TCRE, Myomectomy + TCRE or Hysterectomy

Hello,
I could really do with some help making my decision. This is my first post here, but I've been reading as much as I can in the forums over the last week.

I'm 39 years young, with no children and no real plans to have any. I feel more like 29 than 39 and want to stay looking my best as long as possible, so the thought of a scar or swollen belly concerns me.

I had an ultrasound scan which showed 1 x 4cm fibroid at the top of my uterus and 1 x 2cm fibroid in the middle.

My symptoms are:-
1 Really heavy prolonged periods (9 - 14 days)
2 Clotting for about 4 days per month
3 Gushing on days 1 - 4
4 Bleeding/discharge after intercourse and between periods.

My History (relevant)
Similar symptoms 10 years ago, which were eased by a D&C
CIN 1, 2 and 3 about 9 years ago which was treated with a loop biopsy. All clear ever since.
Latest smear test (January 2004 - Normal)

My consultant says I have 3 options
1 TCRE - which will get rid of the 2 cm fibroid
2 Myomectomy of the 4cm fibroid + TCRE
3 Hysterectomy leaving ovaries but taking cervix and uterus. (probably vaginal but possibly abdominal if my vagina won't accommodate - he can do an examination to check this out before I decide)

My list of what's important to me:
1 I really don't want a scar if I can help it.
2 I really would miss my intense orgasms if I lost them
3 I really want to get rid of this incessant heavy bleeding
4 Totally fed up with even just the spotting and discharge between periods!
5 The idea of a shortened vagina is scary .. My hubby is not average!!


Any input would be appreciated...

This is sooo hard...

I'm seeing my consultant tomorrow to ask more questions, so any input would be very much appreciated before then...

Annii

Good list of what is and what you don't want to have to live with. I think (and I'm not a doc) that to eliminate the heavy bleeding entirely, you'd need the hyster. With your past history, I'd consider that option. Make sure your surgeon is good at the vaginal approach and I think, if leaving your ovaries is an option/preferable? you shouldn't have the hormone issues. the O is just as good as before. You don't need a cervix to have the big O and, I experienced no shortening what so ever. When my doc checked at 5 weeks (internal) she said everything looked good and high up! so, I think if those are issues, they needn't be.

Josie
Thanks for replying,
it's good to know that not everyone has the scary side effects of shrtening or less intense orgasms....
I do worry that it would be just my luck that I would end up being one of the few that do though....
Keep thinking what if a TCRE (Endometrial Ablation) would do the trick without having to have major surgery with all the risks that entails...
My fibroids do seem to be quite small compared to those mentioned by others here too...
So far today I've changed my mind 3 times!!!
Indecision indecision

Annii

	Quote:
Originally posted by Annii My list of what's important to me: 1 I really don't want a scar if I can help it. 2 I really would miss my intense orgasms if I lost them 3 I really want to get rid of this incessant heavy bleeding 4 Totally fed up with even just the spotting and discharge between periods! 5 The idea of a shortened vagina is scary .. My hubby is not average!!

Hi Annii:

Regarding your #1 concern, my surgery twin's hyst went from TVH to TAH in the OR, and she regularly wears a bikini with no scars visible.

Regarding your #5 concern, I once did an extensive (and embarassing!) search on the internet to find out *what is the measurement of the basic vagina*?

The answer: The length is 2-1/2 to 3 inches long (and stretches to accommodate). Snug enough for a tampon going in, yet stretchy enough for a baby coming out. Sexual arousal causes the vagina to relax and lengthen. My doc used the term *millimeters* to describe the small amount of shortening that would take place with a TVH. (Disclaimer: I hope this info doesn't insult any of those zillions of *well-endowed* men out there... The vagina really seems to be one-size-fits-all )

Here is a link to our Resources forum where you can find lots of good info about fibroids & ablation:

https://www.hystersisters.com/vb2/lin...n=browse&cid=2

And here is a website with a message forum about ablation: http://pub76.ezboard.com/bendometrialablationboard

Getting 2 or 3 medicals opinions and investigating the less-invasive fixes are certainly justified before opting for major surgery. My doc #2 had much more cutting & pasting in mind for me than my doc #3. Get smart about your symptoms and your options, and make the best choice for YOU.

I am sending huge cyberhugs

Thanks Twyla
I saw my consultant today and he said pretty much the same as you about the length of the Vagina and that it would be only a tiny bit shorter.
He said that orgasms may be different but should be just as pleasurable.
He went through my list of concerns and crossed them off one by one. The only thing he couldn't guarantee was that he may have to do it abdominally if he ran into unforseen difficulties on the operating table. But he has promised that that would be a last resort. He feels that ablation is likely to be a disappointment for me as I would still have the 4cm fibroid which almost completely covers the Fundus and again recommended the hysterectomy.
I also found out that I have a retroverted uterus and wonder if that may be the cause of some of the pain I experience during deep penetration with intercourse?
Anyway if that is the case, then I suppose a Hysterectomy would solve that....
At the end of the consultation I felt pretty sure I wanted the TVH and have scheduled for the 18th March.
I just hope it's the right decision and that I don't wake up to a TAH!

I still have 4 weeks to change my mind!!

Thanks for your support

.Anni