Endometriosis: Excision vs Ablation

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Detail,”The Endo-Graphic” by Sarah Soward. http://sarahsoward.com/projects/endometriosis.php

So, you may be reading this because you have a surgery pending, or you’ve had surgery and want to know if it was the “right” one.  Well, when it comes to Endometriosis, there are typically two ways of dealing with the lesions that I’ve read of. If there’s more, share with me, please!  Whichever way your surgeon opens you up : laparotomy or laparoscopy, robotic-assisted or not – your surgeon will still need to decide how best to handle the lesions he or she finds within your body.

  1.  Excision – removing the entire lesion by cutting a margin of healthy flesh around the lesion – see the graphic above, scooping the healthy soil around the flower to get the roots, and then some.
  2. Ablation – destroying the lesion by burning the surface away.  Like freezing off a mole or wart, but burning away the Endo.  The graphic above with the flamethrower may leave the roots of the lesion, and unhealthy Endometriosis tissue, behind…

Is one better than the other?  That’s purely a matter of opinion, but the popular opinion is, “yes!”  There are countless studies that agree.  But why?

Ablation only affects the surface of the lesion by destroying the tissue.  It may leave unseen portions of the disease beneath the surface, which may allow for speedy recurrence of Endometriosis growth and symptoms.  Ablation may also cause further scar tissue to develop – you are literally burning or melting the lesion away.  Other names for ablation may include cauterization, vaporization, and fulgeration.  Terms for some of the tools that may be used during ablation can be electrosurgical devices, thermocoagulation devices, lasers, a harmonic scalpel, helium or argon plasma therapy, and the cavitron ultrasonic surgical aspirator (CUSA).

Excision (sometimes called resection) removes the entire lesion, as well as a healthy bit of flesh around the lesion.  The surgeon hopes to remove all traces of that particular lesion, in the attempt to make recurrence more difficult.  The more lesions that can be excised, the better chances you may have at a longer symptom-free life.  Tools can be cold, hard cutting tools such as scissors or even lasers (but…but…heat energy – burning!?!) – nope, lasers are often used for excision surgeries to cut around the lesions and harvest it out whole.

You may be interested to go back, grab a copy of your operation report, and compare these tools and techniques.  What exactly DID your surgeon do?  Or you can use this information to better ask questions of your doctor prior to a pending surgery.

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Imagine an avocado (mmmmm avocadoooo) – you slice that bad boy open, remove the pit, and discover a bit of browning on the surface.  Nasty bruises and icky…But, there’s plenty of good avocado still to be enjoyed.  If you only scraped off the surface of that brown spot, you’d likely still have MORE brown spot beneath it – that rotten little bruise extends deeper into the avocado flesh (delicious green flesh).  You’d want to take a spoon and scoop out the brown spot in it’s entirety, and enjoy the fresh avocado that you have remaining.

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Also, think of an iceberg.  The tip is only visible above the surface of the water, but the iceberg can extend for quite a long while beneath the waves.  Endometriosis lesions do the same.  Who knows what’s lurking beneath the surface.  And if the entire iceberg – um, Endometriosis lesion – isn’t removed, it may resurface.

Studies have shown that women who undergo excision surgery of Endometriosis lesions have less painful periods, less painful bowel movements, and chronic pelvic pain than women who underwent ablation.  Studies also indicate that painful sex levels remain about the same for both excision and ablation surgeries.

Women who undergo ablation surgery for Endometriosis have a 40-60% chance of recurrence, sometimes within months of surgery.  In contrast, 75-85% of women who undergo excision surgery claim long-term relief.    I personally have undergone two excision surgeries, within two years of each other.  Some of my Endometriosis was in similar areas of my body as my first surgery, but some was found in new locations…My surgeon opted instead of excising (or even ablating) a lesion on my diaphragm, to leave it there for safety’s sake – nobody wants a perforated diaphragm! Excision surgery may not be ideal in every situation – and a skilled surgeon will be able to know when, and when not, to cut.   Even then, it may not work and you still may be slated for a future surgery.  The only guarantee with this illness: there is no guarantee.

In the end, it’s not all about the type of surgery or the tools used – it boils down to the skill level of the surgeon and their method of dealing with Endometriosis.  How competent are they? Do they do excision or ablation?  How often do they perform excision surgeries?  What’s their recurrence rate among patients?  Ask questions! Get answers!  Be comfortable and confident with your surgeon’s skills.

And, as always – there is no cure for Endometriosis.  We may get relief from medication, supplements, lifestyle changes, or even surgeries, but there is always, always, the chance for recurrence.  Listen to your body.  And don’t be afraid to head back in for another consultation…

I’d like to extend a special Thank You to Sarah Soward, a local artist and EndoSister who granted me permission to use a detail of her Endo-Graphic as our cover photo for today.  To view the entire image and all of the information contained there, please visit her site.   You can also view and purchase her other artwork here.

Resources:

Center for Endometriosis Care

Diamond Women’s Center

Endometriosis Australia

Endometriosis Foundation of America

EndoSupport.com

Eric Daiter, M.D.

Nezhat.org

Sarah Soward

The Journal of Minimally Invasive Gynecology – (Unedited Manuscript; April 2017) Laparoscopic Excision Versus Ablation for Endometriosis-Associated Pain – Updated Systematic Review and Meta-Analysis

Vital Health Institute

~ Again, I am a layman.  I do not hold any college degrees, nor mastery of knowledge.  Please take what I say with a grain of salt.  If curious, do your own research 😉 Validate my writings.  Or challenge them.  And ALWAYS feel free to consult with your physician. Always.  Yours ~ Lisa

Endometriosis & Perineum

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It’s the only photo I could think of that wasn’t … vulgar

Well, this was a first for me.

I’ve read numerous studies of Endometriosis developing in scar tissue after c-sections or other abdominal surgeries, but this one caught me by such surprise that I wanted to share it with you!  It’s important to any EndoSisters who may have delivered children naturally and have complaints of pain…”down there.”  Read on!

A 38-year-old woman had birthed a baby vaginally 12 years ago, undergoing an episiotomy.  Three years ago she developed pain on the right side of her vulva.  The pain increased during her periods.  Two years ago, that painful spot began to swell. And swell.  And swell until it was an inch long and an inch wide and turned into a hard, discolored bump.  None of her doctors were able to offer her answers or relief.  So, further investigation was needed.

Where was this swelling?  You know sometimes women who give natural birth have to have their (insert grimace here) vaginal openings…made wider in an effort to avoid tearing?  It’s a procedure called an episiotomy – a small incision through the muscular tissue of the vaginal opening, down the perineum toward the anus.  In 12-year-old giggle-girl terms: they slice open the gooch; the taint.  Okay, let me compose myself again…

Anyway, this poor woman had developed an inch-long/wide bump in her episiotomy scar which was painful RIGHT THERE!  Could you imagine wearing jeans? Sitting down? Even just walking? Ugh…

An MRI was taken and it was discovered that the lumpy-bumpy stretched along the perineum and was also involved with the puborectal muscles ( little sling that encircles the rectum – if you’ve seen the Squatty Potty ads on TV or Youtube, it’s the little rubberband muscle that relaxes/released your colon-goods) AND her anal sphincter.  Surgery was ordered and they excised the mass, as well as 1cm of healthy tissue surrounding the lump.  They also reconstructed her sphincter (thank goodness).  Biopsies of the tissue confirmed the suspected diagnosis of scar tissue Endometriosis.  And six months after her surgery, she was still symptom-free.  There was no prior history of Endometriosis mentioned in this article.

I was flabbergasted.  I know Endo can develop wherever and I really shouldn’t be surprised – but all the hullabaloo I’ve read about is women developing scar endometriosis after c-sections.  Just know that it can develop…um…elsewhere…even if you haven’t had a c-section

This just goes to affirm my beliefs that if you have a hard, painful bump *anywhere*, please talk to your doctor and pursue answers.

And happy Tuesday! ❤

Resources:

Babycenter All About Episiotomy

Panacea Journal of Medical Sciences – (April 2017; Article) A Rare Case: Episiotomy Scar Endometriosis with Anal Sphincter Involvement

~ Again, I am a layman.  I do not hold any college degrees, nor mastery of knowledge.  Please take what I say with a grain of salt.  If curious, do your own research 😉 Validate my writings.  Or challenge them.  And ALWAYS feel free to consult with your physician. Always.  Yours ~ Lisa

Endometriosis in the psoas major muscle

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An article was published on October 30, 2016 in the International Journal of Clinical and Experimental Medicine, which caught my interest.  We know that Endometriosis can grow in a lot of places other than the reproductive organs and pelvis.  This study found Endometriosis growing within a muscle: the psoas major muscle.

The pso-what-is muscle? Well, that’s what I said.

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It’s a pair of muscles that run from the lumbar spine, along the back of the abdomen, and end inside the hip area. It helps flex our hips, aids our walking and running, and can improve posture.  In some places, it’s as thick as a wrist!  As a side-note, weak psoas muscles can cause back pain, hip pain, limited movement in the hips, tight/deep pelvic pain, belly aches, constipation, and a twisted pelvis.  Dr. Axe offers some tips, tricks, and stretches to help strengthen your psoas muscles.

Okay, now back to the study!

A 49-year-old Chinese woman was admitted to the hospital because she had increased CA-125 levels.  If you’ve followed my previous blogs, you’ll remember this could be an indication of the presence of Endometriosis. Seven years prior, she had a hysterectomy and oopherectomy (removal of her right ovary) – she had a uterine myoma and ovarian Endometriosis.

After screening and testing, the doctors found a mass in the left side of her psoas muscle and thought she had a tumor.  She didn’t have any of the usual signs and symptoms of Endometriosis.  She was discharged from the hospital (at her insistance).

Three months later she returned for an MRI.  The mass had grown by 3cm and was also involved with her iliac vessels.  Her CA-125 levels were still increased.  And her physicians needed answers.  An exploratory laparotomy was performed and the mass was visualized in her psoas major muscle.  It was 10x10x8 cm and was inside the muscle tissue.  They continue to fear it was a tumor.

Rather than remove the mass in its entirety, a portion was removed and biopsied: confirmed as Endometriosis.  She received more than 3 months of Lupron Depot and the remaining mass decreased in size and her CA-125 levels stabilized.  The authors surmise the lesion may have transplanted during prior surgeries and hope this case report sheds further light on the illness.

Yet another example of extra-pelvic Endometriosis, as well as post-hysterectomy Endometriosis.  Here’s to hoping this case study continues to push the medical and scientific community into further research and greater funding toward better understanding Endometriosis – and one day finding that much-needed cure.

Resources:

Dr. Axe

International Journal of Clinical and Experimental Medicine – Article (Oct. 2016) Endometriosis in the Psoas Major Muscle: A Case Report

Yoga International

~ Again, I am a layman.  I do not hold any college degrees, nor mastery of knowledge.  Please take what I say with a grain of salt.  If curious, do your own research 🙂 Validate my writings.  Or challenge them.  And ALWAYS feel free to consult with your physician. Always.  Yours ~ Lisa

My 2nd Endo Surgery : Recap & Comparison

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Yes, I’m an artist!

Well, here I am, alive and doing well!  Surgery was on September 21, 2016, and today is my 3-week surgiversary.

In a nutshell : my Endometriosis had returned, bringing with it a leaking cyst and a bunch of adhesions.  Endo had also decided to now grow on my bowel (the outer layer of my sigmoid colon) and my ureter (the tube that carries stuff from kidneys to bladder – he had to detach my ureter, clean it up, and reattach it).  AND it disappeared from my liver (doc couldn’t find any there this time).  He was able to cut out all of my Endometriosis, except for a lesion that is on my diaphragm.  He cut away all of my adhesions and put my organs back where they belong.  I’ve still got both my ovaries and fallopian tubes.  My uterus was stuck to my bowel, my ovaries and tubes were a rat’s nest, and my uterus was also stuck to the right side of my pelvic wall.  It just sounds like such a mess…But, he did confirm that my bladder’s exterior AND interior were completely healthy and Endo-free.

For those who enjoy reading medical mumbo jumbo, an excerpt from my Op Report:

op-report-2016

Here’s a little comparison chart of what was found (and done) in 2014 and 2016…as well as the difference in COSTS from the two surgeries.  Don’t get me started on the inflated costs of medical care in the U.S…

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costs-surgeryThis recovery was SO much easier than my 2014 surgery.  I was far less bloated, hardly had any residual pain from the CO2 gas, and felt a lot better both physically and mentally.  Don’t get me wrong; it was still hard (I’ll save that for another blog entry), but it truly was night and day, comparatively. And it’s still rough…I can only sit, stand, or walk for a small amount of time before having to switch it up a bit because of the pain that creeps in around my incisions and abdominal muscles.  And I’m still severely restricted until early November on what I can do…and I’m sure I’ll be building up my strength and endurance for a while after that.

BUT : I haven’t had any recurrent Endo pain since my surgery (other than those associated with surgery).  Wonderful news.

Below is a little .gif I put together so you could see the difference between 2014 & 2016 for the first nine days after surgery.  When I asked my surgeon what he did differently from 2014, he let me know that he let out as much of the CO2 gas as he possibly could.

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And here I am now (well, October 4, 2016):

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If you’d like to see photographs of my insides and the teeny surgical tools, click here 🙂

So, now that I’m all freed-up of 99.9% of my visible Endometriosis, the adhesions have been cut away, and my “anatomy has been restored,” as Dr. Kurtulus so eloquently wrote, what’s the plan?  I’m giving up birth control pills since they didn’t do anything to keep my Endometriosis from returning (I hate the side effects so much).  I’ve already had one period since surgery – it lasted a whopping 3 days and the pain was so minimal on Day One that it was handled with two Ibuprofen.  I’m also monitoring my pain levels and diet daily (made easier via Google Slides).  I’ll go back to see Dr. Kurtulus in April for my annual exam and pap.  BUT if I notice any horrible return of pain before then, I’ll make an earlier appointment.  And, at the advice of my physician, I’ll continue my efforts to “eat healthy, drink healthy, and exercise.”

I am so grateful to my gyno/surgeon, his staff, the hospital, the surgical team, my wonderful Man, my Mum, and my Rosie.  And to all of you who sent me care packages, you’re awesome – they were used well. ❤

Here’s to hoping recurrence is a thing of the past…

Yours,

Lisa

And, if you made it all the way down to the bottom, yes…that is a poop with a corn in it. What better way to illustrate those are my guts? 😉

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Cap’n Poopy Corn

 

My upcoming surgery

 

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Photo courtesy of Wikipedia

So, Wednesday is the big day.  I was talking to my Mum last night and she asked me what exactly my upcoming surgery entailed.  Figured I’d share it in case you didn’t know.

Endometriosis lesions (also called implants) grow wherever they damn well please inside the body.  My brain interprets them much like mushroom spores that *poof* and attach to wherever they land and grow.  However, much like an iceberg, more than just the visible tip exists beneath the surface.  Some people liken it to an invasive cancer, although not fatal.

There are a few different ways different surgeons handle removing Endometriosis:

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Those dark blotches are Endometriosis.  Photo courtesy of Wikipedia

Burning it away.  The surgeon destroys the lesion/implant by burning them, much like you would freeze or burn a wart.  Often times, this does not destroy the entire implant and may lead to the development of more scar tissue and regrowth of Endo.

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Photo courtesy of Wikimedia

Shaving it away.  The surgeon again destroys the lesion/implant by cutting off the top surface of the implant, similar to the removal of a mole or skin tag.  This, again, may lead to the regrowth of Endo.

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Photo courtesy of Flickr

Cutting it away.  The surgeon removes the lesion/implant by not only removing the visible surface of the implant, but by removing some of the healthy tissue around and beneath the surface; in the hopes of removing the entire implant and slowing the rate of regrowth.  This is considered by most experts as the way to do it correctly.

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Photo courtesy of Flickr

My surgeon may also run into adhesions, scar tissue which forms spider webs or rubber bands around the pelvic cavity, pulling organs out of place or sticking them to one another.  These adhesions will need to be removed and treated with a barrier medication to prevent immediate reformation.

It is not an easy surgery, sometimes taking between 1-7 hours to complete.  My 2014 surgery took four hours.  It’s not as simple as removing tonsils or repairing a broken bone, although I’m certain those are not easy either.  It is extensive, requiring great focus and skill on behalf of the surgeon.  And due to the complexity of the damage and repair done, recovery can take several weeks.

During my first surgery, Endometriosis lesions/implants were found on my Pouch of Douglas (a void between your uterus and your rectum), my ovaries, my liver, my diaphragm, the lining of my pelvic cavity, my left fallopian tube, and on the scar tissue throughout my pelvic cavity.  My surgeon was not able to remove the Endometriosis from my liver due to the risks involved.

My uterus was also stuck to my bladder and my bowels, my bowels also stuck to the left side of my pelvic wall, and my left ovary was completely lost within the knotted mess of Endometriosis and scar tissue.

Once my doctor excised (cut out) all of my Endometriosis that he could and freed up my organs and removed the scar tissue, he treated certain areas with a barrier medication called Seprafilm, in the hopes to prevent the adhesions from immediately redeveloping.  I know he will do the same this time around, too.

There. If you were curious what surgery I was going in for, now you know. Everything will be okay.  *deep breaths*

Resources:

All the things I’ve read since my diagnosis and conversations with my doctor.

 

~ Again, I am a layman.  I do not hold any college degrees, nor mastery of knowledge.  Please take what I say with a grain of salt.  If curious, do your own research 🙂 Validate my writings.  Or challenge them.  And ALWAYS feel free to consult with your physician. Always.  Yours ~ Lisa

Surgery: A caveat, footnote, the small print, an asterisk

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So, with surgery a week away, I met with my gyno/surgeon yesterday for my pre-op (you may have already read the details).  But as I was driving to work today, I realized I forgot to mention one important fact.  One that he mentioned to me the second I sat down in his office, before we got to the nitty-gritty.

He asked for my full attention and stated plainly that this surgery may take away my pain, it may not make a difference, or it may even make my pain worse.  He will do everything that he can to make me feel better, but he cannot promise it will.  And he asked if I understood what he just said.

I did.  And it’s true.  And I value him all the more for his blatant honesty (although I know he probably has to tell everyone that to cover his own butt).

I will repeat it:

  • It may take away my pain;
  • It may not make one lick of difference; and
  • It may make my pain worse.

It’s a fact of life.  There is no guarantee this procedure will help.  And there’s a chance that it may increase my pain.  Abdominal surgeries are notorious for causing adhesions to form, which may increase pain and discomfort.  And there’s no guarantee that the removed Endo lesions won’t return.  There is no cure.

Going into this with my head high and full of positive mojo.

2nd Surgery pending…

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This morning I found out Surgery No. 2 is imminent, thanks to my Endometriosis. The date will be sometime in September; I’ll know more in a few days. I met with my doctor today to discuss my ongoing symptoms and worsening pain.  After a long talk and history, an a transvaginal ultrasound (OUCH), and another looooong talk in his office: he felt it’s time to peek under the hood.  I knew going in today that the surgical option was likely it. I wish we could tell if it was present in other ways.  But nope.  My CT was normal.  My US was normal.  But, as you and I both know, it may not always show up on imaging studies.  My symptom history is what convinced him:
  • Painful sex with deep penetration
  • Cramping after sex (sometimes for days)
  • Bleeding after sex
  • Right upper quadrant pain in my abdomen
  • Pain in the middle of my lower abs
  • Pain to the right of my belly button
  • Pain above my belly button
  • Pain when he pushed on those areas of my torso
  • Waking up at night screaming because of the pain in my torso
  • Examining my prior surgery photographs and seeing they line up with my present complaints of pain (diaphragm, liver).
  • Extreme bloating after exertion
  • Flare-ups after exertion
  • A change in the quality of my life, once more.
My surgeon is also my gynecologist, so he is intimately familiar with my bits. And even better? I like him. And I trust him. And he believes in removing the disease, not just burning or scraping it away…but cutting it out. And he frequents many conferences about the disease (he just returned from an Endo conference in Russia). And he TEACHES robotic laparoscopic surgeries, so he really, really, really knows what he’s doing.
He will look in all the usual spots one finds Endo (pelvic region, uterus, ovaries, fallopian tubes, pouch of douglas), but he’s also going to check my bowels, bladder, liver, and diaphragm.  AND he’ll keep his eyes peeled everywhere else while he’s in there.  If the lesions are back, I’ve no doubt he’ll find them.  And if there’s no Endo present, he’ll still remove the adhesions/scar tissue.
And I cried like a baby in his office.  A new nurse practitioner was also present, and she scrambled in search of a tissue box.  It was kind of cute watching her through my tears as she tried to non-nonchalantly reach around his desk and bookshelves, only to come up empty handed.  We talked about my fears:
  • What if it’s all in my head?
    • It’s not in your head.  We’ve already confirmed you suffer from Endometriosis.  Pain is not normal.  And Endo can come back.  You know this.
  • What if you get in there and there’s no Endo?
    • Then we’ll clean up your scar tissue.  It’s the best case scenario, Lisa.  It’d be good.
  • I feel so stupid.  Like a hypochondriac.  Like a wussy.
    • You’re not stupid.  You’ve already been dealing with the pain for at least six months.  You’ve suffered long enough already.  It’s time to clean you up.
And, of course, his incredible support just made me cry harder.  He knows about our support group and our blog.  So he was wonderful when he said, “I know you know all of what I’m about to tell you, but I’m going to tell you anyway.”  And proceeded to explain about Endometriosis’ return, how excision surgery is the “Golden Standard,” and how robotic surgery is usually the best choice.  I absolutely love my doctor.
The DaVinci robotic surgery system is nifty. The surgeon sits at a console with controls (yes, a grown up gamer system!) and controls teeny-weeny-itty-bitty robotic hands to surgically cut out my Endometriosis lesions and free up scar tissue. He can also suture with the bitty arms. Wanna see something amazing? Watch this video of the robotic system skinning a grape….
Now watch this grape getting stitched back together by robotic-assisted surgery system…
So bear with me over the next few weeks as my emotions go up and down. I may clam up and turn hermit for a while. Or I may suffer from verbal diarrhea and you won’t be able to shut me up. I may sniffle at the slightest thing. Or may just stare out in space. I don’t have any fear of the surgery; it’s the recovery I dread. It’s incredibly painful. And after my surgery, don’t mind me if I cancel things on ya. It’s not that I don’t want to go, it’s that I can’t.
I know many of you reading this suffer from Endometriosis. And many of you know people who do. Continue to spread the word about it…I was 35 years old before I’d even heard of it, yet suffered from it most of my life. If you’ve never heard of it, 1 in 10 women suffer. And it’s incurable: they cut it out, it grows back, they cut it out again, it can grow back again. I made it two years since my first surgery before popping daily pain pills…here’s to hoping for a much longer remission this time around.
All in all, I’m doing okay.  What started out as a tearful morning has turned into a kind of “get it over with already” resolve.  I’m ready.  And will let you know when my date is, once I receive word…

Adhesion Prevention

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You may have heard of adhesions and know what havoc they can cause. Have no idea what I’m talking about?  Read more about adhesions here.

Today an article hit my inbox about adhesion prevention, published in 2015.  You can read the article here:

http://www.mst.ru/publications/eng/oxiplexAP/Choi_A%20Sticky_subject.pdf

I found it very interesting.  Of course, it doesn’t yield any answers, but it does discuss ideas and the need for further research and testing.  AND it gives me something to discuss with my surgeon should I ever need to go back under the knife.

Knowledge is power. ❤

Reader’s Choice : Oophorectomy & Endometriosis

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Plushy ovary available on iheartguts.com

When I was getting ready to get wheeled into the Operating Room back in 2014 for my cystectomy, my Doc tells me that if he gets in there and there’s extensive damage, he may need to perform an oophorectomy (pronounced oh-uh-fuhrek-tuh-mee).  I signed the permission slip/waiver without blinking and off we went.  Luckily, he didn’t have to perform one.  And this turned out to be my Endo diagnostic surgery.  Quite the day.

One of our readers & fellow blogger, SnowDroplets, asked the other day if I could look into the pros & cons of oophorectomies, when to have them, and hormone replacement therapy after the ovary(ies) is removed (especially how it may affect with with Endo).  You know how I love to learn about new things, so here goes!  And thank you, SnowDroplets, for asking this question.  I learned A LOT today.

An oophorectomy is a surgery to remove an ovary.  When one ovary is removed it’s a unilateral oophorectomy; if both ovaries are removed, it’s a bilateral oophorectomy.   And if the Fallopian tubes are removed with the ovaries, it’s called a salpingo-oophorectomy.

“But, Lisa,” you ask, “why would you need one or both ovaries removed?” Good question!  Lots of reasons! And we’ll delve into those reasons today.

Cancer

Ovaries may be removed due to the presence of ovarian cancer…or even just because a woman may have a high risk of developing ovarian or even breast cancer.  If the removal of the ovaries is simply as a precaution, the Fallopian tubes will likely be removed, too, as recent studies have shown that the tubes may also develop Ovarian cancer.

Angelina Jolie underwent a salpingo-oophorectomy because of her already-increased risk of ovarian and breast cancers.  Preventative medicine.

Torsion

Ovarian torsion is when the ovary is twisted so badly that it may obstruct blood flow, causing the ovary to swell, which may cause irreversible damage, abdominal swelling, and pain (it can also twist the Fallopian tube).  Torsion is considered among the Top Five gynecological emergency surgeries. Conservative surgery can unravel and save the twisted ovary; however, many women who suffer from ovarian or tubal torsion opt for oophorectomies instead.

Tumors or Cysts

Benign tumors or cysts on the ovary can simply be cut away (cystectomy); however, sometimes the damage to the tissue may be too extensive or the tumor or cyst may be considered cancerous, and the ovary is removed.

Abscess

An abscess can grow on the ovary or Fallopian tube and it can be very painful.  Imagine a nasty like a nasty little puss-filled zit.  It usually is the result of some vaginal or cervical infection and may go hand-in-hand with Pelvic Inflammatory Disease.  Most ovarian or tubo-ovarian abscesses can be treated with intravenous antibiotics and a hospital stay; however, surgery may need to take place to either 1) drain the abscess, or 2) remove the damaged ovary or tube.

Pelvic Inflammatory Disease

Pelvic Inflammatory Disease is a disease of the pelvis, which can affect the uterus, Fallopian tubes, or ovaries, mostly transmitted through sexual intercourse.  Long-term, untreated Pelvic Inflammatory Disease can cause adhesions to develop, or the infection may cause sepsis, which can be fatal.  PID can also cause abscesses, which may need to be treated with antibiotics, drained, or the infected ovaries removed (as we just learned).

Some studies indicate that women who suffer with chronic PID share an increased risk of developing ovarian cancer.  And, as we learned, some women have oophorectomies to combat their increased risk of cancer.

Some women with PID are advised to get hysterectomies because of the damage the infection has caused to their uterus.  The ovaries may be removed, as well.

Hysterectomy

A hysterectomy is the removal of the uterus, with out without removing the cervix, the Fallopian tubes, and/or the ovaries.  Depending on a woman’s age and medical condition, she may opt to keep her ovaries, or have one, or both, removed during a hysterectomy.  That is a decision that she and her doctor must make together, weighing many factors.

Endometriosis

Some women with severe Endometriosis symptoms may ask for a bilateral oophorectomy, thus ending their periods.  Many also opt to have a hysterectomy.  When I asked my doctor his thoughts on the matter, he said that it will not cure Endometriosis, but it would help with the painful periods…since I wouldn’t have my period anymore.  We’ll cross that hysterectomy bridge if we ever truly have to…but for now I have all my LadyBits.

Studies have indicated that Endometriosis sufferers who undergo a hysterectomy and bilateral oophorectomy have a decreased risk of recurrence.  One study had 29 women undergo a hysterectomy, but left their ovaries – 18 of those women had recurrence of Endo.  That same study had 109 women who had hysterectomies with bilateral oophorectomies, but only 11 of them had recurrence.  A second study showed similar findings with a different bunch of ladies.  And yet another study found that it didn’t make a difference if you kept your ovaries or not with a hysterectomy; that the rate of recurrence was the same.

My personal belief is that a hysterectomy isn’t a cure for Endometriosis.  I know it has helped a lot of women with their symptoms, but I also know a lot of women who continue to suffer years after their hysterectomy.  Excision is the key.  And even then it may recur.

That being said, Endometriosis is believed to be an estrogen-fed disease.  Ovaries produce estrogen, but so do a lot of other functions  in our body (adrenal glands, fatty tissue, and certain foods & supplements mimic estrogen) – cut out the ovaries and our bodies are able to still produce estrogen. Just know that fact…


Surgical Options

If you’ve had surgery for Endometriosis, you’ll be familiar with these choices of surgical techniques for removing the ovaries:

Laparotomy: manual surgical procedure using a large incision across the abdomen; usually a longer recovery time with more risks of complications.  May require a hospital stay.

Laparoscopy: manual surgical procedure using smaller incisions, tiny camera, tiny surgical instruments; usually a faster/easier recovery.  May be outpatient (in and out the same day).

Robotic laparoscopy: same as a laparoscopy, but this time it’s robot-assisted! Queue the Terminator!


Pros & Cons

The biggest pro to an oophorectomy : hopefully you’ll be solving whatever issue caused you to have the procedure done in the first place!

If you have only one ovary removed (and still have your uterus), you’ll continue to have your period and are still able to conceive naturally (well, if your body will allow you to).  Even if you have both ovaries removed and still have your uterus, you can still make babies, but with help from SCIENCE!!  Consider freezing your eggs for future IVF treatments before the bilateral oophorectomy, although some doctors just won’t do it under the theory that freezing eggs isn’t a viable option.

Women who undergo a bilateral oophorectomy are plunged into immediate menopause.  The severe lack of hormones that may also cause depression, mood swings, and sex drive, or even lead to heart disease, osteoporosis, or dementia.

Studies indicate that women under the age of 40 who undergo a bilateral oophorectomy are 7 times more likely to develop heart disease.  They’re also at a higher risk of stroke, Parkinson’s Disease, anxiety, or depression.  The younger the age of the woman at the time of surgery, the greater the risks of developing these conditions.

Another study indicated that a woman’s risk of developing dementia or cognitive impairment is increased by 50% if they undergo an oophorectomy.  Further research is needed, and quickly.

As with all science and studies, though, the data is ever-changing.  Reanalysis of past studies are always being conducted and contradicting prior findings.  These pros & cons may seem dark and scary…but know that not all women suffer from these side effects or increased risks.  Our bodies are our own.  Individual.  Don’t let these scare you from treatment you may need.  Please talk to your doctor.


Hormone Replacement Therapy

To combat some of those cons, some physicians recommend hormone replacement therapy (also called HRT).

Some studies have indicated that women with Endometriosis (and no ovaries) may benefit from a continuous combined HRT (estrogen + progestogen) or the use of Tibolone.  Rather than just straight estrogen, these therapies may not stimulate the recurrence of Endometriosis.

Not only can hormone replacement therapy be detrimental to those with Endometriosis, but it once more increases the chance of cancer in women who take HRT.  Research shows that women over the age of 45 who had undergone a hysterectomy with bilateral oophorectomy and are taking HRT have an increased chance of developing breast cancer.

Some side effects to hormone replacement therapy can be irregular bleeding, nausea, breast tenderness, leg cramps, depression, and irritability.


When do you know if you should consider an oophorectomy?

Well, you’ll likely not know until your physician says something.  He or she may bring it up in a consultation after reviewing your symptoms and imaging studies.  Or it may be, like me, a possibility during a surgical procedure.

If the oo-word does enter into your realm of possibilities, please have long discussions with your doctor about your individual medical history, the risks, and the benefits.  See if only one ovary needs to be removed, or if they must take them both.  If you’re getting a hysterectomy, please know that they don’t always have to remove your ovaries; again, talk to your doctor.

Write down your questions before your appointment.  Bring them with you and ask them all…and write down the answers.  Sometimes it helps to have a friend or loved one accompany you; they may remember some information you didn’t.

And most importantly, breathe.  It will be okay.


Resources:

Baylor, Scott & White Health

Dr. Scott Salisbury

Facing Our Risk of Cancer Empowered

Healthy Women

HERS Foundation

International Business Times – (March 25, 2015; Article) What is Salpingo-Oophorectomy? Angelina Jolie Had Surgery to Reduce Ovarian Cancer Risk, But Procedure Not Recommended for All Women

Lifescript

Mayo Clinic

Modern Medicine Network – (July 1, 2011; Article) Bilateral Oophorectomy: Solving the Risk/Benefit Equation – Choosing Candidates, Monitoring Outcomes

OBGYN.net – (Feb. 17, 2014; Article) Oophorectomy Increases Risk of Osteoporosis and Cardiovascular Disease

Obstetrics & Gynecology – (April 2013; Article) Long-Term Mortality Associated with Oophorectomy Compared with Ovarian Conservation in Nurses’ Health Study

Our Bodies Ourselves

RadioGraphics – (2008; Article) Pearls and Pitfalls in Diagnosis of Ovarian Torsion

RadioGraphics – (2004; Article) Unusual Causes of Tubo-Ovarian Abscess: CT and MR Imaging Findings

Susan G. KomenPost Oophorectomy Estrogen May be Safe for Younger, Not Older, Women

The New England Journal of Medicine – (May 23, 2002; Article) Risk-Reducing Salpingo-Oophorectomy in Women with a BRCA1 or BRCA2 Mutation

US National Library of Medicine – (Oct. 2006; Abstract) Hormone Replacement Therapy in Women with Past History of Endometriosis

US National Library of Medicine – (Jan. 2009; Article) Long-Term Effects of Bilateral Oophorectomy on Brain Aging: Unanswered Questions from the Mayo Clinic Cohort Study of Oophorectomy and Aging

US National Library of Medicine – (Aug. 1996; Abstract) Pelvic Inflammatory Disease and Risk of Ovarian Cancer

US National Library of Medicine – (Oct. 1986; Article) Tubo-Ovarian Abscess: Pathogenesis and Management

Wiley Online Library – (2012; Article) An Update on the Diagnosis and Management of Ovarian Torsion

WiseGeek

Women’s Health Concern

 

~ Again, I am a layman.  I do not hold any college degrees, nor mastery of knowledge.  Please take what I say with a grain of salt.  If curious, do your own research 😉 Validate my writings.  Or challenge them.  And ALWAYS feel free to consult with your physician. Always.  Yours ~ Lisa