Questions Regarding Post-Surgery Progestin Usage and Endometrioma Management
I am a 39-year-old female, standing at 5’3” and weighing 120 lbs, with a medical history that includes chronic migraines and cluster headaches (managed with Emgality, sumatriptan, magnesium, vitamin B2, melatonin, and vitamin D3), asthma treated with Symbicort, Raynaud’s phenomenon, psoriasis (treated with occasional topical applications), endometriosis treated with Slynd, uterine fibroids, and iron deficiency anemia requiring occasional infusions. My tests show positive ANA and anti-RNA polymerase III, though I have no explicit diagnosis; it's merely being monitored due to its connection with Raynaud’s. I've also been diagnosed with mild pulmonary valve regurgitation and thickened mitral leaflets, alongside a history of peptic ulcers from NSAID use, which has resolved. I am a non-smoker, do not consume alcohol, and I use tretinoin, Aczone, ipratropium bromide for headaches, and fexofenadine. Next week, I will undergo laparoscopic excision of endometriosis along with a hysteroscopic myomectomy and a revision of my uterine septum. I have a couple of inquiries: 1. What recommendations can you provide regarding which progestin to use after my surgery? My experience with Kyleena was challenging; it led to prolonged bleeding for eight months and significant emotional distress, alongside unwanted hair growth and severe acne, even while using tretinoin and Aczone for seven years. I transitioned to a Mirena, which not only caused daily bleeding but also two significant periods just two weeks apart, along with persistent mood and skin issues. After a month, it was removed, leading to my endometriosis diagnosis via MRI. I switched to Slynd, which has resulted in milder mood and skin reactions compared to the IUDs, which is quite surprising. The surgeon will also perform a hysteroscopic myomectomy to address a small fibroid located at the uterine fundus and revise a 2 cm septum. Ideally, I would like to return to an IUD, as I had a copper IUD for seven years in the past without issues. Is it reasonable to think that my experience with Mirena might differ after the removal of both the septum and the fibroid, along with the excision of endometriosis? Did I perhaps not give it enough time? While I'm aware that bleeding could change, my primary concern lies with mood and skin alterations; I am open to any other recommendations as well. 2. My MRI indicates significant endometriosis, which I'm eager to treat, but I also have bilateral endometriomas under 4 cm. I would appreciate your insight on weighing the pros and cons of excising these versus the risk of impacting my ovarian reserve. My AMH is recorded at 0.8 and AFC is at 6 (measured while on Slynd, around day 15 after the first day of my most recent period, which I continue to experience despite taking Slynd constantly). I worry about leaving the endometriomas intact, especially as I contemplate the possibility of having children in the future; at my age, I would like to consider realistic options without creating false hope. Please be gentle with me regarding my age. This decision is proving to be extremely distressing. Thank you for your guidance!
Answers (1)
2/13/2026, 12:31:04 AM
OpenHealth AI
Thank you for sharing your detailed history and current concerns. It’s understandable to feel overwhelmed given the complexity of your situation. Here are key points regarding your post-surgery progestin options and how to manage your endometriomas:
Main Points
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Progestin Options Post-Surgery: Your experience with hormonal treatments has been challenging, particularly with Mirena and Kyleena. Given your current preference for Slynd, it's worth considering whether to continue with it or potentially explore other IUD options if the conditions improve after surgery.
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Management of Endometriomas: The decision whether to excise your endometriomas must balance the potential risks to your ovarian reserve against the benefits of improving endometriosis symptoms and future fertility.
Progestin Options Explained
- Slynd: Since it has resulted in milder mood and skin reactions for you, continuing Slynd could be a reasonable choice post-surgery. Keeping track of your symptoms in relation to its use after surgery will help gauge its effectiveness.
- IUDs: If you hope to return to an IUD, it’s essential to be aware that the removal of endometriosis, the fibroid, and the septum may enhance how your body responds to the IUD. It is not uncommon for the body to react differently after surgical interventions. However, it’s also important to note how your previous experiences with Mirena may not necessarily improve after surgery, as individual responses can vary widely, even among those with a history of reaction issues.
Next Steps You Can Consider
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Post-Surgery Management of Progestins:
- Consult with your healthcare provider about continuing Slynd or possibly trying a Copper IUD, given your previous good experience with it.
- Discuss the possibility of combining non-hormonal strategies with any hormonal treatment to help with symptom management, particularly concerning mood and skin issues.
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Decision Regarding Endometriomas:
- Have an open discussion with your surgeon about the size and potential impact of the endometriomas on your fertility.
- Consider the possibility of a conservative approach if the endometriomas remain small, as long as they are not causing significant symptoms or complications.
- If you choose excision, request that your surgeon takes steps to minimize any risk to your ovarian reserve, as monitoring and preserving your fertility potential is crucial, especially considering your desire for future children.
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Emotional Support:
- Given the stress related to these health decisions, consider seeking support from mental health professionals who specialize in chronic health conditions or fertility issues. This could assist in managing the emotional toll while navigating treatments.
Final Thoughts
It’s entirely reasonable to feel stressed, especially with the complexity of factors involved in your health. Monitoring your symptoms closely after surgery, alongside your healthcare team, will ensure a tailored approach that considers both your physical and emotional well-being as you move forward. Don't hesitate to reach out for support and clarity from your healthcare professionals as well. Your hopes for the future are valid, and finding the right path can take time and patience.
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