I have suffered from intense pain under my right rib for the last two years. It is cyclical and intensifies in the week before my period and first few days. Could this be pretonial endo? What tests should I ask my doctor to run?
Endometriosis
Top Endometriosis Specialist Florida: Your Path to Pain-Free Living
Endometriosis affects approximately 10% of women in Florida, impacting their daily lives and overall well-being. This chronic condition, characterized by the growth of uterine-like tissue
March 17, 2025
Cyclical pain under the right rib that worsens around your period certainly raises the possibility of extrapelvic endometriosis, including diaphragmatic or peritoneal involvement. While not common, endometriosis can implant on the diaphragm or liver capsule and often presents with sharp, referred, or burning pain—especially in the premenstrual and early menstrual window.
Diaphragmatic endometriosis can be difficult to detect on imaging. An MRI may identify deeper or hemorrhagic lesions, particularly when performed with a dedicated endometriosis protocol and reviewed by a radiologist with experience in this area. However, superficial lesions are often missed. A normal MRI does not rule out diaphragmatic endo.
If you’re pursuing a diagnosis, I recommend:
• Requesting a high-resolution pelvic MRI with views extended to the diaphragm and endometriosis protocol.
• Seeking evaluation by a gynecologic surgeon specializing in excision of endometriosis, especially one with experience in managing extrapelvic disease.
• Keeping a detailed symptom diary tracking pain patterns throughout your cycle, which can help guide both imaging and clinical decision-making.
Endometriosis in this region can cause significant pain and often goes undiagnosed for years. Trust your instincts, and don’t hesitate to advocate for more specialized evaluation. You deserve to feel heard and to receive care that takes your full symptom picture into account.