How do you make this decision?

[givemeananswer]

Preparing my thoughts on paper for when I meet with the Gynecologist in less that two weeks. I have already had the hysterectomy. But suspect with the return of pain in my back/hips/buttocks that has been unresponsive to cortisone injections, that the return of my endometriosis of the uterosacral ligaments and cul-de-sac, or as you say in the UK the pouch of douglas has returned venomously for the 5th time. I read an interesting article last night that removing deep fibrotic endometriosis may be more difficult when there is no uterus between the anterior rectum and the bladder. And that after hysterectomy the endometriosis remaining in the anterior rectum and vaginal cuff frequently becomes densely adherent to, or invades into , the bladder or one or both ureters. So my 11 years of relief may have a price. Now the decision to at this time go ahead with the bilateral salpingo oopherectomy to avoid future development sites, (I'm 50 so nearing the age although not yet showing in blood test the staging of menopause) or going on synthetic hormones to stop estrogen development but meanwhile risk more bone loss (I have been diagnosed with osteopenia) and risk future arthritis thus still having a sore back. Then there is the dreaded menopausal symptoms to deal with, either choice and not having the luxury of choosing HRT's because they contain estrogens which is food for endometriosis' return ie more surgeries. HELP!!! Was I a bad man in a previous life? What can one take for getting through menopause without estrogen? Anyone have experiences with this issue, that found alternative relief? Any thoughts and suggestions, or opinions are appreciated, Thanks.

[Impatient]

Have you tried Depo Provera injections?

Depo-Provera does have some bone density loss - nothing on the scale of the GnRH drugs like Zoladex and Prostap, and is a stepdown from GnRH. You shouldn't even consider the GnRH with osteopenia already confirmed - I would be shocked if any medic did prescribe it to you and it is only a temporary stopgap, for 6 month max in healthy boned woman, the endo is in a coma and wakes up back to square1 soon after stopping the drug, so it in your case not an option to even consider.

Depo Provera works in a similar way to the Mirena- but is injected every 3 months to stop periods.

Both depo and mirena over time thin the menstrual linings of the womb and endo until they no longer bleed each month. Depo will shut down ovulation too.

Both drugs also cause an increase in production of cervical mucus which plugs the cervix when you are not having periods or helps to flush out the bleeds if you are still bleeding on the drugs.

Another option is get rid of one ovary and keep the other to avoid any need for HRT. While also having the exiting endo attacked in the op.

It doesn't matter if you are on HRT or have an ovary - the endo that remains will still be getting a hormone fix and remain potentially active.

There are a lot of pros and cons to consider before coming to a decision, and you don't need to make the decision till you are sure, till you have researched your options and spoken with the surgeon. If you need more time then let them know you are as yet unsure and need more time to come to a decision.

It is an irreversible op,so you do have to be sure that a hyst is the right thing for you at this time.

[givemeananswer in reply to Impatient]

Hi Impatient, nice to hear from you. I so trust you as my go to girl. You said Depo will shut down ovulation too. But on someone else's post I just read you said it doesn't shut down ovulation.Maybe you were referring to something else? I' ve already had a hysterectomy 11 years ago I'm considering having my ovaries out to prevent future developement of endometriosis, and I don't know but does estrogen encourage adhesions also? Just unsure and clarifying does Depo Provera help in the transition to menopause by reducing symptoms of being cut off cold turkey of naturally producing hormones from the ovaries?