Another help request... sorry

[Mistiek]

I know I have posted loads lately... sorry. Just really trying to come to terms with everything.

I see my consultant on Friday and I don't know where to go from here. I am definitely not in as much pain as some on here but am in daily pain. And it seems to be getting worse. I have been off work for 2 weeks due to depression and don't feel any better yet.

I'm getting more and more nervous about my appointment as I don't know what to ask or what to fight for. Unfortunately I'm a bit stuck... I can not take contraception to help stop my cycle. Can't have depo because of this and the migraines. I got sterilised last year when I had my lap.

Medication seems to affect me really badly so don't think prostap, zoladex etc will be a good idea.

I know a hysterectomy is not a cure, but it's the only way I can see of being put into early menopause. If it has not spread further than my ovaries, I want it all out and the ovaries and try natural hrt to avoid it coming back.

I have not just had endo... I have had an ectopian, pre cancerous cells, I have a retroverted cervix, SPD (symphisis pubis dysfunction) which happens every month now during my periods. It's been non stop since I was a teen and now that I can't have any more children I want it all gone!

Because if my issues with contraception and medication I just don't know what else to suggest!

[Impatient]

You do have another option you haven't mentioned.

MEA or microwave endometrial ablation is now available on the NHS as an alternative option for women not ready for the hysterectomy surgery but not able to undergo hormone treatments to control periods.

Basically it involves cooking or freezing the endometrial lining of the womb which scars and then doesn't grow a new menstrual lining each month and either that stops periods completely or at least considerably reduces the surface area that can grow a lining and have a period- so at the very least it will reduce period bleeds considerably once it has healed and the scarring has done what it needs to do.

The options available to cook the lining are:

Laser beam (laser thermal ablation). [Same as used on endo]

Heat (thermal ablation), using:

Radiofrequency.

A balloon filled with saline solution that has been heated to 85°C (185°F) (thermal balloon ablation).

Normal saline (heated free fluid).

Electricity, using a resectoscope with a loop or rolling ball electrode. [Diathermy same as for endo]

Freezing.

Microwave.

It doesn't matter if you do have a retroverted uterus or forward tilted one. The only women that this cannot be used on are those with mullarian deformity of the uterus.

Bicornuate - or Didelphic and other grades of deformity in shape.

If the uterus is a normal shape then it is an option certainly worth considering.

And unless you find smear etc really painful then this process doesn't even need a general anaesthetic - though if it was me - I would certainly want to be knocked out and unaware what was happening down below.

It is permanent and irreversible - but as you have had the tubes tied already I would expect baby making is now off the agenda.

The following clip was from a Daily Mail aricle on this 3-4 years ago - so it is a bit out of date- and MEA is now available on the NHS, it is worth a read though......

"The three-minute hysterectomy

by JAMES CHAPMAN, Daily Mail

Thousands of women will be spared the misery of a hysterectomy by an amazing alternative that can be carried out in a lunch break.

The new treatment takes just three minutes and is expected to be made available soon to NHS patients.

It uses a hand-held 'wand' emitting low-powered microwaves to remove the lining of the womb quickly and safely.

Instead of a recovery period of up to two months after a hysterectomy, patients can go back to work or resume a full family role the same day.

The new technique - called microwave endometrial ablation or MEA - does not have the same high risk of complications as hysterectomies, which have a death rate of between one in 2,000 and one in 5,000.

It could save the NHS an estimated £30million a year and free thousands of hospital beds. The Government's advisory body on health treatment, the National Institute of Clinical Excellence, has now decided that MEA represents a major breakthrough.

A source close to the panel said: 'There's little doubt that it offers huge benefits to patients and will actually save health service money. It's being seen as a huge step forward in women's health.'

A preliminary recommendation from NICE's expert committee says MEA should be offered to all women suffering heavy menstrual bleeding - the reason for half the 60,000 hysterectomies in the UK each year.

The final goahead, which will also cover a similar technique using a heated, fluid-filled balloon, is likely next month.

As many as one in five women between 39 and 54 suffer from painful and distressing heavy monthly bleeding - a condition known as menorrhagia.

It often restricts their social life and disrupts their work and can even trigger anaemia because of a lack of iron.

At present they are offered either hormone treatment, which is often ineffective, or a procedure where the womb lining is shaved away with a wire loop.

This needs high surgical skills, however, and can lead to complications. The only other option is for their healthy wombs to be removed.

The scientists who have developed the MEA treatment say it could save all those women from such major surgery.

Trials have been hugely encouraging - more than 99 per cent of 600 women who had MEA reported that blood loss was significantly reduced and said they were satisfied with the outcome.

Blood loss stopped completely for 62 per cent, overall, and in hospitals with the most experience of the technique the rate was above 80 per cent.

The treatment also offers major savings, costing the NHS less than half as much as a hysterectomy. If the eligible menorrhagia patients all had ablation treatment, it could save the NHS an estimated £30million a year.

Women who have a hysterectomy normally stay in hospital for at least 48 hours, so the wider use of MEA would also free up thousands of beds.

The treatment, which has been pioneered by a Hampshire-based company, Microsulis, uses a handheld rod- shaped device which is inserted into the uterus.

The surgeon cannot see inside the womb but is guided by a sensor which gives a readout on a computer screen.

Microwave emissions from the 'wand' quickly heat up the tissue of the uterine wall, destroying it.

The temperature is controlled at between 60 and 85C, ensuring there is no burning or scarring. MEA can also be used on patients with fibroids.

Like all treatments which remove the womb lining, however, it means the patient can no longer have children.

Sir Charles Masefield, chairman of Microsulis, said that only a handful of hospitals are currently offering ablation treatments but he hoped the NICE ruling would lead to it quickly becoming available in at least 500 nationwide.

'They should all transfer to this technology,' he said.

'A hysterectomy is an extremely traumatic operation. Recuperation takes several weeks and a good proportion of women need hormone replacement and other treatments. All that is avoided with the new technique.'

As well as the wand technique, heat treatment can be carried out using a fluid-filled balloon pioneered by Johnson & Johnson.

The preliminary recommendation from the NICE appraisal committee says women should be offered either treatment as an alternative to hysterectomy on the NHS.

It is expected that some women will still choose to have a hysterectomy, or their doctors may recommend it. "

Certainly something to enquire about with your GP and Gynaecologist. It could be your best bet in the circumstances.

[Mistiek in reply to Impatient]

Thank you for your reply. .. you are always a wealth of info!

However I don't think this is an option. My periods are not lengthy. They are harsh and I bleed very badly with huge clots for about 2 days. However... I'm not worried about the bleeding or my periods. I know the ablation will stop the bleeding... bit that's not what I'm after. I want my cycle to stop completely.... This is what helps endo right? So if I have just ablation then my cycle will carry on... I just won't bleed. So endo won't be helped at all.

Then there is the other worried about endo spreading everywhere and getting worse or the precancerous cells coming back etc....

My gran, my mum and my aunt all had to have early hysterectomy for one thing or another and we're put into early menopause.... They have never looked back.

I'm so confused...