Is a second lap a bad idea?

[miss_miller]

Hi everyone,

I have not used this website for 3 years, after I had a laparoscopy which discovered a chocolate cyst and endo which was all removed (excision). Now it seems after 3 years it is rearing its ugly head again.. I have the same symptoms. Pain after sex, cyclical pain. My menstrual cycle runs like clockwork, and periods are not heavy but very painful, for days before as well.

I visited my doctor who said I shouldn't have another lap, and I should just go on the pill which will shrink whatever I've got in there. She didn't examine me, or suggest any other scans etc. Now I don't know if I'm overreacting, but I kind of feel like she's fobbed me off (much the same as many, many doctors before). Is she right to assume this is the same problem as before?

Has she given me sound advice? Or should I seek another opinion? If the pill really is the best option then I guess I'd go for it. I do prefer to keep my body running as naturally as possible, but if it's true that it could help preserve my fertility (as she said), then I'd do it.

Could a second lap do more harm than good? She said multiple operations pose more of a danger of damaging tubes (which makes sense I guess) What are people's experiences/opinions with this?

[hayls]

Hi

I take it this was your GP? If so she really doesn't have the expertise to be advising on whether another lap is necessary or treatment options etc, particularly if its been a long time since you saw a gynae. Its not her place to be treating you by prescribing the pill etc without any guidance from your gynae. Particularly, I seriously question some of her comments about the pill - (1) it will not shrink any endo you have, and (2) her comment that it will preserve your fertility is seriously inaccurate. The pill can help endo symptoms as by stopping your periods (by tri-cycling the pill etc) will often help stop endo from progressing but it does nothing to the endo that is already there (if there is any) and quite often doesn't help with the pain or actually stop bleeding etc.

If I was you I would go back and ask for a referral back to your gynae, but preferably a referral to a BSGE accredited endo centre as you are already diagnosed etc. Good luck, I hope you get some proper medical advice soon x

[Impatient]

ooo I'd push for at least an ultrasound to check if there is a new cyst there before heading for the lap op.

And if there is a cyst that needs to come out, perhaps look to long term period reduction or better still stopping periods by mirena coil which is best inserted under general anaesthetic. it won't prevent new cysts forming but neither will any BC Pill.

but it will reduce odds of new endo forming. Having that put in during the lap op would be the best time to get it done.

In one sense going on BC pills to reduce the number of periods you have is indeed sound advice, because that reduces the risks of new endo spreading from back flow bleeding or periods along the fallopian tubes. but on the flipside, by stopping your periods with the pill taken back to back a few months at a time, it makes it harder to see in the lap op and more likely any endo patches will get missed too, so if you do go on the pill and get an op date then try and aim to have a period during or just before the surgery so that your endo is recently or currently active and much easier to spot and remove.

Going au naturel and having periods is not in the least helpful for a bleeding disease like endo - sadly.

Even if you have very manageable periods and very little pain or discomfort, every period you have risks that period blood accidentally heading out the wrong pipes (fallopian tubes) and ending up in your tummy not running out the vagina.

Once trapped in the tummy area with no means of escape those endo cells can land on anything - organs tissues, ligaments etc and nest there. it doesn't appear to mind where it takes root. and once it is rehomed it still thinks it is in the womb and every month it will respond just like its sister cells in the uterus, and shed a menstrual lining and bleed, only causing more trapped cells to inhabit the tummy cavity while at the same time the blood from the mini periods that each endo location causes will land on nearby tissue and irritate it causing scarring and adhesions to grow and these as much as endo can compromise your fertility prospects.

there is a lot to be said for reducing or stopping the number or periods you have by whatever means you can cope with. I

t buys you time basically.

If it stops ovualtion which some do then that preserves your egg count.

You only have a finite number of eggs in each ovary in a life time - around 400.

And will mature and lose at least one egg sometimes two each monthly cycle.

So mirena coil for example if that stops ovulation for 4 years would save you at least 48 eggs which could come in handy if at some point in the near future you do need to have IVF for example. that said there is no guarantee that ovulation will stop even if periods do, but it is worth trying to preserve egg stocks if you do at some point intend to make better use of them.

Pills don't shrink endo, they can if taken back to back cause them to skip a period just like in your womb, which is a bonus - but it does nothing to kill off the endo in any way.

The only way to be rid of existing endo is to have it burnt to death (laser or diathermy) or cut out (excision surgery). Pills are really for prevention of new endo spread but won't rid you of the stuff already squatting in new locations.

I'd ask for an ultrasound to check if there is a cyst issue, and then a referal to a gynaecologist - perhaps thistime round at an endo centre, and have a new surgery to remove currently existing endo and then do pills or mirena to stop periods reducing chances for new endo to spread and perhaps as a bonus preserving your egg count to a degree.

[miss_miller]

Thank you both for your replies, much appreciated.

Yes Hayls, this is my new GP, I've moved to Wales and looks like I've got some hunting around to find a doctor who understands this. I didn't think the pill would diminish any existing cysts/endo, but she said it would. But logically it doesn't make sense!

Impatient - you suggestion makes a lot of sense to me, you've confirmed what I've been thinking about all day! I need to go back to my GP and talk through this with her (or try another GP at the clinic). She can't refuse to send me for a scan/refer me to a gynecologist... can she?

I find it really frustrating that it's so difficult to find doctors who listen to us. The first time, it took me 6 years and around 12 doctors before I found one who took me seriously and didn't think pain "is just part of being a woman" (an actual quote from one doctor I saw)

It's good to find this group and be able to talk to other women who have experienced these difficulties and this horrible disease. Thank you ladies, you are stars x

[Starstellar7]

I am in exactly the same situation but I have been tri-cycling the pill (yasmin) for the last three years. It helped and made me feel so much better for 2 years but lately I have a lot of pain and discomfort again and have been booked in for an op.

I would get a scan to see if you have cysts if you do then have an op. Maybe try the pill for three months and see if it helps with the pain. I am reluctant to have a second surgery but I have been feeling very ill now for a few months and the Dr has advised that provera, the coil etc are unlikely to help in my particular situation. Go to a gynae, not a GP. I hope you get some answers.