Q. I have severe period pain. Is it because of endometriosis? What is the treatment?

Hi doctor,

My girlfriend has severe period pains that are certainly endometriosis. Her recent scan showed endometrium was 16 mm thick. She has crippling pains, and she is completely immobile during her period, and sometimes in between. It is getting worse month by month. She is infertile. It is painful going to the toilet when on her period. She often has migraines. She has huge agonizing pain, that does not feel better with Ibuprofen or Paracetamol. The pain starts two days before her period and majority of it ending 1 to 2 days after she starts bleeding. She describes the pain as an extremely heavy weight pushing down on her abdomen, vagina, and bottom.

This is happening from the past 6 to 7 years, but it is getting worse over the past 6 to 7 months. A local doctor prescribed Clotrimazole and Tinidazole. I personally think a Progesterone cream is the best course of action, yet it interferes with the Clotrimazole, so I do not know what course of action to take. We did try the Minidril pill, but it messed up her hormones pretty bad, and she started feeling suicidal, so we stopped. The pain has started happening midway through her cycle now and is getting worse and worse. She becomes completely immobile, not even able to get herself to the toilet, and I have to carry her. I will attach the ultrasound scans so you can see for yourself. Unfortunately, the imagery is the best we have. Please let me know what you think the best course of treatment we should try without having to see a gynecologist.

Hello doctor,

Thank you for your answer. We would like to avoid surgery at first if possible, so can you recommend what would be best to do out of the two options I listed previously, please? Should we stop the Clotrimazole and Tinidazole and start with the Progesterone cream? Or should we use them both together or stick with the Clotrimazole and Tinidazole?