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Re: Question bout possible endo due to previous tubal liagationFrom: AGS (anonymous@obgyn.net)Wed Apr 2 16:57:00 2003
What you may actually have is adenomyosis, which is endometriosis infiltrating the muscular wall of the uterus. It is quite common in those of us who had tubal ligations and prior endo. It is difficult to diagnose with "normal" means (such as MRI or ultrasound -- or biopsy) and only truly curable with hysterectomy. I have to disagree with the writer who said that endo is not found on the tubes normally (don't have the exact quote in front of me). My endo was found to be wrapped around the tubes, tying one of them into a large cyst on the ovary. It is true that a hysterectomy will not "cure" endo, even with estrogen "starvation" afterward. It all depends upon where your implants were located, and what attempts were made during the surgery to eliminate any implants that were reachable safely. However, with adeno, the story is a bit different. Even the most rapidly anti-hysterectomy books and articles all express that in cases of severe adenomyosis, a hyst is the only true solution. This is not going to impact any peritoneal endo, of course, unless it too is dealt with at the time of surgery. But it does cure that heavy bleeding and clot-passing (I used to have actual contractions, similar to childbirth, with my periods). Reversing your tubal ligation (an unpleasant procedure) will not necessarily change the endometrial implants already into the uterine wall, but may restore fertility if that is what you and your partner want. No guarantees, of course, and no guarantees, either, that the endo/adeno doesn't come roaring right back as soon as a new pregnancy comes to term. An ultrasound-assisted hysteroscopy may be a way to diagnose adeno, and if you can at least have some sort of diagnostic look to rule out fibroids or other causes of your woes, maybe you will have more of an answer and a solution will present itself. I did have to have a hyst, thanks to a giant endometrioma and elevated CA-125. All of my organs were fused together with adhesions from prior endo, so the uterus had to go too (and, at 46, with a low blood count, I was ready!). In my case, although there is a touch of endo pain back, I can honestly say I am so much better off than I was for the years preceding the surgery. Granted, I had no desire for another child -- I had nearly died from an ectopic pregnancy and then had such severe pre-eclampsia and HELLP syndrome with my dd at the age of 40, that it was made very clear to me that to become pregnant again would be to risk my life once more -- and I was not in favor. At that time, I did have a tubal ligation...and it was probably that procedure that triggered the severe adenomyosis that was found at the time of my hysterectomy. Do a LOT of exploring for information, and ask for whatever diagnostic testing you might need to sort this out. Good luck, and I hope you find an answer to your pain soon! Audrey
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