I have been told I need an Ablation

Hi ladies,

I am so green to this I don't know where to start. I am 43, long, LONG history of endometriosis. Now battling ovarian cysts; not huge ones but I have had more vaginal ultrasounds this year than I ever had with 2 pregnancies, one of which was considered 'high risk'.

Each month my periods get worse. Heavy bleeding, cramping, unbelievable mood swings just prior to starting and recently, that last 2 cycles to be exact, somewhere within the first 24 hours of starting, out of no where I get nauseated to the point where I thought I would pass out, accompanied with extremely heavy bleeding. My ob/gyn is great - works out of Sewickley Hospital in Pittsburg, Ohio - discussed several options; she suggests something called an 'ablasion'. We tried 3 different kinds of b/c pills with no luck - cure was worse than the ailment. She said the ultimate cure, of course, is a hysterectomy.

My starter questions - have any of you ever had an ablasion? I thought that, like a D & C, once you have this procedure, you have to keep going back. Secondly, I am definately done having children; I love babies but don't want anymore of my own but yet the thought of eliminating that permanently really brings doubts. Is a hysterectomy too soon to consider right now? Then I wonder - HRT or not? Will I grow even more facial hair than I have now? All of a sudden, course hairs are growing out of my chin. And here is a really stupid thought but I can't seem to get by it - I won't be a woman inside anymore - I know how ridiculous it sounds but thats the first thing that comes to mind.

I am a single mom with 2 kids - I don't relish the thought of major surgery and being off work for 6-8 weeks, but the thought of going through this each month isn't appealing either.

Any assistance would be greatly appreciated. I am really struggling with what to do. Do I tough it out or put an end to this madness, either with the ablasion or hysterectomy?

Thanks, ladies.

I had an ablation to control the bleeding from my fibroids last January, and it has been very successful. Not only do I not bleed much now, but no cramps either (they were pretty heavy before on the 1st day). The procedure is pretty simple and easy to recover from, especially compared to a hysterectomy. If I'd had to go back to work the next day, I probably could have (but I stayed out a week because that was what I'd arranged beforehand). There are other women who've had them for endometriosis and weren't as happy - you might try and search back through the messages for those posts (I seem to recall that they had scarring that made pain worse).

Good luck -
Debbie

Hi!

At age 38 I had endometrial ablation done because I had some fibroids which were causing painful periods and heavy bleeding. The ablation removed the lining of the uterus and most of the fibroids but the fibroids had already grown deep into the wall of my uterus so I knew there was a good chance I may have to have a hysterectomy someday. After the ablation I had no pain or bleeding for over a year but gradually the bleeding and pain did come back. I had my hysterectomy (LAVH) about 20 months ago at age 41 - my uterus and cervix were removed, I kept both ovaries.

After an ablation you would no longer ever be able to get pregnant again because the lining of the uterus is removed. Whether or not the ablation will work depends on what is causing your problems. Fibroids can come back. I believe if you have adenomyosis (where abnormal endometrial tissue has infiltrated the muscular wall of the uterus) the only thing that might help would be a hysterectomy. I had some small cysts on my ovaries too but because they were otherwise healthy I kept my ovaries. My ovaries have continued to work fine so I do not need any HRT. I do still get some PMS symptoms each month (slight headache, breast swelling and tenderness, and mild moodiness); however, my symptoms have been less severe since my surgery.

Here is a link about ablation that you may find helpful:

http://www.fda.gov/fdac/features/2001/601_tech.html

HysterSisters is an awesome site for resources. I would encourage you to thoroughly check out all the resources and even get a second doctor's opinion to help you decide what would work best for you.

Take care.

s

Hi! Yes, I did go ahead and have the procedure (D&C to remove polyps and then Novasure performed during same operation). Had surgery on 7/2/03. So far, no problems and I'm glad I did it. My surgery was scheduled for 7:30 AM, and I was home by 10:15 AM! I was given a prescription for pain meds which we filled on the way home, but I never had to take one at all! Was just tired/groggy from being under anesthesia, but no pain. Took it easy for a few days, and then resumed activities as usual. Not to be to graphic, but my experience was some watery drainage for a couple weeks after the procedure which then tapered off, then I had one very, very light period when my regular time cycled around in August, and for the last to months - nothing. No period at all. Frankly, I'm ecstatic as I've dealt with incredibly heavy periods all my life since my teens (I'm mid-40's now). Hormonally, I am not starting menopause yet - so it is great to not deal with periods yet didn't have to go through a drastic hysterectomy. I know time will tell what happens over the next few years. I hope things work out well for you. Good luck!

I had a thermal ablation for bleeding too long. It did stop the bleeding. But I was still having a lot of pain. I went to a different gyno and she told me I had fibroids and the ablation is not for fibroids. Along with the ablation they also do a D&C which I chose not to have, but I think it's best to have both at the same time. You can look in the internet regarding ablation, there is plenty of information there. I ended up havinga supracervical hysterectomy anyways to get rid of the fibroids along with my uterus. I kept my cervix and ovaries. I'm feeling much better now.

Elly:

You've gotten some excellent advice so far. The problem with any of the "alternate" treatments to hysterectomy is that they each work well for a specific problem. Ablation works well, for example, if your bleeding is due to overgrowth of the endometrial lining ("hyperplasia"). Embolization is most effective for distinct fibroids.

When you have endometriosis, however, the picture is a whole lot less clear. Given your history, adeno, as was already mentioned, has to be considered as a distinct possibility. It's where the abnormal endometrial tissue grows into the muscular uterine wall. It's hard to diagnose and even harder to treat. You may be able to see some improvement in your bleeding symptoms from ablation, but it won't do much for the hormonal problems, cysts, or endo pain. If you had c-sections, D&C, or tubal ligation, your odds that it's adeno are much higher, particularly with the history of endo.

Endo also does alter your hormone metabolism. It alters the way estrogen is broken down in your system, and most of us as a result are often "estrogen-dominant" which is why Lupron works well for some. I don't know if you've tried hormonal intervention, such as suppressing periods with continuous BCP therapy, or Lupron, but it can be an indicator of how much relief you might get with a hyst.

Having a hyst for adeno is really the only therapy . However, when endo is also present, you'll have some decisions to make which it sounds like you've considered. Keeping your ovaries is a very controversial choice with endo patients; if all endo implants aren't eliminated at the time of surgery, the thought is that the estrogen will continue to "activate" endo (and the PMS persists). Also, if you're having so much trouble with the ovarian cysts, you may need to consider the odds of having to return at some future date for the BSO.

Although my surgery wasn't really by "choice" (clinically, it looked like I had ovarian CA; not a chance I wanted to take as an older parent of two special-needs kids) it turned out that the hyst was what I needed. I have to say, though, in spite of mixed results, I still feel like it was an improvement in my overall health; no more anemia, not nearly as much pain, and best of all: no more PMS . I do take a very low dose of estrogen for bone density issues, but went without for some months post-op, taking only Prometrium ("bio-identical" progesterone). My mood and concentration were the best they'd probably been since I first got my periods. They're still far more even than they ever were. It's definitely something else to consider.

As far as feeling "womanly": in many ways, I feel more so than ever. My figure isn't "perfect", but I've not gained horrendous amounts of weight; my libido, with proper HRT balance (in my case, that includes testosterone and DHEA) is just fine for someone with my crazy schedule; and I no longer have pain with sex, which improves tremendously my relationship with my DH. I did make it clear to all my doctors (I wound up with about four second opinions before I was done) that sexuality was important to me...even if it's only once a week it had been excellent other than the pain, and I wanted to keep it that way. I made the choice for a supracervical and haven't regretted it.

I often think that endo and adeno are some of the toughest conditions. The endo, especially, is really a "systemic" condition (increasingly they've come to realize it's an auto-immune thing) and just removing the "parts" doesn't come with a guarantee that it's "done". But if my endo suffering was an "8" on a scale of "0 - 10" before, it's not zero now, but it's a "3" -- enough of an improvement to allow me to live a much healthier life.

Hope this helps; sorry about the novel, but I understand all too well how painful this decision is. Research, as you're doing; and get opinions, including a GYN-oncology (they're better surgeons, usually, and accustomed to dealing with endo and its complications, such as intestinal involvement) before making your decision. In the end, you'll feel a lot better about whatever you choose, if you've come to your conclusions based on as much information as you can gather!



Audrey