experimented with numerous analgesics and anti-inflammatory drugs, often needing to exceed recommended dosages in order to achieve some level of relief. Unfortunately, no medication has completely alleviated my suffering. I hope to eventually find a doctor who takes my issues seriously and conducts thorough tests to identify underlying causes, should testosterone fail to stop my periods. At 18, after much insistence, I managed to get an ultrasound, which revealed nothing abnormal. A physician prescribed me birth control injections every three months to manage my symptoms, as they were hindering my ability to maintain employment. However, these injections resulted in severe nausea that made simple tasks like brushing my teeth difficult, and they heightened my sense of smell, complicating my life further, especially since I worked with wood, which has strong odors. Eventually, I quit that job after just a year. In 2019, while living in Bolivia with my aunt, she had to call for a doctor when I fainted multiple times and was incoherent over the phone, unable to eat or stand. At that time, no medication was providing relief. The doctor prescribed ketorolac trometamol, which thankfully offered relief. He also referred me to a gynecologist, who conducted another ultrasound and diagnosed me with PCOS. She recommended a hormonal treatment, but due to financial constraints, I couldn't afford it beyond the first month; I believe it was progesterone or a similar medication. Since then, ketorolac trometamol has been my only means to manage nausea and help me maintain a facade of normalcy at work. Back in Brazil, the labor market is unforgiving; most positions do not accommodate illness, and one is expected to show up even when unwell unless absolutely incapacitated. This culture pressures me into self-medicating because I fear being penalized for taking time off, particularly for menstrual pain. Currently, ketorolac is less effective, requiring me to take two 10 mg sublingual tablets every three hours just to function somewhat normally. Even so, I still experience significant discomfort, fatigue, and common menstruation symptoms like nausea, trembling legs, breast pains (which have decreased with testosterone), and migraines. The standard recommendation here is to take one tablet every four to six hours, without exceeding four tablets daily. From 2019 to 2022, I took one tablet every four hours continuously for three days each month. From 2022 to 2024, I switched to one every two to three hours or two every four hours, and currently, I am at two every three hours. I am increasingly concerned about the potential long-term impacts of such extensive use of this medication. I intend to discuss these concerns with my gynecologist during my appointment in September, urging them to investigate my condition more seriously, not only for my health but also due to the risk that prolonged medication use poses to my body. What arguments can I use to persuade them to consider evaluating me for endometriosis or other potential issues? It's important to note that my pap smears have always returned normal results. Aside from pap tests and vaginal ultrasounds, I have not undergone any other examinations.

Answers (1)

8/21/2025, 4:52:03 PM

OpenHealth AI

It sounds like you have been through a lot of pain and frustration while seeking proper treatment for your menstrual issues. It’s completely understandable to be concerned about the long-term effects of taking ketorolac trometamol, especially given its frequent use. Your goal of identifying and addressing underlying health concerns, such as endometriosis, is valid and important.

Main Points:

1. Long-Term Use of Ketorolac: Prolonged use can lead to gastrointestinal issues, kidney problems, and increased risk of bleeding.
2. Advocating for Your Health: Clearly communicate your severe symptoms and request specific evaluations to explore conditions like endometriosis.
3. Use of Effective Strategies: Prepare for your appointment with organized notes and potential persuasive arguments.

Explanation:

Ketorolac, while effective for acute pain relief, is not intended for long-term management due to potential side effects. Chronic use can cause:

• Gastrointestinal Risks: Increased risk of ulcers and bleeding, especially with higher dosages.
• Kidney Issues: Potential for reduced kidney function due to prolonged NSAID use.
• Cardiovascular Risks: Long-term NSAIDs may increase heart attack or stroke risk.

Given your history of severe symptoms leading to emergency visits, it may be challenging to convey the urgency of thorough evaluations. It’s crucial to express how these symptoms have impacted your life significantly.

Next Steps:

1. Document Your Symptoms: Keep a detailed log of your symptoms, including pain levels, duration, and how they impact your daily activities. This can help provide a clear picture of your condition to your gynecologist.

2. Prepare Your Arguments:

   • Emphasize the severity and frequency of your symptoms (vomiting, fainting, etc.) that lead to emergency care.
   • Highlight the ineffectiveness of over-the-counter medications and the escalating dosage of ketorolac required for relief.
   • Request specific tests, such as a pelvic MRI or laparoscopy, which are more conclusive for diagnosing endometriosis than ultrasounds or pap smears.

3. Set Goals for Your Appointment: Discuss alternative pain management strategies, including potential hormonal treatments and lifestyle changes, while emphasizing the need for a comprehensive approach to your health.

4. Explore Support Networks: If applicable, seek out support groups or communities, both online and locally, where individuals share similar experiences. Sometimes, they may provide additional resources or refer you to more understanding healthcare providers.

Conclusion:

Your proactive approach to seeking better health outcomes is commendable. By presenting your concerns with clear documentation and justifications during your appointment, you enhance your chances of being taken seriously and getting the help you need. Your health is paramount, and advocating for yourself is a crucial step in managing your ongoing challenges.