pain periods | menstrual pain ｜period cramps｜endometriosis pain｜no change surgery | your opinion 这种痛经病例应该从哪里开始重新思考？

This patient has experienced period pain possibly related to endometriosis for around ten years.
She underwent surgery in May 2024, with improvement lasting for about six months, but the pain gradually returned.
During her period, her pain level reaches 8–9/10 and she needs painkillers for one to two days each month.

She also has had urinary frequency for about five years:
• Every 30–60 minutes during the day
• 2–3 times at night
Ultrasound did not show significant findings.
Physical examination revealed marked tenderness in the lower abdomen and pelvic region.

Questions for open discussion:

Why does pain sometimes improve after surgery but return months later?

Could urinary frequency be related to the pelvic pain? If so, how?

When imaging shows no abnormalities, what other sources of pain should be considered?

How should we re-evaluate cases like this?

Share your thoughts, interpretations, or clinical experience in the comments.
I will share my own analysis after the discussion.

这位患者有约十年的痛经和疑似子宫内膜异位症病史。
她在 2024 年 5 月接受过手术，术后疼痛曾缓解约半年，但之后逐渐再次加重。
月经期间疼痛可达 8–9 分，需要连续服用止痛药一至两天。

同时，她有约五年的尿频：
• 白天每 30–60 分钟排尿一次
• 夜间起夜 2–3 次
超声检查未见明显异常。
体格检查中，下腹及骨盆区域有明显压痛。

开放讨论：

为什么手术后疼痛会先缓解，然后又逐渐复发？

尿频和盆腔疼痛之间是否存在关联？可能的机制是什么？

在影像检查没有异常时，应从哪些方向重新考虑疼痛来源？

遇到类似情况，应该从哪几个角度重新评估？

欢迎在评论区分享你的思考和经验。
我会在大家讨论之后，再分享我的分析和观点。