should I try ablation?

I have just found out that an ablation may be an alternative for me. I am scheduled for TVH on August 11 but having doubts and may opt to try ablation. Here is my history:
May 96 - daughter born
Dec. 96 - miscarriage
Dec. 97 - daughter born - sever anemia throughout pregnancy
almost deliverd at 30 weeks...... put on brethene to stop contractions....... daughter born 3 weeks early
Spring 98 - D&C - for clots
I have had severe anemia since 2nd pregnancy. I have a ferratin level of 0........almost impossible but I have it........

I have never considered my periods to be heavy but the doctors believe that must be what is causing my anemia so I have undergone several tests these past few months........
Pap was normal
Endometrial biopsy was normal
Ultrasound was normal
MRI shows questionable areas for adenomyosis.........one doctor says it is adenomyosis and another says it is questionable
No bladder problems

I do not have painful periods........I do have semi-heavy bleeding even though I am on Ortho evra patch........ and lots of spotting mid cycle....... really tired of dealing with all this but this looks mild compared to what I've seen on this site.........

I am wondering if there is anyone else out there who has been faced with this decision........ I would love to try the ablation but am afraid it will fail and make life worse...........However, I am getting more nervous by the day to have TVH done........

I am 34 years old and don't like to mess with mother nature......

Please help!
Thanks

ksue:

The phrase that comes to my mind as I read your post is, "make the decision that you will regret the least". If you are having second thoughts, whether or not you do go for ablation, maybe it's time to seek another opinion, or re-schedule to continue investigating your options and how you feel about all this.

From the medical point of view, there's a couple of issues you may want to address. First of all, if it is in fact adeno (notoriously tricky to diagnose, but MRI is the best modality for that), an ablation will not be successful. The ablation kills off the endometrial lining on the internal surface of the uterus, but adeno is where that lining has actually infiltrated the muscle itself...ablation won't "cure" that. Do you have risk factors for adeno, such as tubal ligation, history of endo, c-sections or D & C? Each "incidence" increases the odds that you are facing adeno...and even the most rabid of anti-hyst "informants" admit that a hyst is the only choice in that circumstance.

One other thought, though, is this: if your anemia is that profound, have your doctors had you see a hematologist? You may be missing some factor that is contributing to your bleeding, or your bone marrow may not be functioning normally, for whatever reason. This is something that probably should be addressed prior to any surgical intervention...if you can't get ferritin levels up over these past few years, maybe something else is contributing besides "just" adeno.

My hemoglobin was only 5.3 grams after my DD was born 8 years ago...but a year later, it and my ferritin levels were normal. And I only got one transfusion (there were no more units of B positive blood that were negative for cytomegalovirus...and I wanted to stay CMV negative). If your bone marrow is normal and not suppressed in some way, it should be recovering somewhat better than that!

I understand equally your desire not to "mess with Mother Nature" and the competing desire to get it all over with...but if you are having these second thoughts, and you have the luxury of a couple of more months to research things (IOW, your surgery isn't for cancer, etc.) then I would urge you to take that time. Get another opinion, investigate your options, check into your anemia a bit further, whatever you have to do.

You may well still opt for a hysterectomy at some future point. But at least you'll be more at peace with your decision, whether it's made now...or in a few months.

This is SOOO hard, I know. You just want to be able to have enough energy to parent your DDs, enjoy your family and whatever other obligations your life holds. But to wait and continue to consider, rather than dive in and then wonder for the rest of your life if you did the right thing...well, if I'd had a choice, that's what I would have done. I would have wound up with a hyst anyway, probably sooner rather than later. But my decision would have been clear, and all the more secure with all information available to me.

Audrey

Hi Ksue,

Audrey has given you some wonderful advice. I simply want to add that it sounds as though you really have some serious doubts about whether or not your menstrual bleeding is heavy enough to be causing your severe anemia. I think that really needs to be checked out ... as Audrey suggests, with a hematologist.

Please let us know what you decide and how you are feeling. Sending hugs your way.

Beth

Thanks to both of you for your wonderful advise. I think I am second guessing everything because I don't feel my issues compare to others I've read here. I did speak to another surgeon today and based on my MRI he confirmed adenomyosis. He showed me the areas of concern and said the only fix is to have the hysterectomy. He thinks I am underestimating my periods (flow and pain) and the patch is also making them less severe. He said I must have a high tolerance of pain. He also said with my mother's history I would be better off having it done now instead of waiting. My mother had similar problems 20 years ago......several D&C's and finally her uterus burst and she had to have emergency surgery. And since I teach the summer is definitely the best time for me to have my TVH. And the surgeon today said an ablation could make things worse. I have had several blood tests to find out why I am anemic. They have tested for just about everything........and it all comes out clear. All my other levels are fine. I should also note that both my mother and sister are anemic. I think I'm just getting cold feet.
This site is sooooooooo wonderful............

Thanks again.
My decision is to meet with my surgeon on Aug. 4 and discuss my concerns..........and then plan on having my surgery as scheduled on Aug. 11.............

Hi Ksue,

It sounds like you are getting confirmation of adenomyosis ... and you would not be the first lady here to have underestimated just how severe her bleeding was! It's so hard to compare to others ... I was the same way. Listened to all my friends complain and assumed I was in good shape. Wrong... I had the hyst and my friends all still have their uteri!

Best of luck. Please keep us posted on how you are doing as you approach surgery day.

Beth

I agree, the advice above is brilliant!
But just wanted to add that an ablation can help adeno in some cases, depending on how deep it is. My gynae attempted one for me (suspected adeno) and said that the heat doesn't just penetrate the womb lining, but does go into the muscle too, and can kill off some of the adeno, basically a "might help" situation. I suppose it depends on which type of ablation you've been offered, mine was a thermal balloon ablation.
Also, even if the ablation did not help your adeno, it would virtually stop your normal period bleeding, therefore reducing a lot of your blood loss. It might be worth thinking about, if you have doubts about a hyst.
If you are not 100% sure about a hyst, take some time out, and rethink your options.
(((((((((hugs)))))))))
Lisa
xxxx

Ksue, The advice the other sisters gave you was incredible. I was also like you thought the bleeding wasn't that bad, the anemia ran in the family, so i considered it just a part of my life. My Dr. had me on extra iron that seemed to help. I was given the option of an ablation or TVH. After talking to several other women who had both and to my Dr. and several of his nurses, I chose the TVH. The women that I talked to had the ablation and a year later had to have the hysterectomy. I am 4 months post and haven't felt this good since my last DD was born 8 years ago. I was in to see the Dr. today and he is amazed at how much better I am. The waiting is the worst part. Good Luck!!
Keep us posted. My thoughts and prayers are with you,

I had a Hysteroscopy and Endometrial Ablation performed 4 weeks ago and it has made such a difference! I have been bleeding heavily since February with little periods of slow down. I become so anemic that when I went to the doctor, he drove me over to the hospital himself to get a blood transfusion and said I was lucky my organs had not started shutting down as my blood cell count was down to 7 (12-14 is normal).

I had a new job and insurance had not kicked in yet so I was desparate for financial alternatives to a hysterectomy. We had already tried drugs to stop the bleeding, none of which worked. My doctor (whom I've been with for 13 years) went through my history with me and gave me the pros and cons of a Hysteroscopy, which I ended up having done. I'm am so happy I explained my financial situation to him! He has been wonderful in searching out alternatives and trying to cut down on my costs.

The procedure is an outpatient procedure; I had it done on Friday afternoon and I was back at work on Monday! The lining of the uterus is "burned out" so that it doesn't break down each month and therefore, no bleeding! I feel so much better and did not have to go through the pain of a hysterectomy and did not lose 6 weeks of work, which I couldn't afford.

I still may have to have a hysterectomy in future years due to prolapse, but for now, I feel great and am happy with my doctor's care and help.

I hope this informs you a little more--Good luck with your decision!

Tess