Hello Jack
Thanks for writing to us with your health concern.
I have gone through the report attached.
Your fiance is having multiple uterine fibroids, in addition to that adenomyosis and endometriosis.
It is really a very complicated problem.
PLease do mention her age to me - that is very important.
Also, you have mentioned that she is against telescope insertion for cultural reasons.
Even for Acessa treatment, laparoscope insertion is a must.
Would she agree to that ?
Acessa is effective, but not very effective, for multiple fibroids, and she has more than one, and big ones too.
The fibroids in conjunction with the extensive adenomyosis, and the endometriosis - really make hysterectomy ( removal of uterus ) the most sensible and recommended option.
It is better to have a hysterectomy instead of living with a lifetime of pain and bleeding.
Please let me know her age, and the severity of her symptoms, also her past obstetric history ( how many kids she has had and what age ) - that will help me to guide you better.
If it was a single fibroid, saving the uterus would be plausible.
With this scenario, hysterectomy is the best option.
All the best
Take care.
Patient replied :
Dr. Vazirani,
Thanks for writing.
DR. Areej age is 45 years.
Please CC/write to her directly to [email protected] as she couldn't use my account on my behalf from Yemen. I only registered with your service for her benefit.
Dr. Areej is in pain and bleeding please help us with referrals to stop her pain and the bleeding immediately. That's what should be her most concern.
Thanks again
[email protected]
415-571-3760
Following are her own words to tell you Sir:
" tell him she is 45 and never being married before and dont have kids but she wanted too. She is not against laparascope at all, she is against invasive methods from the vagina because she is still virgine. she is using Visanne tablets 2mg since two months. the pain is less but she is suffering now from contious bleeding, that she has the menstruation since 4th of January and contious till now the 25 day."
Jack i do nit want to remove my uterus. I only havd God to save me from what im suffering from."
Dr. Vizarani , Please! advise to her satisfaction as best as possible. At least for now.
Hello again.
I fully empathize with your situation.
I would want you to know that at 45, anyways, the odds of her conceiving naturally , are very low.
She can always opt for surrogacy, as it is paramount to first take care of her health.
SO yes, hysterectomy is the best option for her.
Right now, for the intractable pain and bleeding, she needs immediate help.
SHe can take Tranexamic acid with Mefenamic acid tablets ( Trapic - MF ) tablets thrice a day for 5 days.
If that does not work, then Medroxyprogesterone acetate ( Meprate ) tablets 10 mg thrice a day can be taken for another 5 days.
As she is in so much of agony over the pain and bleeding and poor quality of life, I would urge her to consider going in for a hysterectomy as early as possible.
I hope what I am saying makes sense to you.
All the best.
Please do discuss further.
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Admin Message -
Kindly share your password with the patient for your DoctorSpring account for easy access. It is automated email process as such but I'll try to include a cc to the patient.
Patient replied :
Can Areej do Acessa first without removing uterus. Then maybe try to get pregnant first. She doesn't want to hesterectomy.
How much Acessa costs from entry to exit. How much hesterectomy costs. How much both will cost. First Acessa and then hesterctomy. A gynecologist in Lebanon who prescribed Vissane for her told her to use Visaane for 6 months and after which to visit her. She assured her they will not remove uterus.
Dr. Vizrani, these tablets you mentioned in your last reply can she take them along with Visssane? Or how else?
Please advise and CC Areej all along. She hadn't been able to access your website although she has my password. Probably due to security rerouting issues but am not sure.
Thank you.
Hello again,
See at 45, it is better to first assess her ovarian reserve.
This is the capacity of the ovaries to produce mature eggs.
This capacity is drastically low in patients who cross 40.
If this capacity is lost, there is no point in wasting time trying to get pregnant.
If she feels very strongly about conserving her uterus, yes , she can try Acessa first.
Acessa does NOT address the issues of adenomyosis or endometriosis, these two will still continue to cause significant pain and bleeding, even if multiple fibroids are removed, and all of them might not be removed by the Acessa.
If the gynecologist assured her in Lebanon that they would not remove the uterus, then she must have been pretty sure that Areej would respond to Visanne, and she has not.
Also, another point is that the cost of Acessa and hysterectomy both vary from centre to centre, country to country, it is best to enquire locally where she plans to undergo the procedures.
All the best.
Take care.