The specialist doesn't think I have the kind of polyps that would cause bleeding, because my uterus is too small on an ultrasound and my polyps of yesteryore are more cervical-y ones, even though they were on the uterus side, and they are a different beast.
It was recommended that I have the hysteroscopy, but that I also do an endomyometrial resection to fix my woes. Basically, that means removing my lining and the very top layer of muscle to ensure the "root" of the lining is gone. Doesn't that sound pleasant? The pictures on the website look like a fancy medical vegetable peeler is shaving off the entire inside of my uterus. Thank goodness I'll be out for it.
If I have polyps this will remove them, if I have fibroids this will remove them, and it will prevent both from recurring. It will give me a pretty good chance of being done with my periods forever, without having to lose my whole organ.
Not going to lie, it does sound a bit extreme and barbaric, even though the process is very high tech and designed with safety and best possible outcomes in mind, and it was invented by the same specialist who will do it next Wednesday on me.
Positive: I won't have to mess with my hormones again. I can stop the Depo Provera, I don't have to do anything to meddle in my natural (dysfunctional) hormonal state.
Negative: THAT'S BECAUSE I'M PEELING OFF A PART OF MY BODY.
Positive: Most women manage to avoid hysterectomy as a result of this procedure.
Negative: While it's not removing my organ, it has the same effect because it basically renders my uterus completely nonfunctional, reproductively.
This is the one that is causing me some angst. I am hideously infertile, and my chances of a "miracle" pregnancy are about a hundredth of a percent, between the shitty lining and one tube and flighty ovulation and low sperm values. I am on birth control to try to control my cycles (that part's failing mightily) but also to give me peace of mind, to know that I really can't get pregnant...even though that's fairly obvious after so many high-tech attempts that failed. I don't want to live in shady possibility. I don't want to pee on sticks that will always have one line. I don't want to worry about miscarrying because I have all that scarring or because my body just doesn't know how to do this procreation thing.
But it's one thing to control that aspect and another to destroy it. I will have ZERO chance of getting pregnant, because I am effectively destroying the part of my uterus that makes that possible.
Even though no pregnancy has been reality for a long(ish) time, the FINALITY of removing my lining is sobering. And a bit depressing.
I am conflicted. When discussing options (limited since I don't apparently respond to hormonal stuff unless it's estrogen based, and I can't do that because of the whole prothrombin mutation thing) with the specialist, I started to tear up and basically said, "You know, I am not attached to my uterus as a reproductive entity. I just want this freaking bleeding to stop." Cue slow leak waterworks. I don't want to ruin my reproductive system, but in a way it's already ruined.
My poor uterus. Poked and prodded and reluctant to make nice plush linings, and then scarred up and peeled piecemeal in hysteroscopy "lining refreshings" and endometrial biopsies. Never to carry a baby for more than a couple of weeks. Never to do anything but cause me pain and consternation. But does it deserve to be mutilated? Because that's what this feels like, to an extent. Safely, medically, expertly mutilated, but shaved down to the muscle nonetheless. As the specialist said, "Basically we're going to give you Asherman's on purpose." Well awesome, I'm already at least 1/3 of the way there!
The endomyometrial resection is NOT ablation. There's no burning of the lining. It's literally removed. Another positive to that is that they send all of the material to a pathology lab, so if there's something in there that wasn't visible, it will be found. But a negative is that my uterus is also going to look like Freddy Krueger's face, all the way instead of partially.
The risks are that some of the lining grows back and I get blood trapped in the nooks and crannies of the scarring, with no way to escape. The uterus tries to expel it anyway, and so you get really, really awful cramps until it's removed. That's somewhat rare though, but not super rare -- the rate's 10%.
So I am scheduled for next week, first to go in and get this crazy thing called a laminara inserted into my cervix. It's a matchstick-sized roll of seaweed, that slowly expands overnight and dilates the cervix so that the instruments can get in there. Which is especially necessary because I've never had a vaginal (or any other kind of) birth, so my cervix is all locked up. This is the second time I've heard this in a few weeks. How awesome. Apparently this dilation is super crampy and can be more uncomfortable than recovery from the actual procedure...so you know, something to look forward to.
The good news is that they will sedate me for that even though it only takes 3 minutes (take THAT, doctor who wouldn't get me Valium for the SSG/endometrial biopsy!), and then I'm out for the hysteroscopy/resection. Supposedly recovery is 36-48 hours, and this is on Wednesday, so I guess I'm out the rest of the week. I could do the seaweed thing after school on Tuesday, but Wednesday had to be during the day. Although I guess I could teach in the morning...Hmmm. Maybe I'll do that, since I'm teaching The Outsiders and I really enjoy it...I don't want to miss anything. Oh, wait, I'm being sedated Tuesday afternoon. That might not work out. Shoot.
Anyway, I feel like it's a little extreme, but maybe not. I've run out of options. The specialist said if Depo wasn't working to regulate me, then the IUD that was recommended wouldn't, either. If this doesn't work then I am looking at a subtotal hysterectomy, but I'm not there yet. I did have a daydream a few weeks ago where I was having a hysterectomy and I decided to throw a "Salute the Ute" party beforehand. Although really, what's there to salute? What has my uterus done for me, pretty much since it started menstruating? NOTHING, that's what. It was irregular and heavy with its periods, and then tamed into some submission when I took the pill for 15 years, but I still had horrid cramps that would drop me to the floor and curl me up like a dead bug. And then it didn't do the function it is literally meant to do, even with all the help medically we availed ourselves of. It refused to get or stay pregnant.
So really, what do I owe it? I guess I could salute its effort, meager though it was. Also, thanks, uterus, for at least not trying to kill me through all this. I feel a little less guilty about traumatizing you now.
Although in losing 5% of you to the endomyometrial resection, I am still traumatizing myself. It's hard when faced with writing down and then discussing your extensive gynecological history not to feel the acute and cumulative loss of all the failures and babies that never were. And then to realize that without a shadow of a doubt, nothing will ever grow in my uterus but little invaders. So I guess I don't really feel too bad about removing the part that is fertile ground for everything but babies.
Such a mixed bag. I'm sorry, uterus. But you should kind of be sorry, too.