My doctors keep telling me that my severe pelvic pain is normal menstrual pain. Along with pain and cramping, I have painful bowel movements, painful intercourse, spotting and low-grade fevers. I have tried to combat pain with Arthrotec, Celebrex and Naprosyn to no avail. The pain comes throughout the month, and it is getting progressively worse with each period. I have tried many types of birth control pills, all of which have made me sick. I am only 23, and my husband and I have been trying to become pregnant for about six months with no success. Do you have any idea what (if anything) is wrong with me? --Kat

It is pretty obvious something is wrong. Of course, I can't diagnose you without the benefit of examining you personally and doing some tests. But based on the information you have given, my best guess would be endometriosis. This condition, in which tissue of the uterine lining grows outside the uterus, can cause pain before and during your period, pain with sex, pain or bleeding with bowel movements (especially around the time of your period) and irregular bleeding. It may also impair fertility, although at your age, not conceiving after only six months of trying is not worrisome: 90 percent of couples will get pregnant within a year of trying, and fertility investigation is not usually warranted until these 12 months have passed.

There are other possibilities for your symptoms, including irritable bowel syndrome and adhesions (scar tissue). An investigation of your symptoms may include seeing an gastroenterologist (specialist in the digestive tract) to rule out irritable bowel.

If endometriosis is suspected, the usual initial step to address the symptoms is to try birth control pills. Obviously, that's won't work in your case, both because you are trying to get pregnant and because they made you sick in the past. Another option is a course of a GnRH-agonist such as Lupron. Because such drugs suppress the hormones that stimulate endometriosis, a decrease in pain with GnRH-agonist therapy suggests that endometriosis is indeed the cause. This approach would also mean putting the pregnancy plans on hold for a few months.

Another option is a laparoscopy, a surgical procedure that enables a doctor to look inside the pelvic cavity. In your case, since you want to get pregnant, you should discuss laparoscopy with your doctor. Not only is this the only direct and definitive way to identify the presence of endometriosis, it provides a means to surgically remove as much as possible as well.

If you feel your current doctor is not taking your complaints seriously, consider a second opinion. Something is going on; it's just a matter of finding out what it is.