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    Confused about decision to have uterine lining removed
    An_248246 posted:
    I know there haven't been any discussions in a few years but I just thought I would ask this anyway. I am 20 years old and as of several months ago started having great discomfort with my cycles. It dosen't have to do with flow size just the sensations. I started taking birth control and have been on it non stop for almost a year. I am considering getting my uterine lining removed completely so as to get off the pills as I do not like having to take them. My doctor says it is a bad decision but I know it is the one for me. I guess the question is who is right?
    Jane Harrison Hohner, RN, RNP responded:
    Dear An: Gosh, that is like the conflict which arises when a young woman without children wants to have her tubes tied. It can take a couple of years and "doctor shopping" to find someone who will do her tubal.

    In addition to the issue of "doctor knows best" as opposed to the patient who is sure of what would be right for her, there are some concerns specific to an endometrial ablation (EA):

    1. Physicians from the Mayo Clinic reviewed the outcomes of 816 women who had an EA. Factors which seemed to predict successful stopping of all bleeding ("amenorrhea") included: age 45 or older (menopause would be kicking in within 5 years or so), a thin uterine lining of less than 4 mm, normal size of uterine cavity (less than 9 cm), and use of NovaSure type rather than heated balloon. Patient characteristics linked to treatment failure were: age younger than 45 years, five or more pregnancies (leads to larger uterine size), prior tubal ligation, and history of bad menstrual cramps. Of note, 5% of their women had complaints of pelvic pain after their EA procedure.

    2. Over time, especially in younger women with efficient production of estrogen from their ovaries, any tiny fragment of uterine lining (eg from high up in the corners of the uterus where the Fallopian tubes connect) can begin to regrow and "re-populate" the uterus. This can require a second EA or other procedure. Meanwhile you still have to do protection from pregnancy.

    I hear what you are saying, but most GYN's have a bias to try treatments in a stepwise fashion. That is, it's better to try treatments from which the patient can bail out. In your case you might be tried on birth control pills, the progestin IUD Mirena, DepoProvera shots or Provera pills--all of which are reversible--before a surgical treatment is done.

    You may be able to find a GYN to do your EA. But it is good to have all the information so you can make the best decision. Perhaps one of our other readers who had an EA in her early 20s can chime in with her experiences, too.

    surette88 replied to Jane Harrison Hohner, RN, RNP's response:
    hi my name is surette i am 24 and i have two kids regular birth i just was told i have a thyroid and got a breast reduction six months ago and i have a aesset on my ovaries and one in my mouth and i have not have a period since my breast reduction i thought i was pregnant but i took test and i was not so i went to my doctor and they told me i have cancer so where did it stem from

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