ablation vs. TLH

I am looking for some input from the vast experience of my sisters. I have had heavy painful periods for most of my adult life. I tried BCP's as a way to regulate and reduce my periods, but found only a hormonal nightmare of depression, and psychosis. I gave up finding an answer for almost two years but the last six to 9 months have been unbareable. I finally got a referal to a new GYN, who I met for the first time this morning. He was GREAT, although I do have objections to meeting anyone for the first time when I am not wearing pants! Why do they do that? What's wrong with meet the dr. and THEN get undressed. Sorry, I digress. Anyway, the good doctor offered two options endometrial ablation or TLH. He explained the ablation as keeping the uteris and treating the heavy bleeding and clotting, but not the pain, which seems pointless. The bleeding is inconvenient certainly, and I do make adjustments (relatively minor) for three days where I'm a super plus and maxi every two hours, but it is the pain that is crippling. I am 42 and not planning to have children, so I asked him what advantage is there to keeping the uteris if not child bearing. He said it can help prevent prolapse. How common is prolapse? I've never heard of it. Is it more likely in women who have had multiple births? or everyone who has their uteris removed? Plus, if the ablation doesn't provide sufficient relief I'm looking at the TLH anyway, right?? What are your thoughts? What decisions are you making and why? I value your feedback.
Cassie

When I saw my gyn for the first time (I had recently changed docs), I went into her office fully expecting to walk out with an ablation scheduled. I had done my research and expected that would be the way to go.

However, because my uterus was borderline too large for ablation, my doc - while she said she would be willing to TRY ablation first - said that the odds were against it working. We discussed options; I came home and read everything I could find.

Ultimately, I decided on a hysterectomy. I knew I didn't plan on having more children, and I had been miserable for SUCH a long time that I was ready - so ready - to feel better. While the surgery scared me, I also knew I didn't want to go through ablation only to have it fail and have to have surgery anyway.

In hindsight, I'm thankful to say that I feel 100% confident that I made the right choice. However, it is a big decision, and a very personal one.

Best wishes, whichever path you choose!

Hi Cassie
I had heavy, painful periods too, but they didn't start until I reached perimenopause. I think it's important to know why you have the heavy bleeding and pain. Some things can be cured with a hysterectomy and some can't. The same is true of an ablation.

I wonder if you have had endometriosis? This is a common cause of painful periods and bleeding. If this is the case you will have special needs to consider before making an informed decision. If this is your situation there are other hostesses who can help with a lot of information that will help you with your decision. I wonder why your dr feels an ablation wouldn't take care of your pain? Adenomyosis is another condition that can only be cured with a hysterectomy. If you have pain being caused by this condition an ablation won't help.

I had the ablation first. I really wanted to avoid the risks of the bigger surgery if at all possible. It was worth it to me to give it a try. It didn't last for me, but I still don't regret that decision.
There is the possibility of prolapse after a hysterectomy because the uterus provides support for our other organs. There are a lot of other issues that make some women more suseptible to them than others. Heredity plays a part,vaginal births, hormone health and the general health of our pelvic floor. You have probably heard of kegel exercises. Those are one of the things that help us avoid these types of problems.

There really is a lot to consider. You need to understand the risks involved with a hysterectomy too. While most of us do great and are very glad we made the decision, there are those who have long term complications and regret their decision. It would be good to ask your dr about all of that too.

This gives you a few more things to think about. I know I haven't answered everything. If you have more questions, let us know.
's, Rita

Rita,

Thank you so much for your reply. It always helps to have more information to make a good decision. I have reading material from my doctor and am reviewing it. I have not been diagnosed with endometriosis. In fact my previous GYN said she found no sign of endometriosis before she started me on BCP. How is endometriosis usually diagnosed?
I go back for an ultrasound and further consultation 11/12, so I appreciate the good questions to ask.

Hi CWolf

My thoughts on my ablation were same as (((Rita))) - I wanted to avoid a hyst if possible and I do not regret the morning of my time it took for my ablation. My sister and 2 friends have had successful ablations so I certainly wanted to give it a try too. I knew I wasn't an ideal candidate because I had other issues but still don't regret trying.

Endo can only be diagnosed by direct visualization, so many women will get their diagnosis during a laparoscopy or during their hyst. I kept asking the Nurse Practitioner if she thought I might have endo and she kept blaming my pain on ovarian cysts and cramping from the heavy bleeding related to my (small) fibroids. I had those things, but I was also later found to have stage IV endometriosis as well as adenomyosis. If we would've known more ahead of time - via laparoscopy - then I wouldn't have tried the ablation. But you just do what you can at the time with the knowlege you have at that time.

My pelvic support was affected by the hyst. Despite always being good about doing my kegels, I developed a 3rd degree rectocele after my hyst. The surgery to correct that was much more painful than my hyst. A year after that surgery I developed a cystocele, so I need repair for that now to help my bladder and incontinence.

It really is a personal decision for you to discuss with your doc - and second opinions, of course. True, my ablation didn't fix things for me - but the ablation didn't add to the rectocele or cystocele either - the hyst did. So, if the ablation had worked maybe I would've avoided more than just a hyst, but anterior and posterior repairs as well. Knowing that I did end up with a rectocele and cystocele, when I look back it makes me glad I did try to avoid the hyst.

We are all different, and what's right for one may not feel right for another. Best wishes & s as you decide what feels best for your own situation. Whatever you decide, we'll be here for you.

Gentle s,
Beth