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Just for peace of mind, this past Saturday I went and got a second opinon about my surgery. I took a 2 hour drive from New Orleans to Mobile, AL. I was treated by this doctor at Ochsner Hospital in New Orleans for about a year right after he finished his residency there. He left and moved back to Mobile, Alabama where is originally from. After that, I began seeing my current ob/gyn. He didn't think that I really needed the laproscopy. He said that pain from endometriosis wouldn't come on that fast and that it would be a gradual increasing pain. He said that he finds endometrial implants during surgeries all the time and the patients don't even know they have endometrosis. He said that I definitely needed the endometrial biopsy. He said that if the biopsy came back negative, he said that the endometrial hyperplasia could be treated with progesterone therapy. I told him that there was no way I was taking Provera again since it makes me so sick. He said that he would prescribe an oral medication called Aygestin which is progesterone but doesn't have the bad side effects of Provera. He said that if the biopsy wasn't normal, he would recommend the d&c followed up with progesterone therapy. Either way, we would want to do a repeat endometrial biopsy in 6 months. He thought that the pain that I've been having is more related to not having a period for 8 months and would go away on its own rather than being caused by the small fibroids. I decided to let him do the endometrial biopsy and that was the most horrible pain that I have ever felt in my life! I found that I have a titled uterus and the cervix was pointing upwards which made it very difficult (and very painful) to do the biopsy. He tried twice and wasn't even able to get to the cervix and stopped when I started crying because the pain was so bad. He wanted to stop all together because he didn't want to hurt me and he thought it would be best to do the endometrial biopsy and D&C under general anesthesia and I told him to try one more time. He did and he was able to do it. I thought I was going to pass out the cramps were so bad. I couldn't stop shaking. He gave me some medicine for the cramps right after the biopsy and about 30 minutes later all the cramping was gone. The pain that I've been having in the left side of my pelvis is gone. I am still a little sore and tender from the biopsy but this is the best I've felt in the last 5 weeks. I should have the endometrial biopsy results by Thursday. I'm going to ask him about going ahead with the d&c even if the biopsy results are normal and then starting the progesterone therapy. I think that if all that extra lining gets taken off, I won't have all the bad contractions and cramps when I get started with cycling on progesterone therapy. I don't know if I'll be able to go though another endometrial biopsy in 6 months though. He said that the d&c is more extensive than an endometrial biopsy, but at least I would be asleep during it.
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Question - I went and saw my ob/gyn last Thursday to talk to him about what to expect with the d&c and laproscopy procedures. I asked him why I still needed a d&c if I didn't have any fibroids. He said that technically I didn't have any fibroids but I had a cluster of 6 small connective tissue growths in my uterus and showed them to me on the ultrasound. He said that they didn't meet the criteria of being called fibroids even though they probably were small fibroids. He said that I didn't have to have the surgery right away but as they grow larger, they are going to cause more problems and would require a more extensive surgery than a simple d&c. He said that as a precaution, he's also doing to do an endometrial biopsy during the d&c while I'm asleep. He said it's not a nice procedure under local anesthesia. He said that he doesn't think I have endometrial cancer but it would be malpractice on his part not to do it. My doctor eally eased a lot of my fear with the surgery. My doctor is going out of town next week for the 4th of July holiday. He said that he really didn't want to do the surgery on July 1st since he's leaving on the 2nd in case I have any complications. I'm scheduled to have the surgery on July 15th. I guess I should go ahead and fix the problem now since I'm already having pelvic pain from them, the Anaprox is working at all in relieving the cramps/contractions and the Bextra which should last for 24 hours only works for 9-12 hours. Even though I'm not sexually active, I asked my doctor about giving me a prescription of birth control pills after the surgery to regulate my cycles so the endometrial hyperplasia doesn't happen again. He told me that we'll talk about it after my surgery. I don't think he would have prescribed the birth control pills if I had decided against the surgery. I just absolutely can't take the Provera again!
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Question - I had my ultrasound done yesterday. My ob/gyn called me yesterday and said that I defintely need the d&c and laproscopy. He said the endometruim is too thick especially after 7 days of heavy bleeding. The ultrasound didn't show any fibroids but did show a chocolate cyst on my left ovary. I've had several transvaginal ultrasounds which haven't bothered me at all but with the one I had yesterday, when the ultrasound tech pressed on two areas on my left side, I thought I was going to jump off the table because it hurt so much. He said that because of the chocolate cyst and the severe cramping I've been having, I probably have endometroisis and said that during the laproscopy he would use a laser to remove the implants. I'm still a virgin and even though I've been seeing my ob/gyn for 8 years, I still get really nervous during my pelvic exam. Now I'm going to have a whole operating room of people looking at all my private parts. I'm just so embarrassed. My ob/gyn is wonderful though and said that he's going to help me get through the surgery. He said it will be over before I know it and I'll feel so much better after the surgery.
I am 34 (will be 35 in sept), never been pregant, 06/12 - lmp.
It's been almost 8 months since I had a period. I have PCOS. My ob/gyn prescribed Provera 10mg to take 2x day for first 5 days of month. After (06/03/04) 3 days on Provera, I started having severe cramps on my left side. My dr said that the Provera can cause PMS type symptoms. After the 5 day on Provera, the cramping was still there but less severe. On 6/12/04 I started having a heavy period w/large clots which last 2 full days. The cramping turned into contractions. My dr gave me Anaprox which did relieve cramping for a little while but after I started bleeding again on 06/17/04 the Anaprox didn't help at all (I even exceeded the dosage by taking 3 that day). All the pain and cramping seems to be only on my left side. I went back to my dr last thursday. He said I shouldn't be having that much severe cramping and recommended a d&c and a laproscopy. He said that from not having a period that long, I probably have a tremendous buildup of uterine lining. He also said that during the d&c he was going to use a hysterscope to look inside my uterus for fibroids and polyps and removed them. He also recommended a laproscopy to check for endometriosis since I'm almost 35 with no children and the pain and cramping would be caused by that. My dr said that a d&c will only cause minor menstrual-type cramping for a few days, but some people have told me the pain is awful after it. I was also wondering about the pain after a laproscopy? I'm a total chicken!
Thanks for your help. Vicki
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If you are having such abnormal bleeding and discomfort on your left side, I would agree with your doctor to rule out any abdominal pathology. A D&C will show if there is any reason for the abnormal bleeding (fibroids, polyps, thick endometrium) and a laparoscopy will show if you have endometrial implants which can cause excruciating pain. The post operative discomfort from a D&C is very minimal and is not a reason to avoid having one. The pain from a laparoscopy is also minimal and, as long as the gas is removed, you should be fine. You may wish to have a sonogram done first. This will show the thickness of your endometrium and if you have any fibriods. HOwever, your symptoms have been going on too long now and a definitive diagnosis must be made. I agree with your doctor.
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It sounds like you really need to have the laparoscopy and the D&C. Try not to be embarrassed. In the operating room there will only be an anesthesiologist, the scrub nurse, the circulating nurse, your doctor, and his assistant. You will be draped and only your abdomen will be showing during the laparoscopy. During the D&C, you will have drapes all over except for a small area around your vagina. It is very clinical and nobody really looks at you. It will be over before you know it and you will feel better after the diagnosis is made, the chocolate cyst is drained or removed, and any endometrial implants are cauterized or removed. Good luck to you. Let me know how it goes and what they found.
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I think you are doing the right thing. The findings in your uterus may merely be polyps, but they can also be small fibroids. The endometrial biopsy will rule out any pathology and you will probably be reassured that all is well. Let me know how it goes. Good Luck. Your doctor is absolutely correct.
AnswerUsually, an endometrial biopsy in the office does not cause the discomfort that you had. A D&C is a better test because the entire endometrium (in four quadrants) can be examined. The only way to diagnose endometriosis is by laparoscopy. However, if the pain went away, you do not have to do the laparoscopy. You will know better after your next period, It is very rare for endometrial implants (clusters such as you had) not to cause pain and, perhaps, the doctor you saw in New Orleans had not seen enough cases to realize that, yet. HOwever, the next time you need a biopsy of your uterus, I would suggest having it under general anesthesia. Aygestin has many side effects and should not be used for too long a period of time. HOwever, you may have less discomfort using it as compared with Provera. A D&C under anesthesia would have been the correct procedure for you to evaluate the thickened endometrium and to see if you had any fibroids. A single biopsy in the office may miss polyps or fibroids. However, I never thought you had endometrial cancer either. As long as the pain goes away and stays away, you do not need the laparoscopy. The chocolate cyst deos not necessarily mean that you have endometriosis. HOwever, any nodularity in the pelvis may be endometriosis and you may need a laparoscopy in the future. Good Luck.
