Decisions

I was scheduled for surgery on April 6; we are now postponing due to conflicts with both the drs schedule and my schedule. The reason I'm having surgery is that I have fibroids (several), enlarged uterus, causing heavy bleeding and anemia. I have little to no pain, but have been taking iron 2x daily since this summer when extreme bleeding (hemorraghing?) sent me to the ER. It has been hard for me to come around to having the surgery because I am not in pain. Just a real hassle when on my period and a lack of energy that varies from slight to occasionally extreme. Initially the dr thought she could do the surgery vaginally but told me today that she thinks the uterus is too enlarged, so that means abdominal surgery. I suspect she also wants to look at things.
Here are my questions.
1) If we put the surgery off until September (which works best for me) then she wants me to either take Lupron (sp?) or Depro Prevara (sp?), hoping these will help with the bleeding in the short term.
2) She is inclined to recommend having my ovaries removed, she says this reduces the risk of ovarian cancer by 75%. That would mean HRT. I would really prefer to keep my ovaries and have a chance at keeping my own hormones and having a more natural menopause, hormonally speaking. She is willing to discuss this further with me before we make a decision.
3) If we wait until summer she wants to do an endometrial biopsy. Any idea why? She said to make sure there were "no precancerous changes" (?)
I have no family history of ovarian cancer, but there is a history of breast cancer.
Other factors are that I'm overweight with slightly elevated cholesterol levels but great blood pressure.
Any thoughts on the things my doctor has recommended?
Finally, I rather terrified by the thought of surgery.... guess that's typical...
Thanks!
P.S. My doctor is the one who recommended this site!

Hi Sasquatch,

I had a LSH for large fibroids. Contemplating a hyst can be VERY scary!! I remember. So, do not feel alone. You will find many ladies on H.S. experiencing the same feelings.

I went on lupron prior to my hyst. It caused temporary chemical menopause. My Dr. wanted to shrink my fibroids enough for my surgery. Lurpon can also relieve symptoms from heavy periods and it can help to get the blood count up before surgery. My Dr. explained that lupron is a temporary fix..a "band-aid" on the problem and is good for short term use only, since long term use can cause bone density loss.

I have seen several Hyster Sisters post that they had a biopsy prior to their hyst.

On the ovaries, I could suggest you do a lot of research. I was 46 at the time of my hyst and I wanted to go through natural menopause, instead of chemical menopause, if I was a candidate. The ovaries secrete important hormones that help with the bones, skin and hair, to mention a few. Also, since your profile says you are just 40, keeping your ovaries could possibly help you to get to menopause. Just some food for thought.

Also, your Dr. mentioned ovarian cancer. My Dr. told me the chances of ovarian cancer are less than 5% in women. Check your female family tree and see if anyone had ovarian cancer. I did and I found out I didn't, so that helped me in my decision to keep my ovaries.

Best wishes,

Mary

I am also so glad that you found us!

You are doing a very thorough job of researching what is going to happen to you. Let me offer just a few thoughts:

	Quote:
It has been hard for me to come around to having the surgery because I am not in pain.

I can understand that completely. It most likely comes down to quality of life for you. I had several (or "lots", if you read my tagline) of fibroids, too -- but they were not the type which could be easily removed because so many were right in the lining of my uterus. Is it possible that you could have a myonectomy (removing just the fibroids)? It's still major surgery, but it preserves your uterus and ovaries, and it might be well worth a try!

	Quote:
She is inclined to recommend having my ovaries removed, she says this reduces the risk of ovarian cancer by 75%.

I don't know about you, but I get really easily confused when I'm presented statistics. While it may be true that you are 75% less likely to get ovarian cancer if your ovaries are removed, the overall chance of getting ovarian cancer is relatively low.... So if your chance of getting ovarian cancer overall is 4%, this lowers the chance to 1%. Make sure you know what your chances are being reduced to..... Only you can make this decision with the help of your doctors. All I know is that surgical menopause can be very difficult. For some it isn't -- for others it is horrendous.

	Quote:
If we wait until summer she wants to do an endometrial biopsy. Any idea why?

This is probably to see if you have endometrial hyperplasia, which is something I had. Hyperplasia is sometimes pre-cancerous, although rarely so. There are several stages of hyperplasia, and some are even reversible.

I hope this information helps! Please be assured that unless your situation is life-threatening, you have time to make decisions. You can wait even beyond summer to have surgery if it takes that long to get answers to your questions, and there is usually time for one or more additional opinions. You owe it to yourself to have as much information as possible before undergoing a surgery you cannot reverse!!

Hello!
I had a TAH in November and am a breast cancer survivor. My gyn told me that there is a greater chance of having ovarian cancer with a history of breast cancer. So, out the little buggers came.

I am also like you and overweight. I have had very mild hot flashes and not much else in the way of symptoms. I fell that I do not put up with people playing games as much as I did before, that that may not be a bad thing!

Hugs and best wishes on your decision.

A very good article that sums up the major issues regarding your ovaries is:

Rational for Ovarian Conservation by Donna Shoupe MD

Also read hormone forun and What did your doctor tell you thread? Both of these highlight the issues that many real women deal with after loss of their ovaries. It is very difficult to predict who will sail through an oophorectomy and not percieve the loss and who will.

It may be that your doc wants the endometrial biopsy to make sure she has all the info she can before conceding to wait until September. If there is no sign of problems with the uterine lining, then you can both feel better about waiting.

It is hard to contemplate major surgery when there are no pain issues. I didn't have pain, either. But, you still have to consider the long term consequences of anemia which can be serious indeed.

It was a quality of life issue for me. I'd already been held hostage for three years by hemorrhaging from my period and it was getting worse. At 45, I just couldn't see being anemic and housebound for a week or more at a time for as many as ten more years.

Depo Provera did not work for me. It did slow things down for a while but when things started flowing again, the dam really burst. I didn't have any of the nasty side effects so many women worry about, though. I worried about it being an immunosuppressant but, if it had worked, I might have stayed on it anyway.

Best of luck to you as you decide.

Hi,
I, too am questioning my upcoming supracervical hysterectomy. It is scheduled for April 11th. I was supposed to have it done on March 14th but I developed an infection in a tooth. The doctor put off the surgery for one month. I had to have oral surgery and have the tooth removed. Now I am scheduled for the hysterectomy on April 11th and I am wondering whether I should do it. I have one day a month where I practically hemorrage all day and that is it. I have been going for intravenous iron treatments for 25 weeks now. Every time I have my period my hemoglobin drops usually more than a point.

I am now wondering whether I should just go back on iron pills and take my chances or do the surgery. I am definitely in a dilemma. My next pre-op appointment is next week.

I guess many of us are perplexed.

I would like to say to try to relax and have some fun but I know that is hard to do.

amy