5:32 pm - 07/18/2018

fibroids and PCOS

Update on my last entry:

I had my ultra sound today to find out if there was an underlying issue to my early break through bleeding and just got my results back(that was fast!)

They found a fibroid on one of my ovaries(which they think is the cause of the bleeding) and also found evidence of PCOS. Ugh.

The doctor said we can either see if I am an candidate for an ablation or try new birth control to get better control of the bleeding. I am not sure which I want. I want the break through bleeding to stop, and I have no idea of an IUD would help that or if just freezing/removing the fibroid would stop it. Would having both done ultimately stop it?

Then I read that PCOS could cause infertility? At some point(hopefully in the next few years) I do want to have kids. I also read that diet helps, which I kind of thought. I have gained weight in the last year or so, so I wonder if that has something to do with it.

This is all new to me. What do you all think?
archangelbeth 19th-Jul-2018 04:08 am (UTC)
Most of the stuff I'm finding on fibroids is for uterine ones. (I didn't know ovaries could have them!) At least one of the things I found searching "IUDs and fibroids" at duckduckgo suggests that estrogen tends to make uterine fibroids (dunno about ovarian ones!) grow, while progesterone-only hormonal contraceptives are more likely to have them chill out -- so in that respect, if your uterus is large enough for a Skyla or Mirena, it might indeed help.

Getting rid of the fibroid should make the bleeding stop, but of course there's always a risk another might form. If it's on the ovary itself, then that might be a threat to fertility from that ovary, though. I dunno if leaving it there would be fine, either... Definitely something to ask an obgyn who knows their stuff!

PCOS both encourages and is exacerbated by weight gain, so if you can lose weight safely and in a sustainable way, then that wouldn't be a bad idea -- mostly because of the whole "PCOS encourages weight gain, and then weight gain makes the PCOS mess up your metabolism more, so it's even easier to gain weight (plus the other issues PCOS can cause)" circle of PCOS-messing-with-your-metabolism... (Obviously, you don't want to trigger an eating disorder or try to diet in a way that will crush your metabolism in the long run!)

https://www.mayoclinic.org/diseases-conditions/pcos/diagnosis-treatment/drc-20353443 (warning for colorful cutaway medical pictures -- one of using fingers to palpate the uterus and vaginal area, and one of an ultrasound wand being inserted vaginally) has some stuff about things that can be tried. Adding progesterone-only contraceptives shows up as a useful thing for managing the symptoms. (There are some other tests that they recommend in that page, too.)

So. It looks like an IUD might help, but depending on the size and positioning, a fibroid might have annoying bleeding anyway (citation: anecdotal from IUD-Divas.livejournal.com). An ablation, you'd want to talk about how that might affect future fertility. (An IUD just gets yanked and unless you've got one of the very rare complications with embedding, your fertility should revert to normal within the usual timeframe for "came off hormonal birth control.") It is possible that both might be useful, if estrogen is promoting the growth of fibroids.

...I'm a little vegged today, so poke me (over on my Dreamwidth account, on whatever post is most recent or amusing, if I forget to check in here!) for more details on stuff?
actorgrl04 19th-Jul-2018 06:19 pm (UTC)
Ah, meant to say uterus not ovaries! The fibroid is on my uterus. I am emailing my doctor with questions I have, but a lot of them go to a gynecologist, so we'll see what they say. She did say it all depends what the size is and where it is located to determine if I should get the surgery or not. I'm thinking switching to an IUD might help as well, but any type of surgery kind of scares me, so I don't know.

I definitely will try to eat healthier and work out more(schedules are always so busy!) I gained more weight than I thought, so no wonder I've been having issues.

Thanks for the advice!!
archangelbeth 20th-Jul-2018 04:34 am (UTC)
If the fibroid doesn't interfere with the IUD's placement, then that might indeed help! Though some people, anecdotally on IUD-Divas, seem to find that fibroids can rub against IUDs and cause breakthrough bleeding that way. (Fibroids are a nuisance, is what I'm gathering.) It probably depends on how big the thing is.

Anyway, good luck with the scheduling! (I'm doing well to get an hour of walking, barely enough to start sweating, but that does seem to've been helping a little with my lizard metabolism, so yay...)

Also, total fistbump of solidarity on not wanting surgery. It'd probably be all through the cervix, but ow, and also another scheduling PITA.
pklemica 20th-Jul-2018 05:02 am (UTC)
Fibroids were the cause of my increasingly heavy breakthrough bleeding. If you only have one, my understanding from my doctor is that statistically you are not any more likely than someone who has had none to grow another. I had mine removed with minimally invasive surgery and that did fix the bleeding issue entirely. I did eventually grow many more and have a hysterectomy, as I wasn't going to have any kids; docs would have kept up removal instead if there was any hint that I might to use my uterus for anything down the line.

Before the second surgery, we had success with norethindrone to control the bleeding; I went from significant overgrowth of uterine lining a few weeks before the surgery to basically blank walls the day of. Now, we were using this as an emergency measure given the volume of bleeding I was experiencing and stacked on top of my usual HBC (xulane)... that was an awful lot of hormones, but worth it with what I was going through. Did lead to some permanent localized skin discoloration, definitely amp up your sun protection to the max if you are going on a high dose of hormones. But it sounded like they would have tried the norethindrone even without other HBC. In my case an IUD wasn't an option as the fibroids were in the way of getting it in, but it was definitely something we discussed before seeing the more detailed scans.

Ablation would definitely stop the bleeding, but I don't think they tend to go that route if you want to still get pregnant later?
actorgrl04 20th-Jul-2018 07:52 pm (UTC)
I wasn't told that its not recommended if you want to get pregnant later. My doctor knows that's what I am planning on doing a few years down the line, so not sure why she would suggest it. From what I've read, it's more just freezing/shriking the fibroid. Unfortunately, I can't get into the gynecologist until September 4th, so I have to wait until then to get more questions answered.
pklemica 21st-Jul-2018 04:52 am (UTC)
Ah, I think you maybe mean embolization?
Hm, ok, more careful googling (ablation fibroids -endometrial) reveals a relatively new technique called radiofrequency ablation, which is basically a higher-tech and even less-invasive approach with different physical mechanisms but ultimately similar goals/effects to uterine fibroid embolization. In both cases, you are targeting just the cells of the fibroid, to kill them off while leaving healthy tissue around it alone; in UFE this is achieved by blocking the fibroid's bloodsupply, while with RFA you use converging soundwaves to fry only a small specific point (within the fibroid) at a time, leaving points outside that tight area of convergence unharmed.

Endometrial ablation, on the other hand, is a longstanding technique used to treat this symptom of fibroids as well as many other conditions that cause disordered uterine bleeding. There, they either burn or freeze off the endometrium, which will certainly stop the bleeding as there's no more lining to slough off each month, but also makes the uterus an incredibly inhospitable environment for an embryo and also makes it dangerous to carry to term if you do still manage to get pregnant.

It sounds like your doctor means this newer procedure, of which I was not previously aware, but where endometrial ablation is such a common treatment for various uterine bleeding disorders I'd definitely recommend specifying which ablative procedure you are talking about when interacting with any of your doctors about this!!!
actorgrl04 21st-Jul-2018 02:54 pm (UTC)
I asked my doctor if this would cause infirtility and she said it doesn't. It's more localized procedure, so it sounds like that new one. She said this is the procedure bmost gynocologest recommend.
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