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Had Hysterectomy, Endometriosis Was Found And Scarring In Uterus Due To C-section. Have Pelvic, Back And Leg Pain
Question: Hi. I am 3 months post partial hysterectomy (still have my right ovary). Some endometriosis was found during surgery as well as significant scaring in my uterus from one previous c-section. I am continuing to have severe pelvic pain, lower back pain and leg aches when I ovulate and when I should be menstruating. I read that laparoscopic surgery is the only real cure for endometriosis, but since they obviously didn't get it all out during my hysterectomy why would a laprascopic procedure have any better result? Is my only option to remove my remaining ovary?
Brief Answer:
Laproscopic removal of right ovary is necessary.
Detailed Answer:
Hello XXXXXXX
Thanks for writing to us.
You are having sever pelvic pain, low back pain during ovulation and menstruating after partial hysterectomy with left oophrectomy (removing ovary).Endometriosis causes severe adhesions of uterus with the surrounding structures that is ovaries, intestine and ureter. The surgeon who has operated upon you might have encountered lot of adhesions between uterus and adjoining structure and might have opted for partial hysterectomy to save the important structure like ureter and not to damage to structures like intestine and urinary bladder which are very close to uterus. If a part of uterus could not be removed by open surgery it is more difficult to remove that portion by laparoscopic means. However you have the choice to undergo laparoscopic surgery to remove as much as possible excessive endometrial tissue along with right ovary (if possible) as hormone produced by right ovary is a stimulus for endometriosis.
Medical treatment that is treatment of the endometriosis by drug is also a option which can be discussed with your treating gynaecologist.
Hope this answers your question.
If you have any more queries write back I am readily available to answer.
Take care and regards.
Dr Sadiq.
Laproscopic removal of right ovary is necessary.
Detailed Answer:
Hello XXXXXXX
Thanks for writing to us.
You are having sever pelvic pain, low back pain during ovulation and menstruating after partial hysterectomy with left oophrectomy (removing ovary).Endometriosis causes severe adhesions of uterus with the surrounding structures that is ovaries, intestine and ureter. The surgeon who has operated upon you might have encountered lot of adhesions between uterus and adjoining structure and might have opted for partial hysterectomy to save the important structure like ureter and not to damage to structures like intestine and urinary bladder which are very close to uterus. If a part of uterus could not be removed by open surgery it is more difficult to remove that portion by laparoscopic means. However you have the choice to undergo laparoscopic surgery to remove as much as possible excessive endometrial tissue along with right ovary (if possible) as hormone produced by right ovary is a stimulus for endometriosis.
Medical treatment that is treatment of the endometriosis by drug is also a option which can be discussed with your treating gynaecologist.
Hope this answers your question.
If you have any more queries write back I am readily available to answer.
Take care and regards.
Dr Sadiq.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
My gynecologist is recommending Lupron for six months but I am not hearing many good things about the side effects and temporary increase in symptoms from this drug. What is the difference between using Lupron vs using estrogen production in my case?
I was considering depo provera specifically because I suffer from migraines and don't want a daily pill if possible. This seems like it would come with much more predictable side effects, but I am worried that maybe it wouldn't be as effective in stopping the estrogen as Lupron and thus the remaining endometriosis.
*By the way, the entire uterus was removed so there is no source of tissue other than the remaining endometriosis itself.
I was considering depo provera specifically because I suffer from migraines and don't want a daily pill if possible. This seems like it would come with much more predictable side effects, but I am worried that maybe it wouldn't be as effective in stopping the estrogen as Lupron and thus the remaining endometriosis.
*By the way, the entire uterus was removed so there is no source of tissue other than the remaining endometriosis itself.
Brief Answer:
Lupron will be the next best option after laparoscopy.
Detailed Answer:
Hello XXXXXXX
Thanks for your follow up.
Lupron is luprolide which is an antagonist at pituitary GnRH receptors desensitizes the GnRH receptors ,down regulates the secretions of gondotropins hormones ((LH,FSH) leading to dramatic reduction in estradiol and testosterone in both sexes. This effect is useful in treating endometrosis. Yes during the first few weeks of treatment, it increases hormone levels, before they start decreasing. This is a normal response of body to this drug. Be assured increase in symptoms is temporary and disappears after a week of treatment. By lowering estrogens levels it prevents menstruation. This causes endometrial tissue to shrink. It can force the endometriosis into remission during the treatment and sometimes for months to years afterwards.
Hormone therapy that is oral contra captive pills (OCP )and Depo provera though reduces the hormone but is not a permanent treatment for endometriosis. Symptoms recur after stopping therapy. This is a suitable alternative for women who want to retain their fertility.
As far as side effect is concerned, yes, hormonal therapy has less side effects as compared to lupron; but both OCP and depo provera cause headache and aggravate the migraine, so you should be looking to take lupron. Despite the fact that no drug has been proven to provide lasting relief for endometriosis, Lupron has emerged as most frequently prescribed medication for women with endometriosis as well as for uterine fibroids.
The best available option for you is start taking Lupron for 6 month.After 6 months get your left over ovary removed Laproscopically. As with 6 months of treatment with Lupron endometriosis would decrease considerably and it would become possible for surgeon to remove the left over ovary.
Hope this answers your question.
If your are all concerns are answered,close the discussion and rate the answer.
Take care.
Regards.
Dr XXXXXXX
Lupron will be the next best option after laparoscopy.
Detailed Answer:
Hello XXXXXXX
Thanks for your follow up.
Lupron is luprolide which is an antagonist at pituitary GnRH receptors desensitizes the GnRH receptors ,down regulates the secretions of gondotropins hormones ((LH,FSH) leading to dramatic reduction in estradiol and testosterone in both sexes. This effect is useful in treating endometrosis. Yes during the first few weeks of treatment, it increases hormone levels, before they start decreasing. This is a normal response of body to this drug. Be assured increase in symptoms is temporary and disappears after a week of treatment. By lowering estrogens levels it prevents menstruation. This causes endometrial tissue to shrink. It can force the endometriosis into remission during the treatment and sometimes for months to years afterwards.
Hormone therapy that is oral contra captive pills (OCP )and Depo provera though reduces the hormone but is not a permanent treatment for endometriosis. Symptoms recur after stopping therapy. This is a suitable alternative for women who want to retain their fertility.
As far as side effect is concerned, yes, hormonal therapy has less side effects as compared to lupron; but both OCP and depo provera cause headache and aggravate the migraine, so you should be looking to take lupron. Despite the fact that no drug has been proven to provide lasting relief for endometriosis, Lupron has emerged as most frequently prescribed medication for women with endometriosis as well as for uterine fibroids.
The best available option for you is start taking Lupron for 6 month.After 6 months get your left over ovary removed Laproscopically. As with 6 months of treatment with Lupron endometriosis would decrease considerably and it would become possible for surgeon to remove the left over ovary.
Hope this answers your question.
If your are all concerns are answered,close the discussion and rate the answer.
Take care.
Regards.
Dr XXXXXXX
Note: Revert back with your gynae reports to get a clear medical analysis by our expert Gynecologic Oncologist. Click here.
Above answer was peer-reviewed by :
Dr. Prasad
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