Question: I am a 34 y/o female with a hx of endometriosis, s/p TAH-BSO 2001 and numerous abdominal surgeries for the endo and adhesions including several vaginal cuff excisions and ablations due to ongoing vaginal bleeding for the past 14yrs. I had cauterization with silver nitrate of my vaginal cuff this past Wed (which I routinely need done) due to ongoing bleeding.

I have passed several brown/black clots, as usual for this proceedure but I continue to bleed. I was going through a pad/hr yesterday but it slowed today. The cramping is really bad though , approx 9/10 on the pain scale and I usually don't have such severe pain 3 days out from the proceedure.

Could it just be taking longer to heal this time? I don't want to go to the ER unless it is absolutely necessary. I work at the hospital and if I can get through the weekend I can see my dr on Monday. Do you think I need to see someone before Monday? My Drs usually tell me if the pain is that severe I should go to the ED. I was hoping there would be an alternative though to spending all night and all day for them to tell me to see my dr on Monday. Any thoughts? Thank you, XXXXXXX

Thank you Dr. XXXXXXX It is reassuring to know I don't have to rush to the ED.

Unfortunately I am in the 1% of cases that do not respond to any treatment.
The endo was dx in 1995 as stage 4 at age 14. I then required laparoscopy every 6 mos for excision. We tried every combination of hormonal therapy including Lupron as high as 22.5mg inj qmonth and synarel. They did try a presacral neurectomy in 2000 prior to making the decision about the TAH-BSO, but the sx still persisted. Initially we tried to preserve one ovary but my gyn onc had to close and go back in 2wks later for the other ovary. It was adhered to the anterior abd wall and had several large endometriomas attached. The path report on both ovaries indicated that there was not only endo on the outside but the endometrial cells has filled the inside of the ovary and some cells had characteristics similar to pre-ovarian cancer cells.

Since 2001 no one has been able to stop the bleeding from the vaginal cuff despite multiple cuff ablations and 2 cuff revisions with excision. The endo still grows back after approx 1-2yrs post laparoscopy to excise the endo. It is mostly involved with the intestines and has caused severe
Adhesions where my intestines are fused to my abd wall. I've been told that it is likely microscopic endo causing the cuff bleeding, but they can't resect the cuff any further and the best I've been told all they can do is cauterize with silver nitrate and if that doesn't work bring me in for an ablation of the cuff in the OR.

I've read some articles that research is being done on whether aromatase inhibitors could help treat endo since endo is dependent on estrogen. My dr did not want to take me off the estrogen since I am so young. I am on a low dose 0.5mg of Estradiol.

It would be one thing to deal with spotting all the time but the bad cramping with bleeding though a pad/hr makes it difficult to function. I am bleeding for approx 75% of the month rand I was told I am anemic. Have you ever heard of this happening from the vaginal cuff and if so is there anyway to stop the bleeding (and the pain associated. Thanks so much for your advise! XXXX