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Forum Name: Gynecology

Question: Dysfunctional uterine bleeding (second opinion)


 charlie12880 - Sat Oct 24, 2009 6:18 pm

I am 29 years old and have two children, I had a tubal ligation after my second child and now i am experiencing DUB again. I have been on birth control pills most of my adult life and they no longer have an effect. I am seeing a dr. and they are suggesting edometrial ablation. I am not interested in having this procedure done. I am more interested in a hysterectomy. I don't understand the reason they would want to damage my uterus instead of just removing it. I understand they want to try the least invasive procedures but ultimately it is my body and my quality of life that they should be looking at. How do i get a dr. to listen to what i feel is right for me?
 swlilbit84 - Sun Oct 25, 2009 7:17 pm

im not a doctor but i thought you might like a first hand opinion. my mother had a historectomy done for a seriousl medical condition. now she is having problems with her bladder. her doctor told her that because her uterus was gone her bladder is shifting. she has a hard time controlling her urination. if it is not a life threatening disease you have it might cause more agitation than helpfor you.
 problems101 - Fri Nov 20, 2009 8:32 pm

I had constant spotting so I had the novasure procedure, I haven't bled since, it was out patient. I was home in a few hours, My doctor did a D& C first then finished with the ablation. After sleeping off the anesthesia, I was feeling well enough to bake.

Good luck with your decision
Di
 Debbie Miller, RN - Sat Dec 05, 2009 1:29 am

User avatar Hello,
I agree with your doctor's recommendation. The risks of hysterectomy vs the risks of ablation make it worth going this route. Not only is healing rapid and the results excellent, it is cost-effective, will not result in surgical menopause and the major risks of surgery are avoided. These include blood clots, incision infection or rupture (dehiscence), bladder or other organ injury, excessive bleeding and adhesions. In addition to the direct surgical risks, there are sometimes longer-term physical and psychological effects, such as depression and loss of sexual pleasure. If the ovaries are removed along with the uterus prior to menopause there is an increased risk of osteoporosis and heart disease as well.

Other complications that may occur after a hysterectomy include weight gain, constipation, and pelvic pain. Symptoms of menopause such as hot flashes can occur if both ovaries are removed. Women may require estrogen replacement therapy with potential side effects and there is no way to know in advance which women will have trouble getting their hormones regulated. Women with a history of psychological and emotional problems before the hysterectomy are more likely to experience psychological difficulties after the operation.

While many women do fine with hysterectomy, it is now considered a drastic and often unnecessary surgery. Times have changed and new technology has given us better, less invasive options for some of the conditions that used to be treated with major surgery. Hysterectomy is the most common elective non-pregnancy-related procedure done in the U.S.A. (600,000 hysterectomies are performed annually in the United States, with a cost of approximately $5 billion per year). It should only be performed when it is truly needed and alternative treatments are not possible or effective. For heavy bleeding, endometrial ablation is the treatment of choice and your doctor would be irresponsible to not recommend this. Major surgery should never be done simply because the patient wants it; only when it is the best solution and the decision is made jointly with your doctor and with all risks and benefits revealed.

I have no doubt that if you are insistent you can find a doctor who will perform it on demand, but I would not feel this was someone with the patient's best interest in mind.

Best wishes.
 problems101 - Sat Dec 05, 2009 10:03 pm

Debbi may I ask you a question, If you review my posts I've been dealing with chronic pelvic pain & have searched for answers through obgyn's, urologists, gastroenterologist, family physicians, myofascial release treatments, deep massages.

I'm curious about your answer to this post about hysterectomy resulting in pelvic pain. Why would that be?

My most recent doctor ordered an mri & believes I have adenomyosis, I want to get rid of the pain & have asked for a hysterectomy. So it's possible pain would remain?

Any thougths
Thanks
Diane
 Debbie Miller, RN - Mon Dec 07, 2009 1:24 am

User avatar Hello again,
Pelvic pain is a reported long-term complication in some women following hysterectomy. It is not always known why the pain persists. In some cases it is due to adhesions - a common occurrence following surgery. I know of women who complain of pain a year after a c-section delivery with no real explanation for the ongoing pain. Sometimes the very pain the woman assumed would be cured with this procedure continues and only then do we know this was not the actual cause. If the diagnosis is adenomyosis menopause will cure the condition. If you are years away from menopause, and this is the correct diagnosis, hysterectomy can cure it.

But, for heavy periods, ablation is a good first step. You can always later opt for hysterectomy if the problems continue but if this takes care of it, you have avoided the potential risks associated with major surgery.

I must emphasize that not all women have the complications and problems listed above. Many women feel great after healing from surgery and it solves their problems. There is just no way of knowing in advance if you will have any of these complications. It is very unlikely you will have all of them of course. These are just complaints that have been reported by others who have undergone this procedure. It is necessary to weigh the risks and benefits whenever contemplating major surgery as an answer. Since your doctor who knows your health history has recommended ablation, it seems like a good option.

I do wish you success in this attempt to end your distress. Good luck.

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