Pouch of Douglas/ gynaecologist app

[Lauren8642]

Hi! I had a second gynaecologist appointment a few weeks ago after my first one didn’t go too well. I’ve just received my summary/plan that she’s wrote up which is good because I’m bad a remembering important information 🤦🏼‍♀️.
So she did mention that I could have possible endometriosis due to the pain but she wouldn’t offer a laparoscopy she also wouldn’t offer anything to search for adhesions.
Whats standing out for me in the tenderness in pouch of Douglas but it being clear has anyone had similar to me and had it come out to be anything?

Was this an ultrasound or an MRI?

@seasaltwater i had a ultrasound back in July last year came back clean. Haven’t had a MRI. This was just by internal examintaion

Hmmm... I see it says you're concerned because you haven't conceived in 5 months?

I would maybe wait and see since 5 months isn't long and then push for laparoscopic surgery if after a year nothing has happened.

I have endometriosis and I can't have children. I've had a few surgeries and the negative of that is the scar tissue it can produce. Every time they go in I end up with more adhesions.

@Josette77 that wasn’t my main concern of why I went to the gynaecologist. I know it comes across that way with the way she’s worded it.
The main reason I contacted my doctor was because of painful sex to the point that I just don’t enjoy it and irregular periods. By time it come to my gynaecologist we had been trying for another child so I brought this up during my appointment and said I am slightly worried that my pain and periods would cause us to have some problems but that’s not why I had the initial appointment. She’s going to see me in October (hopefully will fall pregnant before then) when it’s been a year to test further. But it was the pain that was wondering if anyone had the same.

You don't have to answer but painful sex in any position or less in some than others? Sometimes the penis can push against endo deposits so trying all and every position might be far less painful.

Any treatment for suspected endo would prevent pregnancy. Your c section could cause adhesions and any laparoscopy runs the risk of more adhesions which isn't conducive to conceiving so I can sort of see where she is coming from re no lap at present.

I have endo, some of it is in the pouch of douglas but I don't and never have had painful sex from that. I had a horrific period pain which is how I finally got the laparoscopy but had to have loads of meds first and I have a lot of scar tissue (formed before the laparoscopy) on my ovary and ligaments in that area. Because of the irregular period cycle similar to yours when we were ttc Ds2 we used ovulation dip test strips for the best chance. This might be helpful to you if sex is painful.

@FrameMyDoorKnocker Its normally positions that have deep penetration so we are stuck just doing one position.
I used ovulation sticks only for one cycle because I knew I would get obsessed with them but I never got a peak, I mentioned this to her and she said that ovulation tests are only good for the people that sell them, basically suggesting that they aren’t great. And the best thing to do it DTD regular 🤷🏼‍♀️

Not entirely sure what you're asking but my pouch of Douglas is apparently completely closed up due to endometriosis, and yes, it is tender/painful. I think it's a pretty common place to get endo.

@SeeingRainbowsInTheGloom Just asking about if anyone else has had pain there and hearing about other periods experiences. What other symptoms do you have if you don’t mind me asking ?

@Lauren8642 I'm post-menopause now, but endo has caused pretty permanent abdominal damage with adhesions, so I have constant low level discomfort and regular higher levels of discomfort. Fortunately ibuprofen seems to work pretty well for me most of the time, but I try not to take it all the time. The risk/reward of deciding to have yet another operation to try to resolve things is complex, as I could end up with more serious bowel damage.

When I still had periods they were very painful, and for a while painful ovulation as well - the latter was probably due to ovarian cysts which I then had removed. Endometriosis definitely took my life down a worse, limiting career choices and other opportunities and meant I could not have children.

@Lauren8642 of course ovulation test strips work as they detect luteinising hormone, mine registered my peaks and I conceived using them because my cycle was so long at times I was testing and testing waiting for that peak. I think I would use them to determine whether you are indeed ovulating.

One of my ovaries is so scarred that I was told after my laparoscopy that they weren't sure it would even function but the other one looked okay. Hence why for baby number 2 I was ovulation testing as for baby number 1 I knew one ovary was okay and I did become pregnant.

@FrameMyDoorKnocker shes the first person I’ve heard say they don’t work and were made to trust professionals 🙄.
ill try them again my next cycle (hopefully this cycle has worked) as im already on day 24.
I asked if I could have the 21 day blood test with me not peaking on the tests and she said no not until I’ve been trying a year (understandable) but I don’t want to wait if I’m not ovulation right now I don’t see why it makes any odds.

Oof sorry you're in this position.

I think endo and gynae treatment can become quite fixated around conceiving (which totally fair enough as that is overriding aim for some ) but it isn't the only issue.

I asked about the type of scan because ultrasounds are basically not a reliable method of identifying endo - they might identify it / they might not. As an example, I had an US that showed literally nothing. They did a laparoscopy and found stage IV endo,across bladder, bowel, both ovaries, everywhere. The pouch of Douglas was 'obliterated' according to summary afterwards. So, US isn't the final word.

MRI is much more reliable and can obviously be done non invasively.

In terms of symptoms, I had bad endo in PoD - and recent MRI showed more problems In that area. I also have endo around ovaries and adenymosis. Sex is and always has been painful for me - it's shit and it makes me very reticent about the whole thing tbh. It's painful while DTD but also afterwards.

Conceiving has also been v difficult. I have had a lot of gynae surgery and emergency surgery post birth so there's a lot of adhesions and scar tissue etc. having said that my first and only hard won child was conceived c 10 weeks after big endo surgery (yea it was OUCH!!) so I do believe excision and ablation made it possible for me to conceive.

Sorry that's a rather gloomy picture. I suspect / it looks like the gynae has taken the conceiving as the main issue and give you advice based on that. I don't know if you can, but you could ask for a referral to a different endo team (there are ones that are accredited within the NHS ) and seek an MRI. As for treatment, hormones (out if you ar TTC), laparoscopy and excision / ablation (might help/might not), and pain relief (might work, obvious side effects).

As for ovulation tests.. well I hope they work! As that's what I'm relying on. I do remember a GP telling me they were worthless though so who knows.

Depends on the definition of "work" I suppose. Yes, they detect LH, but that's not necessarily the whole of the story. They need a little bit of knowledge to interpret and many people have double peaks yet dont continue testing after the first. LH is also no guarantee of actual ovulation, it's just a proxy measure

Then you've got all the issues that come with medicalising TTC.

She's right that lots of sex throughout your cycle is usually the better bet in most cases, rather than depending on test sticks

@seasaltwater did you ever have any internal examination? I know when she was doing the examination she said she couldn’t feel any endometriosis ( forgot what the right term was)
The gynaecologist said she will never do a laparoscopy which is very frustrating and something I may have to see another gynaecologist about basically but in terms of testing fertility for example more blood test and stuff like that she she wants to wait till I’ve been trying a year so in October.

How old are you OP?

I was diagnosed through internal examination and then had a laparoscopy. She could feel my adhesions inside of me.

I was 27 at the time and already infertile. I did go on to be pregnant but lost every pregnancy.

@Josette77 im 26, ah that must of been really hard. I am lucky that I’ve got my daughter already and I know people struggle to just have the one

@Lauren8642 an MRI is far less invasive than a laparoscopy for diagnosing endo but doesn't do anything to treat it. Usually they do a laser lap and dye so laser any deposits, cut away any deep infiltrating deposits and then flush dye through the Fallopian tubes to make sure they are not blocked.

I agree that the ovulation testing strips only test for LH but it is part of the whole picture. It is all well and good people saying just have loads of sex but when sex is painful it becomes a chore and not something fun.

There was another gynae on here a few days ago telling another poster that ovulation tests are no good. Absolute rubbish of course, as a poster who replied explained very well. Perhaps do an AS and look at the response - it’s about the tests you use and how you use them.

Any treatment for suspected endo would prevent pregnancy.

This isn’t true - excision surgery would enhance the chance of conceiving.

Pain while having sex is a symptom of endometriosis.

I would push for an MRI, to be interpreted by a clinician who has an endometriosis specialism.

Aha - I have found that poster’s replies and will paste them here as they are very comprehensive! Hopefully it will be of some use to you:

Ovulation tests - especially the dip ones with two lines rather than the smiley/flashing faces ones - are excellent at identifying a luteinising hormone peak. What they can’t do is then guarantee that you ovulate 24 hours later, as some women will have anovulatory cycles (an egg isn’t released).

However, the vast majority of women will go on to release an egg afterwards and so on that respect, for the majority of women, they are an important and useful tool for identifying the one or two days of the cycle where you are at your most fertile.

The tests are also a lifesaver for those who have been TTC a while meaning that sex ‘every other day for three weeks’ simply isn’t possible any more.

They are also very useful for those with older partners or partners who have sperm issues, who should only be ejaculating every 72-96 hours as again it helps pinpoint when to have sex with the greatest chance of success.

Finally, they are also useful for those women who assumed they ovulated on a standard 14dpo, only to find out that in fact they ovulate on day 12 or day 16 (or so on), meaning they had either been stopping having sex too early or starting having sex too late in the cycle.

I think your Gynae was wrong to say that without explaining the above.

Final point - the two lines ones are excellent when used correctly. This means:

• Use them daily from the end of your period (at least until you get to know your usual cycle pattern, then you can start a bit later).
• Don’t skip a day, especially when approaching the middle of your cycle
• Don’t use first morning urine - do them later in the morning
• Once approaching the middle of your cycle, do them twice daily so you don’t miss your peak
• Look out for physical signs, mostly EWCM, that indicates your peak will be on its way soon.

@SeeingRainbowsInTheGloom sorry to hear what you've been through. It's a horrible disease.

I'm glad that there is a lot more awareness of it now and I saw a Gynae a few weeks ago who was very positive about some of the treatments being developed.