Pelvic Adhesions

Adhesions are really common after pelvic surgery but they don't necessarily have to cause you problems or impact your fertility. Some doctors will perform an HSG (hysterosalpingogram) a few months after a myo for women wanting to try to conceive but mine thought we should just see what happened for a few cycle on our own. We were able to conceive and have implantation in my uterus so no problems there for me.

Adhesions & Pelvic Pain
What Women Need To Know About Prevention and Treatment

Pelvic Adhesions

Pelvic Adhesions - Their Role in Infertility and How to Prevent Them
PDF brochure from RESOLVE

Reduction of Adhesions

Asherman's Syndrome

Pelvic Abnormalities: Pelvic Adhesions (photos)

International Adhesions Society
(they are also conducting a survey of patients regarding informed
consent forms with regards to mention of adhesions)

Adhesion Related Disorders

Chronic Pelvic Pain
(includes some info about how to minimize adhesion formation)

Pelvic Adhesions
(fairly clinical and scientific information about adhesion formation and prevention in a Powerpoint presentation)

Pelvic Pain Needing Treatment

Wound Healing and Scarring - Sutures

Prospective clinical trial of SprayGel as a barrier to adhesion formation: an interim analysis.
(there are other media that can be used to prevent adhesion formation as well, if you are interested continue searching on these terms:
"pelvic adhesions barrier agents")

To someone who is wondering whether or not to have a myo

Lots of women get pg with fibroids in place, it is an elective procedure however so in part you get to decide when it is right for you. Some considerations I've noted about when it is a good time to have fibroid surgery:

• you feel like you have exhausted all other possible treatment options
  
• you are feeling pain and discomfort, even some of the time. This can include back pain, pelvic pain, leg pain, etc.
  
• you are having bleeding problems (really heavy periods, or periods that don't seem to stop -- this can lead to problems with anemia which can impair fertility and put you at risk for other health problems such as clotting)
  
• you have had trouble conceiving or have had miscarriage/s
  
• you are wanting to try hormonal fertility treatments and your fibroids are already a good size
  
• you are having difficulty urinating or are having to pee all the time or you are developing urinary tract infections
  
• you can't stand the thought of having fibroids inside of you and want to get rid of them
  
• you fibroids are compromising the interior space of the uterus
  

Since you are already dealing with TTC with one tube I can see that it doesn't feel like a straight shot decision for you at all. There is a risk of adhesions after any abdominal surgery, but whether or not these will cause problems is another question.

The surgery is a big deal in that it can be quite invasive and most of us haven't had that much physical trauma before. It is also one that you will recover from quickly. An abdominal myo is very similar to a c-section and loads of women have those operations every day.

Have you read What Your Doctor May Not Tell You About Fibroids yet? It is a super book that really helped me to feel empowered about my body and my fibroids. It describes in detail about the various procedure options and includes info about fertility success rates post-op.

So, over the past couple of years I noted that a couple times a year I was in a lot of pain around ovulation. At first I thought it was my fibroid causing it, actually it was partially due to this pain that my fibroid was diagnosed. It it focalized on the right side and if I press on the area it feels worse. In the past I've noted that ibuprofen wouldn't help the pain at all.

When I had u/s to check it out after the fact and always they have seen that I have ovulated on the opposite side (which was opposite from my fibroid as well) and that there was some fluid in my cul de sac consistent with ovulation, but nothing else.

Last night I was in so much pain that I couldn't sleep and I finally broke down and took some percocet I had left over from my surgery in November. I fell asleep around 3am. This morning I still have dull pain, but it is a lot less intense then last night. I put a call into the REs office for advisement, it seems like I should at least ask since it was painful enough to keep me up.

Part of me wonders if it was an ovarian cyst rupturing and not just a regular follicle. I didn't have such a great ovulation last cycle -- hardly any EWCM, and dry generally -- I wonder if I didn't actually ovulate or else just had a cyst. Still, the u/s when I've had this pain before showed just a single ruptured follicle on the other side.

Other Causes of Pelvic Pain Besides Fibroid Degeneration

A common complain of women with fibroids is abdominal Pain. This pelvic pain can come from from fibroid degeneration, when the fibroid outgrows its blood supply and dies, but that's fairly rare and there are other possible causes of pelvic pain including (an incomplete list):

Appendicitis

Constipation

Adenomyosis -- endometrial tissue grows into the wall of the uterus and can form pockets that bleed each month

Endometriosis -- endometrial tissue grows on other pelvic structures outside of the interior of the uterus and swell and bleed with the hormones produced as a part of your menstrual cycle

Ovarian Cysts -- mature follicle that does not rupture and can grow pretty large, if they rupture they can be quite painful. Some cysts are normal and most of the time they are just reabsorbed. There are other forms of cyst which require medical intervention such as dermoid cysts, endometrioma, and sometimes chocolate cysts.

Ovulation -- mittelshmerz is pain that is felt around ovulation, perhaps from the release of the egg or perhaps from irritation from fluid released from the follicle

Pelvic Inflammatory Disease -- bacterial vaginosis, gonorrhea, and chlamidia can all cause infections in the pelvic cavity

Pelvic Adhesions from prior abdominal surgery or infection -- a d&c or IUD can sometime result in an infection as well

Fibroid Pressing on blood vessels or other abdominal structure

Cystitis -- bladder infection

Kidney infection

There is also a diagnosis in traditional chinese medicine/acupuncture called blood stagnation which can cause pelvic pain and is generally associated with gynecological conditions such as fibroids. Liver stagnation is usually part of the diagnosis as well, the liver being the major detox organ in the body and one that is also associated with emotion and grief in chinese medicine. I've found acupuncture to be helpful in managing my pelvic pain, as well as breathing exercises that promote movement in the abdomen. Here's a link about blood stagnation that you might find useful.

All About Blood Stagnation
http://www.acupuncture.com/Herbology/bloodstag.htm

If your doctor checks you out and you are still having problems then
you might consider the blood stagnation possibility.

Uterine Cramps and Pelvic Pain

Fibroids cause pelvic pain, here's what I know about uterine cramps and their physiology from a variety of sources...

From an RE...
Prostaglandins cause uterine contractions. Ibuprofen can be taken regularly to reduce prostaglandin formation but won't help if contractions and pain are present since the prostaglandins are already causing problems. If you are trying to conceive though you shouldn't be taking ibuprofen or other NSAIDs as they can impair ovulation and possibly implantation (there's no winning is there?).

From naturopathy...
Arachidonic acid is involved in the production of prostaglandins and is found in animal products. Reduce animal products consumption such as meat and dairy products, increase essential fatty acid consumption (such as flax seed oil). As ibuprofen interferes with the liver it is not advised.

From acupuncture...
My acupuncturist says that the weird crampy fullness in my belly is related to blood flow not going the right direction. Acupuncture can stimulate blood flow to go in the correct direction.

From my personal experience...
Ibuprofen won't stop cramps from fibroids. Hot water bottles do help with the pain and discomfort. Food and gas passing through your colon that is having to negotiate around the fibroid can also feel like cramps or cause uterine area discomfort -- as can a full bladder. Acupuncture can help with pain. I just had an amazing treatment this morning BTW, and I can't feel my fibroid at all right now and I feel really energized, almost lightheaded and lighthearted. My practitioner said that my blood was swirling around the fibroid and that instead of flowing in the right direction it was coming back around where it wasn't supposed to.

From the web...

There are links between progesterone and ararchidonic acid but I haven't totally made sense of them yet (I'll continue to research and see if I can make more sense of it for us).

I do know that progesterone stops contractions of smooth muscle (see: http://www.rnceus.com/hormone/progest.html and http://arbl.cvmbs.colostate.edu/hbooks/pathphys/reprod/placenta/endocr
ine.html)

Arachidonic acid is also linked to tumor formation as well (scary but here we all are with our tumors):

The Role of Essential Fatty Acids in Cancer
http://www.positivehealth.com/permit/Articles/Cancer/good6.htm

Skin carcinogenesis, inflammation, arachidonic acid metabolism, cancer prevention
Susan M. Fischer, Ph.D.
http://sciencepark.mdanderson.org/documents/sfischer/fischer.html
(note that they are interested in applying this research on skin tumors to prostate cancer)

This page has links to a bunch of studies that are available through Amazon.com about arachidonic acid:
http://www.health.xq23.com/arthritis/Arachidonic_acid.html

Dermoid Cyst for my Sister

My sister's MRI last week indicated that her right ovary is twice the normal size and that she has a dermoid cyst. This was the first MRI she has had done. Her doctor didn't do an MRI prior to her abdominal myomectomy last Spring where they removed 6 fibroids totally the volume of a grapefruit.

She continued to have pelvic pain after the surgery and didn't know what was up. The doctor told her she would feel better after the myomectomy and that wasn't the case. She started having ovarian pain when she was in high school. The dermoid cyst was probably the thing causing her pain and not her fibroids.

She will have to get more information before deciding on when to schedule the surgery.

Dermoid Cyst Facts:
* Dermoid cysts contain cells that are fetal in origin. They can contain hair, teeth, skin, sebaceous oil, and even eye tissue (I don't know what that means). One website said that it was from a self-activated egg that was trying to start growing in the absence of fertilization but I'm not sure if that is true or not. Otherwise it might just be left over from when you were a developing embryo.
* Ovaries are fairly adaptive and even a portion of tissue remaining will continue to function
* Sometimes the dermoid cyst will take over the ovarian tissue, this sounds rare
* There have been cases where dermoid cysts have turned cancerous, but it is a small percentage of the time.
* The medical term for a dermoid cyst of the ovary is a ovarian teratoma.
* The name of the procedure that doctors do to try to save the ovary is called ovarian cystectomy.

Related Links:

Will dermoid removal affect getting pregnant?

Dermoid Cyst

What are ovarian cysts?

Ovarian cysts ~ treatment
"If you are under forty, s/he is likely to recommend leaving the ovary intact, particularly if you want children. Even if the ovary is badly damaged by the cyst and only a small part remains, that part can still go on working normally."

Ovarian Cysts

Laparoscopic surgery of dermoid cysts--intraoperative spillage and complications.

LAPAROSCOPIC OVARIAN CYSTECTOMY: SELECTION OF PATIENTS AND CONSEQUENCES OF RUPTURE OF OVARIAN MALIGNANCY

Ovarian Teratomas: Tumor Types and Imaging Characteristics

Teratoma, Cystic