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Posted

Hello ladies in Phuket,

I would really appreciate some information from (especially) Phuket residents. My wife has/is going thru a rough time and needs help with decisions.

Background:

Age - 36. History of Chocalate cysts. Operated about 5 years ago to clean. Cut across lower stomach similar to a Ceasarian. History of non-regular periods and very bad moods/anger during periods.

Recent...last 2 weeks:

Lots of pain in the abdomen. Especially the lower right side.

Thought its time to check the Choc cyst condition.

Gyno did ultrasound and found a cyst in vagina. No big issue with this. Pain persisted. So followed up with a Laparoscopy. During this, the surgeon cleaned/cutoff most of the growths etc. He said about 10% remains but cannot remove this due to adhesion between the fallopian and the large bowel.

Visited the Dr. yesterday to remove stitches of Laparoscopy/and pinpoint surery, etc and consultation on next actions.

Wife's wishes: Operate again, now. Remove the adhesion completely and separate the 2 organs.

Dr's advice: No. Use hormone injection. Give it 6 months, then next action according to him is Hysterectomy.

Wife: Does not want hormone inj, because the growth will continue any way and the condition will be similar. Does not want hysterectomy due to obvious side effects such as rapid aging, bad moods, etc etc. Wants to consult another Dr. I fully agree with her rationale.

So far , recent actions sone in Phuket International. Lost confidence. Now want a second opinion. Bangkok Hospital or Mission Hosp. Anyone with these experiences and recom of a good Dr/Surgeon at these hospitals please?

Other relevant: Insurance expires at end on June. She wants to complete op. before then. Happy to renew the policy (although we were a bit surprised with this last In-patient payment, where we paid 40% of the total). Any advice re. going with another Ins. provider under current situation is also welcome.

All advice is most appreciated.

Posted

Your wife's condition is called endometriosis. In addition, she appears to suffer from Premenstrual Dysphoric Disorder (PMDD, previously called PMS), which accounts for the anger and mood swings around her period.

Surgery to deal with adhesions is very dicey and often ends up making matters worse. The treatment being recommended by the doctor (hormones) is in fact standard approach for management of confirmed endometriosis and should always be tried prior to hysterectomy. I do not know why your wife thinks "the growth will continue any way and the condition will be similar" if she follows the recommended approach. The whole point of hormone therapy for endometriosis is that it will cause the lesions to stop growing and eventually disappear (although they may recur after treatment stops)

In short, what she is insisting on is a very bad idea and it is unlikely a reputable doctor will go along with it.

Now where she does have a special issue is with the type of hormone therapy to be given. It is quite possible that the hormones typically used would worsen her PMDD and she might do better to take natural (bioidentical) progesterone. I doubt you can find anyone familiar with that in Phuket, though, would be hard even in Bangkok. There is also a scarcity of bio-identical progesterone preparations in Thailand, the only one I know of currently is called Utrogestan. It is sold over the counter and, endometriosis aside, would be very helpful for her PMDD. You'll need to go to a large pharmacy and they may have to order it in for you, but it does not need prescription.

I understand that the Vita-Life institute affiliated with Bumrungrad will soon start compounding bioidentical hormone preparations but I think not yet.

What I suggest you do is as follows:

- read up via the Web on (1) PMDD and its treatment with progesterone AND (2) treatment of endometriosis with natural progesterone

- contact the following hospitals and ask them specifically if they can recommend a gynecologist with experience using bio-identical progesterone in the treatment of endometriosis: Samitivej, Bumrungrad, BNH and Bangkok Hosp (Bangkok... there is extremely little hope of finding this in Phuket). And if you can find such a doctor, fly up there for a consultation (after the current crisis eases of course). In the case of Bumrungrad instead of emailing them try a PM to TV member Scott as their email responses in my experience are often far off the mark, the staff who respond to them have no medical background.

Do not persist in trying to get someone to operate on the adhesions. Very bad idea and could lead to serious surgical complications.

If you cannot locate a gyn experienced in use of bio-identical progesterone (not progestins!) - and you indeed may not -- you could consider self-treatment with Utrogestan. For PMDD, the protocol would be to take 1 tablet nightly starting from about the 10th to the last day of her cycle, determine either by onset of menstruation or the number of days that would normally lead to a new cycle. For some women this is 25, for some 28, for some 30. Exact timing depends on how long her usual cycle is and may need some trial and error to get this right. If menstruation occurs before then, stop the progesterone and treat that as start of a new cycle,

For endometriosis, the regiment is as above but starting earlier i.e. from the 6th day of menstrual cycle. This will also treat the PMDD. It will take a few months but improvement should be considerable. Would need to remain on this long term but as it is a substance natural to the female body (and present in much larger quantities during pregnancy) it is not known to have any seriosu suide effects. Nonetheless to be on safe side get yearly check-up inc pap (thin prep) and breast exam and be sure to tell the doc she takes progesterone.

The progesterone will greatly relieve the the anger/mood wings during menstruation and in general help her feel calmer and more balanced. If progesterone alone does not do the trick, addition of a low dose SSRI like sertraline is effective, should first ascertain that her liver function is normal and I'd suggest starting at only 25 mg (half of a scored tab).

Note I suggest Utrogestan only because it is AFAIK the only bio-identical progesterone currently available in Thailand. Ideally one would use a progesterone cream or gel rather than oral form. You can buy progesterone creams online, but quality is an issue.

  • 6 months later...
Posted

Your wife's condition is called endometriosis. In addition, she appears to suffer from Premenstrual Dysphoric Disorder (PMDD, previously called PMS), which accounts for the anger and mood swings around her period.

Surgery to deal with adhesions is very dicey and often ends up making matters worse. The treatment being recommended by the doctor (hormones) is in fact standard approach for management of confirmed endometriosis and should always be tried prior to hysterectomy. I do not know why your wife thinks "the growth will continue any way and the condition will be similar" if she follows the recommended approach. The whole point of hormone therapy for endometriosis is that it will cause the lesions to stop growing and eventually disappear (although they may recur after treatment stops)

In short, what she is insisting on is a very bad idea and it is unlikely a reputable doctor will go along with it.

Now where she does have a special issue is with the type of hormone therapy to be given. It is quite possible that the hormones typically used would worsen her PMDD and she might do better to take natural (bioidentical) progesterone. I doubt you can find anyone familiar with that in Phuket, though, would be hard even in Bangkok. There is also a scarcity of bio-identical progesterone preparations in Thailand, the only one I know of currently is called Utrogestan. It is sold over the counter and, endometriosis aside, would be very helpful for her PMDD. You'll need to go to a large pharmacy and they may have to order it in for you, but it does not need prescription.

I understand that the Vita-Life institute affiliated with Bumrungrad will soon start compounding bioidentical hormone preparations but I think not yet.

What I suggest you do is as follows:

- read up via the Web on (1) PMDD and its treatment with progesterone AND (2) treatment of endometriosis with natural progesterone

- contact the following hospitals and ask them specifically if they can recommend a gynecologist with experience using bio-identical progesterone in the treatment of endometriosis: Samitivej, Bumrungrad, BNH and Bangkok Hosp (Bangkok... there is extremely little hope of finding this in Phuket). And if you can find such a doctor, fly up there for a consultation (after the current crisis eases of course). In the case of Bumrungrad instead of emailing them try a PM to TV member Scott as their email responses in my experience are often far off the mark, the staff who respond to them have no medical background.

Do not persist in trying to get someone to operate on the adhesions. Very bad idea and could lead to serious surgical complications.

If you cannot locate a gyn experienced in use of bio-identical progesterone (not progestins!) - and you indeed may not -- you could consider self-treatment with Utrogestan. For PMDD, the protocol would be to take 1 tablet nightly starting from about the 10th to the last day of her cycle, determine either by onset of menstruation or the number of days that would normally lead to a new cycle. For some women this is 25, for some 28, for some 30. Exact timing depends on how long her usual cycle is and may need some trial and error to get this right. If menstruation occurs before then, stop the progesterone and treat that as start of a new cycle,

For endometriosis, the regiment is as above but starting earlier i.e. from the 6th day of menstrual cycle. This will also treat the PMDD. It will take a few months but improvement should be considerable. Would need to remain on this long term but as it is a substance natural to the female body (and present in much larger quantities during pregnancy) it is not known to have any seriosu suide effects. Nonetheless to be on safe side get yearly check-up inc pap (thin prep) and breast exam and be sure to tell the doc she takes progesterone.

The progesterone will greatly relieve the the anger/mood wings during menstruation and in general help her feel calmer and more balanced. If progesterone alone does not do the trick, addition of a low dose SSRI like sertraline is effective, should first ascertain that her liver function is normal and I'd suggest starting at only 25 mg (half of a scored tab).

Note I suggest Utrogestan only because it is AFAIK the only bio-identical progesterone currently available in Thailand. Ideally one would use a progesterone cream or gel rather than oral form. You can buy progesterone creams online, but quality is an issue.

Hi...

also me need a help.

I'm 43 years woman old, from Italy.

And just one week ago Phuket International Hospital and also Bangkok Hospital they told me I have the big uterus fibroid about 6 or 7 cm.

Both of them told me I have to do surgery and hysterectomy too.Mean keep the ovarian but take out uterus.

I'm scared about idea to do so big surgery. I have some symptoms like a abdominal pain.

Anyway in last week I read all possible about some kind of Therapy.I read very well about natural progesterone cream,but I can not find it here in Phuket.I

asked in many pharmacy but no one can order it.everybody told me in phuket can not.................

May be someone is in the same situation and can give me more information and more directions.

Thanks a lot

Posted

Hi...

also me need a help.

I'm 43 years woman old, from Italy.

And just one week ago Phuket International Hospital and also Bangkok Hospital they told me I have the big uterus fibroid about 6 or 7 cm.

Both of them told me I have to do surgery and hysterectomy too.Mean keep the ovarian but take out uterus.

I'm scared about idea to do so big surgery. I have some symptoms like a abdominal pain.

Anyway in last week I read all possible about some kind of Therapy.I read very well about natural progesterone cream,but I can not find it here in Phuket.I

asked in many pharmacy but no one can order it.everybody told me in phuket can not.................

May be someone is in the same situation and can give me more information and more directions.

Thanks a lot

Uterine fibroids are growths within the wall of the uterus made up of muscle and fibrous tissue; they can remain inside the wall of the uterus or grow on the outside. Those within the wall of the uterus tend to give rise to earlier symptoms than those on the outside simply because those on the outside have more room to grow. Those on the inside usually presents with overly heavy periods and pain etc.

No hormonal treatment or creams will help; I am afraid the only option here would be surgery either just to remove the polyp if it is on the outside but at 43, a hysterectomy with preservation of the ovaries should be considered as an option.

See a reliable Gynaecologist that you feel comfortable with for an opinion.

Posted

With fibroids of this size and symptomatic then indeed surgery may be necessary but as FBN mentioned there are 2 options: removal of the uterus (hysterectomy) or removal only of the fibroids, leaving the uterus intact, this is called a myomectomy. It is often done in the case of women still planning on having children. In women who are not, doctors tend to recommend hysterectomy bit the choice is yours.

One problem with myomectomy is that the fibroids may later recur.

By all means ask about the pros and con s of myometecmy vs hysterectomy and also get at least 1 second opinion.

Posted

With fibroids of this size and symptomatic then indeed surgery may be necessary but as FBN mentioned there are 2 options: removal of the uterus (hysterectomy) or removal only of the fibroids, leaving the uterus intact, this is called a myomectomy. It is often done in the case of women still planning on having children. In women who are not, doctors tend to recommend hysterectomy bit the choice is yours.

One problem with myomectomy is that the fibroids may later recur.

By all means ask about the pros and con s of myometecmy vs hysterectomy and also get at least 1 second opinion.

thanks a lot for your help....

Yes of course I will have a second opinion and then i will make a final decision. May be someone else made the same surgery here in Phuket and can be great idea - know her experience.

  • 1 year later...
Posted (edited)

Fgis

The link you provide relates to a VERY SMALL study involving only 40 patients in total. The study was undertaken to

1) Identify any pain control advantage.

2) Determine if time to discharge from hospital and total recovery time was shortened.

A more complete overview of the advantages/disadvantages of Laparoscopic(Laser) Myomectomy can be found here--- http://guidance.nice.org.uk/IPG23

A summery is found here ----- http://www.nice.org....31016/31016.pdf

The Mayo Clinic provides a overview of treatment options here ---http://www.mayoclini...ments-and-drugs

You should note that all treatment options may not be available in Thailand.

Edited by jrtmedic
Posted

Also note that myomectomy is only one of several options for the management of fibroids (which are not, BTW, what this thread concerns).

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