Prostap or straight to hysterectomy

Hi, ive just been diagnosed with adenomyosis after yesterdays laparoscopy and my consultant has said its advanced, so he mentioned prostap, or others to induce a temporary menopause, my question is if he is 100% sure that it is adeno! then why not go straight to hysterectomy,

I'm 40 this year and am lucky to hav my 3 children, so don't need my uterus anymore.


11 Replies

  • Hi - as you will no doubt have gathered from many posts about these medications they can have severe side effects in some people - not just the menopausal ones. They give them before surgery on adeno as it's driven by oestrogen like endo is so it aims to shrink it berfore they operate. But, as you say, why if you are looking at a hysterectomy and will be throwing out the baby with the bath water anyway? I would say why take the risk if there is no reason for it. The hysterectomy is a decision with implications though at your age. Are your ovaries (or one at least) in tact and would you retain them/one as you don't want HRT triggering endo afterwards. Have a look at my post on postmenopausal endo and hysterectomy.

  • He said to leave overies,

  • Then I wonder like you why they are suggesting the medication. The surgeon should send a report to your GP about your surgery that will be summarised to your medical records and the document will be scanned and attached. I think the first thing I would do is wait a week or so for this to come in and then go to your GP and ask what the surgeon said in the report. It should say why the prostap has been suggested. x

  • Hi, I'd also add that they often use Prostap as a guide to see if a hysterectomy will solve your problems - apparently if you still have issues while on Prostap, a hysterectomy is unlikely to be a 'cure'.

  • Why would you still have symptoms if they took the uterus away, there wouldn't be any where else for it to grow,

    Please explain

  • I think what Charlie means is that if pain persists when on prostap then it might suggest the source is something else. But you know you have adeno.

    Going back to your other post I know this is all so confusing and I think it's best to give yourself a while to recover a bit before considering the options.

    I think it's best to ignore the prostap if it's reconfirmed that all the endo has gone as it couldn't be long term anyway and think about your post hysterectomy situation when you've recovered a bit. If you were say 45 plus you would just have everything out since you would most likely be near to natural menopause anyway. At 40 you might want to consider bone health by retaining ovaries. When you have your uterus out the oestrogen produced by retained ovaries is much less than with a uterus. Keeping one would be less still but should protect your bones. It's all a case of balancing risks so after you've cleared your head of all the confusion and are ready to do your research I should look into this aspect. x

  • Hi I have the same and have just been offered pro stap to try before hysterectomy, I'm 32, what are you trying? Are you going for the prostap?

  • Hi ck 13, I'm really confused, I'm just thinking that both things, prostap and hysterectomy wil act differently, as prostap stops your period by your brain telling your body that it is ready for the menopause and there for slows down the process of producing estrogen, and therefore we don't procuse eggs and have periods, estregen is still produced in other ways through the body so we can never be totally without estregen, and then this helps our symptoms because of not having periods, and the adeno stuck in the muscle dosnt bleed every month ect, but it will still remain there and therefore surly can still cause symptoms exspecialy as mine are all month not just whilst bleeding

    When we have out hysterectomy we are removing the problem, but our bodies will still produce estregen as our overies will be left, but the adeno will be gone with the uterus so surly can't cause problems,

    Sorry bear with me, I'm so confused,

    I've just had my endo excised so providing his done his job properly, if my symptoms where coming from that I should now be free of symptoms, 4 days after and I'm still experiencing the same pains as before, however it's early days so need to give more time before I can come to that conclusion,

    But, my train of thought is telling me that if he is 100% sure I have adenomyosis then I want it gone, I don't want to be put through 6 months of shit because I think if my symptoms persist he might put it down to something else, but because of above I don't think it would be right.

    So on my appointment 14th April, I'm going to grill him about it till the cows come home, and then I'm hoping to opt for hesterec tony Asap

    What do you think, it's very rambled I no, but can't explain it any better it sounds my straight forward in my head lol


  • I am having a total hysterectomy next Monday due to dermoid cyst endo and adenomyosis , I am 53 and not having periods but have been given prostap for 1 month to shut down the ovaries prior to removal she said it calms symptoms and helps your body transition into menopause after surgery so it's eases the symptoms , sweats etc it's not as much of a shock once the ovaries both go, the hot flushes are awful at the moment but be worse after surgery.

  • Hi again

    I can see why you are so confused.

    When I first read your post title I assumed it had been suggested/agreed that you were to have a hysterectomy because of the severity of the adeno and so why was he suggesting medical treatment prior to doing the op? But I'm wondering now if that decision has not yet been made on his part. After initial diagnosis the order of treatments is usually painkillers/hormone treatment then the last resort, hysterectomy. This is NHS protocol that perhaps he is following, even though with severe adeno the hormonal treatment is unlikely to have any overall benefit as it aims to give up to 12 months of relief before symptoms all usually kick in again as your hormones get back to 'normal' (which are never normal in endo and adeno). But as you have indicated this would only (perhaps) relieve pain from periods - heavy bleeding, contractions etc. - and not the pain you get all the time. With advanced adeno you will have substantial fibrous masses in your uterine lining that no medication will take away. You will have a thick and 'heavy' uterus.

    The taking of any medication is a joint decision between doctor and patient and Prostap (Lupron in the US) does have some documented serious symptoms. It seems clear to me that after the 6 months of what might be a terrible time you will end up having a hysterectomy anyway, which is where I think your thoughts are? In an ideal world we would all have a beautiful uterus, precisely balanced hormones and a pristine pelvis. But we know it doesn't work like that and treatment options for these conditions is a based on a risk assessment depending on severity, age, documented side effects of treatment and outcomes etc. Treatment options must be jointly considered but the ultimate choice must be for you to make as the owner of your body as long as it's an educated and reasonable one, which going straight for a hysterectomy would be with confirmed advanced edeno. You can't be forced to take a medication that would give only short term relief, if at all, and has documented adverse side effects. Your decision then would be how to protect your bone health and other issues arising from hysterectomy and keeping your ovaries would be the usual recommendation if they are healthy. Oestrogen levels would be much reduced but you could potentially have endo recur and would monitor any symptoms knowing they are no longer from adeno. It is unlikely though with properly excised endo followed by a hysterectomy. I think you will have looked at my post on postmenopausal endo/hysterectomy.

    This might be helpful in making your decision from Mayo Clinic, a reliable source:

    'What are treatment options for adenomyosis?

    Effective treatment options for adenomyosis are limited. Although treatments may be effective in some women, the benefit often does not last and women seek alternative treatment options.

    Treatments can include:

    Hormone treatments including birth control pills, progestins (oral, injection or IUD) or GnRH-analogs such as Lupron

    Endometrial ablation

    Uterine artery embolization


    Unlike fibroids, the adenomyosis cannot easily be shelled out or removed. The only way to remove the adenomyosis is to remove the uterus.

    The treatments listed above frequently do not provide adequate symptom control. If a woman opts for a hysterectomy, there are minimally invasive techniques and the ovaries are typically left in place so they can continue to produce hormones.'

    I sense you already know what you want and should trust your instincts. Ask your consultant:

    Why he suggests Prostap with advanced adeno as documented evidence suggests it will have no long term effect and is associated with adverse side effects that you want to avoid?

    Does he think you will ultimately have a hysterectomy anyway?

    Does he agree that it would be best to go straight for that in view of the severity of the adeno found and the severity of your symptoms all the time which would not be resolved by Prostap even short term?

    Does he agree that you should retain your ovaries and definitely not have oestrogen therapy instead due to its association with reactivating endo?

    I hope this might have made things a bit clearer? x

  • Thank you for confirming my thoughts, one minute I think I've got it all clear in my head and then I confuse myself with another question thought ect.


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