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Painful menstruation, history of adenomyosis. Is presacral mymectomy needed?

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Practicing since : 2005
Answered : 3163 Questions
Hello Doctor,
My sister in law got affected with severe adenomysis. This was evidenced one year back. Due to that she used to have severe updomen pain during the whole mensus cycle & the cycles became irregular. To cure the same she has undergone the medical treatment called "Mymectomy" in the leading hospital in chennai. Also she was using "Marina loop" to avoid the further addition of fibroids in her utreous wall. She was quite OK for 4 months after mymectomy. But she is again feeling severe pain during the mensus time. Now the doctors are referring hystrectomy or Presacral Nurectomy (only if she wants to keep the uterus). She is just 31 years old. The pain is killing her. Also she needs to have a baby. She has a 3.5 years old girl baby who has the T-1 diabetes. We the entire family are in XXXXXXX trouble in this situation. How can the pain be avoided?? Is the Presacral mymectomy is good option for this? Is is possible to get pregnant after this treatment? Who is the specialist for Presacral Mymectomy in chennai? Kindly suggest how can she come out from the issue.
Posted Wed, 26 Sep 2012 in Vaginal and Uterus Health
Answered by Dr. Rhea Chanda 6 hours later
Mirena loop usually works well for such cases like your relative.It works well in adenomyosis and small fibroids. The bleeding and pain usually decreases significantly within a year of use. Neurectomy is a option for pain relief but fertility doesnt change with that treatment.If her main aim at present is to get pregnant,the mirena loop will have to be removed and she should try for pregnancy as soon as possible. Neurectomy may be a temporary measure and even if its done,it would probably be best after pregnancy. Since she is just 31 yrs old,obviously the best option would be to keep the uterus. However,i would prefer to rule out endometriosis as a possible cause for the pain. It is often present along with adenomyosis. The are some medical treatments available for that. Its important to rule out endometriosis because if such is the case, hystrectomy may not always be the cure.
You need to discuss with your relative and is she want another pregnancy,it should be done soon,before the adenomyosis increases or fibroids develop. Only then can the decision about further treatment be made.

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Follow-up: Painful menstruation, history of adenomyosis. Is presacral mymectomy needed? 10 hours later
Hello Doctor,

Thank you very much for your feedback.

1. Kindly suggest the possible procedures to rule out the endometriosis & adenomysis.
2.Also please suggest the ways / treatment to improve the pain threshold limit within herself.
3. Who is the best doctor in Chennai to carryout the procedure of "Presacral Neurectomy" through Labrascopic/Robitics.
4. What would be the sideeffects & complications of Presacral Neurectomy? & what is the success rate of PSN based on the Indian medical history?

Thank you!
Answered by Dr. Rhea Chanda 1 hour later
Well,firstly the best way to diagnose endometriosis is by diagnostic laproscopy. The pain can be managed with medication,pc pills etc. The point here is to confirm the diagnosis first because just managing the pain won't help. We need to manage the cause of the pain. Usually adenomyosis doesnt cause too much pain but endometriosis can. Neurectomy will be done by a pain specialist and not all hospitals will do it. Appollo in chennai should have that facility. You could enquire there. Its not widely done in india so i cannot comment on the success rates. If u want another pregnancy,i would hold the surgery.
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Follow-up: Painful menstruation, history of adenomyosis. Is presacral mymectomy needed? 3 hours later
Hello Doctor,

Thanks a lot! I really like your reply that "we need to manage the cause of pain".

Already she tried with different types of Pills/Injections to manage the pain. But nothing really helps her. It means the cause pain & Pain threshold limit are the points to understand.

I have already attached the scan results of her (before & after mymectomy and the latest one) . Is it possiblie to you to identify the cause of pain. In case you want to see the medicines what she took, i can also provide that.

Thank You!
Answered by Dr. Rhea Chanda 1 hour later
I have seen the reports. They suggest that the uterus is bulky which could be due to adenomyosis/fibroid. There is also the mention of a cyst which sometimes may be due to endometriosis. Ultrasound should be repeated 3 monthly. Send me a list of the medicines taken. The size of the uterus and cyst needs to be monitored. From the history you have provided,i feel that endometriosis needs to be ruled out first. Talk with her doctor and find out if that has been done or not.
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Follow-up: Painful menstruation, history of adenomyosis. Is presacral mymectomy needed? 7 hours later
Hello Doctor

As per your request herewith i have mentioned medicined which she had taken recently ( from Feb 2012 to Auguest 2012).
1. T.Triquilar
2.C. Evening oil of primosa
3. T. Pyricontin (100 mg)
4. T.Clotan 200 mg( or ) T.Drotin DS (or) Ultramed (Tramadol + paracetamol)
5.T.Anxit (0.25 mg)

From 17 nov 2011 to XXXXXXX 2012

1. Tranexamic acid tablet
2. Sangobin capsule
3. Northisterone tablet
4. Mefenamic Acid Cabsule
5, Antacid double Strength tablet

There are some other tablets she had taken last two years.

Answered by Dr. Rhea Chanda 33 minutes later
All these tablets are for the management of pain and heavy bleeding. I suggest that you speak with your doctor and find out if any tests have been done to rule oit endometriosis. If a diagnostic laproscopy needs to be done,then it might be helpful in the diagnosis. Get another usg done 3 months after the last one.If there is any increase in the size of the uterus and the cyst then you need to let your doctor know.As i have said,some cysts develop even in endometriosis called endometrioma.It needs to be confirmed whether the existing cyst is due to that. If another pregnancy is required,then i suggest that it be done asap otherwise progressive endomteriosis can also cause infertility.
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