Brief Answer:
You will need HRT until 50 years of age

Detailed Answer:
Hi
Welcome to Healthcare Magic.
I am Dr Ramadevi Wani.
I will be answering your concerns today.

Is the pain so severe that you have decided this last option of treatment. Did you try using birth control pills/Mirena.

Have you used GNRH injections for three months? What was the response? If this treatment relieved you of all the pain then hysterectomy with removal of ovaries will be beneficial for you.
What type of surgery is planned for you? Is it laparoscopic surgery or laparotomy.
Side effects you may face are,
1. During surgery-- a small chance of injury to bowel, bladder or ureter as usually endometriosis results in adhesion formation and the surgery can be difficult. A very small possibility of blood transfusion if there is excessive bleeding during surgery.

2. Immediate post operative:
a)Pain for which your doctor will prescribe medicines.
b)Gaseous bloating of abdomen which settles down with medicines.
You will be given medicines for few days to prevent clot formation in legs.
You will usually be sent home on the third or fourth post operative day.

3. Late postoperative.
a) Infection (2/1000)
b) Sometimes mild vaginal discharge or bleeding which settles down in 2-3 weeks time. If you have this, use sanitary pads. Don't use tampoons.
c) Low back ache and abdominal pain in the first 2-3 weeks. It can be relieved with medicines
d)Since ovaries will be removed at this young age you need to start hormone replacement therapy (HRT) to prevent premature menopause symptoms and long term problems like bone thinning. You need to take this medicine until 50 years of age. I am sure your doctor has already discussed this with you. The problem with HRT is that it may sometimes cause reactivation of residual endometriosis. In this situation your doctor will reduce the dose of HRT.

Laparoscopic surgery is better than laparotomy in experienced hands.
If you have any further queries, do contact me through Healthcare Magic.

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Brief Answer:
Hormone replacement therapy in the form of patch is the best option for you

Detailed Answer:
Hi XXXXXXX
I read your notes. Since you have suffered from blood clots in the leg earlier, birth control pills definitely are NOT an option for you.
In my clinic, for a lady with similar complaints like you, I would try MIrena ( Progesterone intrauterine device) insertion too.
I understand from your notes that you will be having open abdominal surgery and not key hole (laparoscopy) surgery. CO2 is used to inflate abdomen in laparoscopic surgery. There is no need for CO2 in open abdominal surgery.

One might start experiencing surgical menopause symptoms within few days (2-4days) after menopause. Usually HRT is started a week after surgery. There are special concerns which need to be addressed in your case before starting HRT. In view of previous history of clot in the legs hormone replacement therapy in the form of patch is the best option for you. Were you investigated for the cause of clot in the legs? Did you have thrombophilia screening? Your doctor may seek advice from clinician with expertise in thrombosis.

I hope this answers your concerns. If you have any further queries do write to me through Healthcare Magic.
My best wishes to you. Good luck.

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