Five days of ovulatory pain
I suffer every month for at least five days during ovulation. My period is like clock work, every 28 days, and my pain too is right on track, 10 days after the first day of my period and has become increasingly painful.
I am 31 years old and have been dealing with this for 3 years. I had laparoscopic surgery two years ago to determine if it was endometriosis and was told it was not.
The pain is getting so much worse as are my periods. I have very heavy bleeding the first three days, during these days too, I am passing quarter size clots regularly with bad cramping. I am really hurting and am afraid my doctor will think I am whining if I go back again.
Is there a different problem this could be that would not be seen by laparoscopy while looking for endometriosis?
Ovulatory pain at midcycle (day 14 or 15 after start of menses in a 28 day cycle) usually does not last longer than a day or two in most cases. It is thought to be due to some bleeding that takes place at the time that the egg is ovulated from the ovary.
The bleeding is usually into the abdominal/pelvic cavity internally and irritates the lining to produce pain. Bleeding could be into the substance of the ovary at that time and cause pain however.
Endometriosis usually doesn't cause pain at midcycle; it characteristically causes pain and cramps at the time of menses. In your case the pain is starting on day ten when the follicle (egg) to be ovulated is just starting to distend (swell) the ovary.
It could be that you are very sensitive to any ovarian capsule swelling. I would expect your midcycle pain to vary-- sometimes on the left, sometimes on the right. Does it do this?
The cramps and heavy flow can represent endometriosis. There are two types. One affects the lining of the abdominal/pelvic cavity around the uterus and ovaries.
This usually can be seen at laparoscopy, however sometimes it is missed if it is not the classic bluish/black appearing lesions. There are also red and clear looking lesions that really need to be biopsied to diagnose endometriosis.
The second type of endometriosis is an internal type in which the endometrium grows down into the muscle of the uterus. It is called adenomyosis or endometriosis interna and it cannot be seen laparoscopically.
It is usually diagnosed only at time of hysterectomy when the pathologist looks at the uterus microscopically.
So to specifically answer your question, yes there are some things that may not necessarily be seen at laparoscopy that could explain your symptoms.
On the other hand, it would still be possible to have endometriosis that could be diagnosed at this time but not have been diagnosed two years ago at laparoscopy.
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