My situation is that my original GYN has gone on leave (for very valid reasons and my heart goes out to her). I have an appointment with a second GYN tomorrow before surgery on the 23rd June. I'd pretty much agreed with the first one that we'd go straight for an SAH with endometriosis clean up, reviewing ovaries when she got in there but with the view that I'd like to try and keep them.
First GYN has said she thinks the second will agree to this but isn't sure. I'm worried she'll either say she's only happy to do a lap procedure to remove the endo and will leave the uterus intact (possibly condemning me to adenomysosis pain for ever more) or she'll agree to a hyst but will then whip the ovaries out as well as that's what they did as an automatic thing in the UK during most of her practising years.
I want to go in to see her with good questions and reasons for my choices.
My first question is going to be what does she think we should do and why? If she says lap only I want to ask her what she thinks the chances are that I have adenomysosis, whether she thinks it exists and I might have it and, if so, why can't we do the SAH straight away?
With regard to the endometriosis clean up I want to ask whether she does laser ablation or excision or a combination of the two.
To the ovary question. The difficult one
My thoughts are that there are many nasty side effects of removing the ovaries in a 42yr old woman. Osteoporosis, heart attack, stroke, high blood pressure, alzheimers, dementia - the list goes on. In a high proportion of hysterectomy patients the ovaries fail to post menopausal state within five years anyway which will reduce any endo left behind.
Even if my ovaries keep working, if the GnRH works OK for me, can we control endometriosis regrowth with intermittent schedules of GnRH? The idea is that we'd be balancing GnRH against ovary hormone production and seeing if we can get me to menopause with ovaries intact. Am I missing something obvious here? Would the add back required to prevent bone density loss negate the benefit of the Lupron? My reading suggests not.
I know I may well have some pelvic endo after hyst if we go this route but I'd rather cope with lower grade pain and keep them than have her take them out and have me spend the rest of my mid-life in fear of dementia which has seen off both my grandmothers and is claiming my mother. My reading says that 98% of women who have their ovaries out during hyst for endo have no further surgery seven years later. The same statistic even when they are left in is 78% of women free of repeat surgeries, that seems pretty good odds to me.
I have a terror of her rupturing my bladder. Would it be OK to ask her to reassure me that this is a rare occurrence?
I've been brought up that questioning healthcare professionals is disrespectful and wrong so asking questions like this is hard. Does all this sound OK to my hyster sisters?
GY questions - Ovaries in/out? Adenomyosis? Have I missed anything?
