Choices, choices

I’m going to take the time to thrash out what I feel are the pros and cons of the treatments I’ve been offered by the consultant I saw on Tuesday.  As I find thinking on the page just as helpful as talking to Helios and my mom, I hope you don’t mind my “thinking out loud”.

  1. Drug Treatment (Lupron)

Pros

  • Temporary effect
  • Won’t have a period at all while on it

Cons

  • Will take time to take effect (which is a bad thing if I am trying to cope at a full-time job)
  • May not work
  • May not have the same effect as a surgical hysterectomy
  • Would need to take HRT (progesterone) which has been known to make me crazy.
  1. Laparoscopy to treat endo

Pros

  • I’ve had this before so know what to expect
  • If done well, can significantly reduce pain for a period of 2-3 years for me (but not guaranteed!)

Cons

  • It’s still surgery and has risks
  • Will still need to take birth control tablets
  • Will still get periods
  • I know for certain that pain will return in due course
  1. Hysterectomy (but retaining ovaries)

Pros

  • Never have a period again!!!!
  • No need for birth control

Cons

  • Endo will certainly return and I will need to ascertain what new symptoms to anticipate
  • Need to find out if I will need hormone treatment for endo and/or PCOS post surgery
  • Irreversible
  • Need to find out how to ascertain when endo has spread enough that I need to see a doctor again
  • Will my hormone levels still rise and fall every month?
  • Will it affect my physical relationship with my husband?
  • Not sure if it will positively affect my pain levels
  • Don’t forget all surgery has risks
  1. Hysterectomy (with ovary removal

Pros

  • Never have a period again!!!!!
  • No need for birth control

Cons

  • With the added element of ovary removal – hormone levels will be a complete unknown and therefore impossible to anticipate.
  • Will need to take HRT post-surgery
  • I will still have endometriosis – so need to ascertain what new symptoms to anticipate
  • Irreversible
  • Will it affect my physical relationship with my husband?
  • Unsure if it will positively affect my pain levels
  • Osteoporosis runs in my family so, at the very least, I would want a strategy to combat this.

My current thinking is to reject the chemically induced hysterectomy – but not outright.  If I have surgery and then try the lupron, I may find that an appealing option because, if the lupron is difficult for me, I would know that my pain would not be as bad when I came off it.  I don’t know if they’ll let me try it in that order but that’s what I’d like to do.

As appealing as the lap is, I am concerned that my doctor may be right in her thought (I won’t have a diagnosis until the womb is taken!) that I may have adenomyosis.  The symptom that tipped her off was post-intercourse back pain.  She examined me with a trans-vaginal ultrasound (or I call it sonogram on a stick!) and found that my uterus seemed “painful”, that she expected it to be pliable but it seemed very solid and had no movement.  She asked if I had a history of fibroids and I had the rare opportunity to say “no, not that one doc!”  If she’s right then the lap won’t go far enough in removing my pain-giving beasties…

Since my examination, when Helios and I were intimate, I experienced discomfort on climax.  It wasn’t horrible and, because I was enjoying myself, I called it “odd” at the time because I didn’t want Helios to stop.  I am so grateful that Helios hates me in pain.  Pain is not sexy.  However, the incident served to cement the thought in my mind that if I don’t do something to get my uterus out, that I may be having more discomfort during intimacy.   This could lead to less frequent intimacy which, over a significant time period, may lead to a change in our relationship.  I think I’ve said it before but it bears repeating – now that I’m in a healthy and happy relationship, I want to do everything in my power to ensure that it remains so.

My next choice therefore is the hysterectomy but retaining my ovaries.  The significant plusses to this are 1) I will never have a period again, 2) with ovary retention I can ask to try the chemically-induced hysterectomy post-surgery in order to suppress the return of my endometriosis and 3) if I do have adenomyosis, the discomfort I experience on intimacy will completely disappear.  However, if it’s not adenomyosis, then I may have another new pain-giving beastie and I’ll be a medical miracle worthy of study!!

As with all my choices, I assume I will need further surgery for endometriosis in due course – while that will be the case for all my choices, I am slightly in the dark as to what form of pain I will encounter next if I have my womb removed.  Will it be worse?  Will endometriosis spread throughout my pelvis?  Perhaps it will want to travel further afield, get a train ticket and go around the UK?

At the moment I’m completely discounting a full hysterectomy with ovary removal.  I feel this option is simply a bridge too far.  I feel that I need to retain my ovaries (as PCOS-ridden as they are) in order for me to feel a bit more womanly.

With all the usual frustration of my conditions, why oh why can’t I just have an easy choice?  Just for once wouldn’t it be nice to be given a tablet and told “You’re cured!  Now off you go, I have sick people to attend to!”  Nope.  We’re stuck in the queue of sick people, tapping our fingers against our new list of ever-growing symptoms.  I wish I had a crystal ball to see the different ramifications of each option so I could choose the option I can live with.

Isn’t it ridiculous!  I’m sitting here crying because my options are so crap that I have to choose one that is the least worst!  When else does anyone do this??  Oh yeah.  When we choose our politicians!  That’s the only time when healthy people can begin to contemplate how CRAP my life has become thanks to endometriosis!

Wishing you a brighter future

Foxy

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2 thoughts on “Choices, choices

  1. Hey Foxy
    So know how this all feels. Am looking down the barrel of a Zoladex gun now – am so scared of the depresion and anxiety/goodness knows what else it might bring, and for 6 months relief. Would love a hyst but they won’t give me one before Zoladex.
    Let me know what you do – thinking of you xx

  2. Hi Jo!
    Thanks for visiting and commenting. I can’t help but wonder if the mere six months relief is worth the risks of side effects, etc. I have a full-time job and I cannot afford to be a bit crazy for six months. I feel for you because no matter what I choose and if it works for me, I still cannot advise you because all of us are different, aren’t we? I’m sorry that you’re in the same boat as me. You seem like such a nice person and you certainly don’t deserve this either!
    Foxy

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