So I went to see my doc for the post-op appointment and, of course, things are always more complicated than I want them to be. I was just sure she was going to recommend the hysterectomy and, if not, I was going to insist. Well, insist is a strong word, I guess.
We had a long talk, though, and went through all sorts of permutations of what might happen for whatever course we take. The short story is that, at the moment, the surgery isn't going to happen. There's some relief in that, but also some concern on my behalf.
There are some risk factors for the surgery. My weight, of course, is a big issue, although that would not probably be enough of a factor to keep me from having it. The biggest risk is that I never gave birth! The gory details are that hysterectomies are usually done these days vaginally, and it's just easier to do it with women who have given birth. So the surgery for me would be done by a relatively large incision, which is prone to infection and the worst case scenario (and this is perhaps because of weight) is that the infection would have to be cut out and the wound left open and packed until it healed from the inside. (Or I could not get an infection at all, or it could be anything in between.) Anyway, she feels a conservative agenda is better.
The biopsy had shown that I had complex cell growth, with focal atypia associated with polyps. What? Well, the complex cell growth means there's a lot of it, but most of the cells are not worrisome. There were some that are troubling within polyps that I understand were removed during the D&C. At the time of the D&C, she inserted a Mirena IUD that provides a continuous supply of progesterone to balance the hormones. She said that very recent research has shown that this can be effective in reducing or eliminating the extra cells, even at this stage.
Another thing that can help is if I lose weight. I'm working on that through this group therapy thing, but she's concerned that it won't work, I think. She's encouraged me to have bariatric surgery, which I'm pretty opposed to -- but I'll be thinking about it. I have met so many people for whom it has been a nightmare, and one person for whom it seems to have worked pretty well. Even that wouldn't happen until at least six months from the time I decided to do it, because of extensive pre-surgery hoops to jump through -- and one of those things is this same group therapy that I'm already taking. A lot of the women in the group are there as a requirement of the surgery and they're all very excited to get their surgery. They assume I'm there for the same reason. The thing is -- if you get the surgery, you need to learn to eat less, etc. My feeling is, if you have to do that anyway, why not learn to eat less and then not get the surgery.
So, for the time being, this is what's happening. I'm going to have *another* D&C/biopsy in 3 months (about early/mid-January). We'll see if the treatment with the IUD is making things better. Meanwhile, I'll be working on the weight loss thing too. If things are worse, then we'll do the hysterectomy. If I'm still having trouble losing weight, then I'll be willing to reconsider the bariatric thing at that time. But I want to go through this group thing and see how it works out first. After that, there are other programs here -- metabolic fitness, etc. -- that might be a good follow-up.
So that's a lot to say. But the upshot is: No surgery now. A D&C every three months until the problem goes away, or gets worse and a more invasive solution takes place then.
Phew! I'm a bit on a roller coaster about the whole thing, but I feel again that we're on the right course under the circumstances. The IUD was a bit uncomfortable at first, but it's not bad at the moment, so I can live with it. I'm not feeling depressed about it (I keep checking to make sure!). As long as I have a clear understanding of what the options are, even if none of them are a quick fix, I'm OK with it.