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Suffered prolonged bleeding and now anemic. Taking tranexamic acid and iron supplementation. MRI showed adenomyosis with large adenomyoma. Cure?

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I am 52 & female. For years have suffered from heavy, prolonged bleeding & am frequently anemic although I can almost manage it with tranexamic acid (lysteda) & iron supplementation. Had d&c in dec, did not help except to confirm no cancer. Doc said had one cantaloupe sized fibroid. He expected to find many. I opted for UAE but MRI showed adenomyosis with large adenomyoma and I was told not a candidate anymore for UAE. Tried combination bc, lo loestrin fe, with very poor results. Had extreme bloating and swelling in feet and ankles ( never had swelling before) and then chest pressure and elevated d dimer & doc said my heart murmer sounded louder. In checking for clots found out I had severe venous insuffiency in one leg & cardiologist said never try bc again. Now doc says we can try Mirena or ablation. Since bc attempt in August (stopped tranexamic acid & bc on 8-29) am exhausted, SOB, no appetite, discouraged. I don't believe I want Mirena bc of hormones involved, feeling cautious there, and last time I tried one hurt bad and then after four days popped out. What about ablation? I don't know how deep my adenomyosis is but doc seems confident it will help bleeding. I have pain but can manage that with OTC ibuprofen most of time. He says helps most women and might get me to menopause.

I want to trust my doctor but he seems unconcerned about the impact bc had on me and it almost seems as if I am getting this standard speech from him every time and new info doesnt seem to change his opinion. I brought him a copy of Mri but he said he didnt need to see it and seemed dismissive of it. Said he knew what it was going to say.

I have missed a lot of work, due to fatigue. I really need advice.
Posted Fri, 11 Oct 2013 in Women's Health
Answered by Dr. Shanti Vennam 4 hours later
Brief Answer:
Hysterectomy is the ideal choice of treatment.

Detailed Answer:

Thanks for writing to us.

After having gone through your description, I think that hysterectomy is the ideal treatment of choice in your case. You are not a candidate for using hormones given your history and your age; nor are you fit for menopause and hoping for the fibroid as well the adenomyosis to regress; or to get a hysterectomy done as a one time solution to all your problems. If I were your consultant, I would advice hysterectomy if there are no medical contraindications because this gives you freedom from most of the symptoms, especially the blood loss and you can get back to work properly.

Hope your query is answered. Please feel free to contact if you need further clarifications. I will be happy to help.

Above answer was peer-reviewed by
Follow-up: Suffered prolonged bleeding and now anemic. Taking tranexamic acid and iron supplementation. MRI showed adenomyosis with large adenomyoma. Cure? 15 minutes later
Thank you. I know I'm not a candidate for UAE and that hysterectomy is always an option though not what my doc recommends; but my question is about ablation, which is what my doc wants to do. He thinks it will help me get to menopause. With adenomyosis, am I a candidate for that? I am not convinced it's a good option for me.
Answered by Dr. Shanti Vennam 16 minutes later
Brief Answer:
Not a good option.

Detailed Answer:

Thanks for writing back.

Endometrial ablation can help to stop the blood loss and pain during the periods but does not help with constant pain. Failure of the procedure is more with adenomyosis as the procedure aims at denuding the inner surface of the uterus while adenomyosis is extension into the muscular layer of the uterus. Failure of the procedure once will call for hysterectomy, preferably laparoscopic. Considering all these factors, I suggested hysterectomy.

Hope your query is clarified. Please get back if you need more clarifications. I will be ready to help.

Above answer was peer-reviewed by
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