At age 45, after sterilization and then having a miscarriage, what my next step to prevent pregnancy #1228/11

Hello!

In May I had a DaVinci myomectomy, resulting in the removal of 21 fibroids.  At age 45, it seemed reasonable to also have my tubes cauterized. This past week I experienced a miscarriage.  I didn’t connect a late period with pregnancy.  What is my next step to prevent another pregnancy?  I am ultimately confused!!!

 

Thanks



My very tardy thoughts:

 

Clearly you are ovulating some of the time if not regularly.  Therefore, you need to use contraception until you go through menopause.  Condoms are of course, a possibility.

 

Are you quite certain that fertilization leading to that pregnancy occurred AFTER tubal sterilization?  

 

Her reply on 12-28: “Dr. Hatcher:

 

First, thanks for taking the time to reply. I should tell you that I am a Big Fan. My original career goal was to become a lobbyist for Planned Parenthood, but life seems to have taken me in a different direction. During election periods, I volunteer with the Rocky Mountain chapter to get out the vote. The state’s voters have twice rejected personhood amendments and we are bound for a third vote in 2012. We simply have a low bar here for getting issues onto our ballot and we have some very energetic evangelists in Colorado Springs and elsewhere.

 

I took a course at Penn State which used one of your textbooks. It was clear, concise, informative and, our very entertaining professor (Dr. Wickersham), made it come to life.

 

The class enabled me to serve as a health education outreach advocate for a student-run contraception and sexuality program called PCEP (the Peer Contraception Education Program). Students who wanted to meet with a health care practitioner to obtain birth control from the school’s health center first had to attend one of our seminars to review all of the different methods. Over three years (one as student director), I probably spoke to 10,000 students about contraception, communication and sexually transmitted infections (STIs).

 

The irony is not lost on me.

 

Since my surgery was in May and the miscarriage at the close of November, I feel confident the fertilization happened after sterilization. My hCG level in the emergency room was just over 3,700, which seems like a 4 – 6 week pregnancy based on my online research and a few comments from the various docs I’ve chatted with since everything happened.

 

I’ve met with a new GYN since I wrote you and have been reviewing all options, ranging from Essure/Adiana to hysterectomy and everything in-between. I believe I have a nickel allergy (sensitive to jewelry with a big reaction) and the Adiania website names tubal ligation as a contraindication to its use. I’m not loving the idea of having a medical device left inside me anyway which also isn’t a big call to action for an IUD either.

 

Perhaps the most disappointing thing for me (beyond the overall shock or the core event) came when a new ultrasound revealed that I had two more fibroids about ½ inch each. These may seem small, but I am apparently a ‘Fibroid Factory’, having had two surgeries with five years in between. The surgeon simply missed these and I feel certain I will grow additional ones, despite the race to menopause. Until last week, I’d never seen the pathology report from my original laparotomy in 2006. I’d had a large dermoid cyst on my left ovary and I was tickled to learn that it contained a tiny calcified tooth. Those cysts are total freak shows. Truly fascinating.

 

So… condoms for the next five years would be ultimately depressing for me, though certainly fine for the short term. My partner will consider vasectomy. We’ve been together two years but are not married, so I would hate for him to take this step and regret it later.

 

I am considering all options, but some sort of laparoscopic surgery (non-DaVinci) with re-cauterization or tube removal combined with myomectomy and uterine ablation reflects my current thinking. Would ablation discourage pendunculated fibroids?  I have had a few of those, but most of mine have been intramural. None has been intracavitary.

 

Again, I am so pleased to hear from you. I hope you have a lovely holiday!”

 

I am so happy to know there are folks out there for you.  Glad you found our textbook useful.  The Peer program you worked on sounds great!  Thanks for this important work. 

 

Tubal removal combined with myomectomy and uterine ablation would, with ablation certainly discourage pendunculated fibroids.

 

Her updated reply on 7-20-2012: Hi Dr. Hatcher:

Just thought I would give you an update on my choice for re-sterilization after I (unknowingly) became pregnant and miscarried post-tubal ligation via cauterization.

 

Rather than select tube removal via laparoscopy with its considerable recovery time, I chose Adiana implants despite my disinterest in permanent medical devices. After everything that happened, this minimally-invasive procedure was more appealing in the end. Last Friday it was confirmed that my fallopian tubes are occluded and I hope this will end the chapter of my rather unexpected, continued fertility.

 

We continue to follow several small fibroids that the original surgeon missed. Basically, it’s just a race to menopause and I’m hoping these don’t lead to any symptoms that would require additional surgery. Based on my current reading and the thoughts of my doctor, I am holding off on endometrial ablation right now as I don’t feel confident that it will prevent fibroids moving forward. If you have any information to the contrary, please let me know.

 

Thanks for your interest in my case and willingness to correspond!

 

RAH’s reply 10-1: Thanks so much and I hope that you will keep me posted.

 

To learn more about the advantages and disadvantages of sterilizations, , go to our website: www.managingcontraception.com and click on Choices.  You can also order this wonderful new educational book from our website or by calling 404-875-5001.  Do you have your copy yet?

 


Key Words:  DaVinci myomectomy, fibroids, tubes cauterized, miscarriage, period, pregnancy, protection, ovulating, contraception, menopause, condoms, Planned Parenthood, health education outreach advocate, PEEP Contraception Education Program, birth control, fertilization, hCG levels, hysterectomy, Essure/Adiana, dermoid cyst, depressing, vasectomy, laparoscopic surgery, ablation

Posted 12-28-2011, Updated 10-10-2012

Skills

Posted on

October 10, 2012