Hysterectomy
Hello Doctor, I would like to ask: I am 43 years old, have two children, and do not wish to become pregnant again.
I have adenomyosis with a size of about 8 cm, experiencing severe dysmenorrhea, and passing many blood clots.
My hemoglobin level is 8; does this indicate anemia? Blood tests show a tumor marker level of 57; is this considered too high? The clinic doctor suggested a hysterectomy; are there any other options available? Thank you for your response.
Anne, 40~49 year old female. Ask Date: 2016/10/05
Dr. Lü Lizheng reply Obstetrics and Gynecology
The hemoglobin level of 8 is considered severe anemia.
If you prefer to avoid surgery, there is a device similar to an intrauterine contraceptive device called Mirena, which you can find more information about online.
Its size, shape, and method of insertion are similar to that of a standard contraceptive device; however, once placed in the uterus, it releases progestin, which can reduce menstrual blood flow and help improve anemia.
Since you have severe anemia, your health insurance will cover the cost of Mirena.
Dr.
Lu from Taoyuan Hospital.
Reply Date: 2016/10/05
More Info
Understanding your condition and the options available for treatment is crucial, especially when dealing with uterine adenomyosis and associated symptoms like severe menstrual pain and anemia. Based on the information you've provided, let's break down your situation and discuss the potential treatment options.
Understanding Your Condition
1. Adenomyosis: This is a condition where the inner lining of the uterus (the endometrium) grows into the muscular wall of the uterus (the myometrium). This can lead to heavy menstrual bleeding, severe cramping, and pain during menstruation. Given that you have a significant adenomyosis with a mass size of approximately 8 cm, it is understandable that you are experiencing severe symptoms.
2. Anemia: You mentioned having a hemoglobin level of 8 g/dL, which is indeed indicative of anemia. Normal hemoglobin levels typically range from 12 to 16 g/dL for women. Anemia can result from chronic blood loss due to heavy menstrual bleeding, which is common in cases of adenomyosis. Symptoms of anemia can include fatigue, weakness, and shortness of breath, which can significantly impact your quality of life.
3. Tumor Marker: The tumor marker level of 57 you mentioned could refer to CA-125, which is often elevated in conditions like endometriosis, adenomyosis, and certain cancers. While elevated levels can be concerning, they are not definitive for cancer and can be influenced by various factors, including benign conditions.
Treatment Options
Given your situation, the recommendation for a hysterectomy (surgical removal of the uterus) is a common approach, especially since you have completed your family and are experiencing significant symptoms. Here are some options to consider:
1. Hysterectomy: This is often considered the definitive treatment for adenomyosis, especially when symptoms are severe and other treatments have failed. It can provide relief from pain and heavy bleeding. Since you do not wish to become pregnant again, this option may be suitable for you.
2. Medications:
- Hormonal Treatments: Birth control pills, hormonal IUDs, or other hormonal therapies can help manage symptoms by regulating or stopping menstruation, which may reduce bleeding and pain.
- GnRH Agonists: These medications can help shrink adenomyosis by inducing a temporary menopause-like state, reducing estrogen levels. However, they can have side effects similar to menopause, including hot flashes and bone density loss.
- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Over-the-counter pain relievers like ibuprofen can help manage pain and reduce bleeding.
3. Uterine Artery Embolization (UAE): This is a minimally invasive procedure that blocks blood flow to the adenomyosis, potentially reducing its size and alleviating symptoms. It is an option for women who wish to preserve their uterus.
4. Lifestyle and Dietary Changes: While these may not directly treat adenomyosis, maintaining a healthy diet, managing stress, and regular exercise can improve overall well-being and may help with symptom management.
5. Second Opinion: Given the complexity of your case and the potential for significant surgical intervention, seeking a second opinion from another gynecologist or a specialist in reproductive health may provide additional insights or alternative treatment options.
Conclusion
In summary, your symptoms of severe pain and anemia due to adenomyosis are significant and warrant a thorough discussion with your healthcare provider about the best treatment options. While a hysterectomy is a common and effective solution, there are other treatments available that may help manage your symptoms. It is essential to weigh the benefits and risks of each option and consider your personal preferences and lifestyle. Always feel empowered to ask questions and seek clarity on your treatment plan. Your health and comfort are paramount.
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