Pressured into surgery?

Hi just got my diagnosis, discovered because I was in a great deal of pelvic pain, and felt that my consultant said that because I have a 4x3cm cist in my ovary that surgery was the only route forward. I am 28 and thinking about fertility, but wondering if in anyone's experience going on a contraceptive pill for a few months would sort my body out enough to get pregnant which in turn would clear out everything down there! I hate the mood swings that contraceptive pills give me but am even less happy about going under the knife unless essential. Have been having unprotected sex for about a year but because u was referred because of pain not fertility I'm a bit unclear on the best way forward for my body.

8 Replies

  • Hi, I am sorry your in so much pain.

    I had a ruptured cyst on my ovary which caused a lot of problems, but still had my ovary and tube for another two years, it shouldn't really effect pregnancy,

  • Sorry hit the wrong thing. I've also had to have cysts removed from my ovary as well as the ruptured one and it's so helpful with the pain side of things. Is think about it.

  • The problem with endo cysts is that they don't just go unless they rupture. Also sometimes your body will be fighting the cyst not letting you fall pregnant. When you next speak to your doctor mention pregnancy as they should come up with a timescale plan. I think I had endo long before it was diagnosed, always ibs or in my head pains!! My diagnosis was after a cyst ruptured resulting in emergency surgery and a stay in icu. I managed to have a baby before it was diagnosed although am struggling for number two. I have to have a cyst removed in two weeks. I'm seeing at a clear out in preparation for baby making :)

  • Hi - I assume the endometrioma was found on ultrasound. This will usually suggest endo elsewhere. The problem is that you don't want this cyst rupturing as, apart from the pain that causes, it is likely to spread further endo around.

    Treatment for endo is based on two reasons - for pain or to aid fertility or both. For pain the first course is usually contraceptives as they reduce oestrogen levels and aim to suppress endo activity. They can actually be very effective at controlling pain for a long time if the endo is just mild. The only potential problem then is that hormone meds can mask progression of disease. If that doesn't help then surgery would be suggested, but ultimately it is the patient's choice. Obviously contraceptives can't be taken if you want to conceive and it is recommended that endo cysts should be best removed (excised as opposed to drained). The evidence is that taking contraceptives before trying to conceive does not improve fertility. These issues are discussed in the ESHRE guidelines that underpin NHS treatment. The first link below is to the full publication - section 2.4.4 covers treatment of endometriomas over 3cms and sections 3.1 and 3.2 cover hormone and surgical treatment for infertility. Basically endometriomas should be removed and endo treated surgically to improve fertility. Which method of surgery is to be used depends on the severity of your endo and the skill of the surgeon. The severity cannot be known until someone goes in and the accuracy of the diagnosis is likely to depend on whether your first lap is done by a general obstetrician or a specialist in endo.

    You are young enough to get this right from the start and I strongly suggest you get a referral to a specialist centre where they will deal with all aspects. Click on my name and have a look at my post on how to find a specialist centre. x

    ESHRE guidelines:

    Patient version:

  • Ok if you have endo, the absolute best way to preserve and increase your chances of getting pregnant is to have surgery. You may have multiple adhesions internally as well as the cyst which can alter your anatomy and make both conception and pregnancy difficult - while they are in dealing with the cyst they can excise (excision surgery is better than laser) any troublesome tissue getting you into good shape.

    I would make sure you get to see an endo specialist for a second opinion and get them to do the surgery rather than general gynae.

    To be perfectly honest the pill is going to do nada for you. I was on it for 14 years and my endo kept progressing to the point where I was bleeding every day and when they opened me up initially was a mess!! What helped for me was firstly surgery, then I was put on prostap injections (inducing menopause - which prevents endometriosis growth I.e. I had time to heal up properly without any disease grow back), then I went on the pill back to back (no periods) until I was ready to try to conceive (currently a few months into that journey.

    Treating this disease with a pill alone will probably only waste your time, having a laparoscopy will put you out of the ttc game for about 2-4 cycles depending on how extensive the disease is when they open you up. But compared to the year you've already spent trying it's not that much time and you'll be much more likely to get pregnant! (Lindle's advice spot on)

    I wish I could say the pill would be a cure all, but if your disease is already advanced to the point of being visible on an ultrasound I'd say the pill ship sailed some time ago.

    Hope everything goes well and you get a treatment plan that works for you x

  • As Applebird says, endo can actually hinder conception by altering anatomy.

    The human body really is the most amazing machine in that everything has been thought of - when it is unhindered. The Fallopian tube actually moves into a position over the ovary to accept the egg and if the tubes and ovaries are bound up in adhesions then fertilisation would be nigh impossible without this movement being possible. This is a description of what should happen:

    'Egg transport begins at ovulation and ends once the egg reaches the uterus. Following ovulation, the fimbriated, or finger-like, end of the fallopian tube sweeps over the ovary. Adhesive sites on the cilia, which are located on the surface of the fimbriae, are responsible for egg pickup and movement into the tube. The cilia within the tube, and muscular contractions resulting from the movement of the egg, create a forward motion. Transport through the tube takes about 30 hours.'

    What a beast endo is to actively seek to hijack this beautiful process.

  • thanks for your comments ladies. Didn't realise until after I posted that letter came yesterday saying surgery is on Friday! So looks like I'm doing that. Anyone got anything they can recommend for preparing me mentally for surgery. I'm the anxious type! My husband works as an ODP and has some experience with these ops so going to check it is a consultant led list when I go to pre op, and also have more trust in nhs staff around the consultants than I would in private healthcare. So for rambling, my head is all over the place right now. *sorry

  • You're okay, that is quite a lot to process over a very short space of time!!

    The best way to prepare yourself is to try and relax as much as possible - fill the next few days with as much chill time as poss, hot baths, stock up on your fave mags, films etc. for when you are home, have everything all set and comfy jammies etc. all ready - I always find getting all the comfort stuff organised therapeutic plus it will keep you busy! Basically do whatever floats your boat and don't worry about anything stressy - you and your health are more important!!

    They will have given you a list of stuff to bring/not bring. Much will depend on whether you're a day patient or going to be in for a few days (bring stuff for overnight just incase even if you are a day patient. Beforehand there may be some prep - I've had bowel prep and iv fluids before but that would all be in your letter. As for the op - you go and wait for your slot, anesthetist and doc will chat to you and then you'll have the anesthetic, I remember having some sort of amazing hot blanket thing put over me!! When you come round you'll feel rubbish - pain relief is good and well controlled, they'll have you up within 24hrs and the only way I can describe it is as if you've really overdone it in the gym and are also really bloated!! (they pump your tummy full of gas to inflate it and thus be able to see what they're doing - don't worry it will dissipate in a few days)

    Here is a link to advice from endo resolved that is really helpful

    Most of all know you're doing the best for your body. It may take a number of weeks until you feel totally recovered, be patient and take care of yourself, all will be well in time.

    Hugs xx

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