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BANGKOK 19 January 2019 11:43
Swiss1960

Ob & Gy specialist

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Wife has been diagnosed in Bangkok hospital Pattaya with possible pelvic endometriosis (based on ultrasound) and while currently treated with hormone therapy, has been confronted with possible hysterectomy. While doc in the hospital seemed reasonably knowledgeable and also explained everything pretty well in 2 languages, we would like to get a second opinion.

 

What is the best choice for this, either in Pattaya or Bangkok? Thanks for all your inputs

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Prof. Chartchaisrisombat at Bumrungrad

 

Bring US report with you

 

Definitive diagnosis of endometriosis usually requires laparoscopy (minimally invasive surgery). Any "chocolate cysts" or adhesions can often be removed at same time.

 

Initial treatment is indeed with hormones. Hormonal contraceptives may be tried first. If not sufficient more costly hormones may be used.

 

Hysterectomy is last resort, not least because to be effective it has to include removal of the ovaries which will trigger a surgical menopause.

 

Intractable pain that does not improve on hormone therapy would be main indication for such surgery. The condition per se is not dangerous but the resulting pain can affect quality of life.

 

Natural menopause will cure the condition so if she is say over 40 keep this in mind, problem will solve itself in time.

 

If she wants future pregnancies that is a whole other matter and should be under the care of an infertility expert.

 

 

 

Sent from my SM-J701F using Thailand Forum - Thaivisa mobile app

 

 

 

 

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21 hours ago, Sheryl said:

Hi Sheryl, I didnt want to open a new thread, but I have a question to ask on the similar matter. My wife was tested positive for HPV type 16, that possible can lead to cancer and she is worried. We would like to travel to BKK to consult with the best possible doctor at Samitivej or another private hospital. Can you please recommend someone that specialize in those issues? By now we have been recommended Dr. Wisit Supakarapongkul from Bumrungrad. Thank you very much in advance.

 

 

 

Prof. Chartchaisrisombat at Bumrungrad

 

Bring US report with you

 

Definitive diagnosis of endometriosis usually requires laparoscopy (minimally invasive surgery). Any "chocolate cysts" or adhesions can often be removed at same time.

 

Initial treatment is indeed with hormones. Hormonal contraceptives may be tried first. If not sufficient more costly hormones may be used.

 

Hysterectomy is last resort, not least because to be effective it has to include removal of the ovaries which will trigger a surgical menopause.

 

Intractable pain that does not improve on hormone therapy would be main indication for such surgery. The condition per se is not dangerous but the resulting pain can affect quality of life.

 

Natural menopause will cure the condition so if she is say over 40 keep this in mind, problem will solve itself in time.

 

If she wants future pregnancies that is a whole other matter and should be under the care of an infertility expert.

 

 

 

Sent from my SM-J701F using Thailand Forum - Thaivisa mobile app

 

 

 

 

 

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Hello Sheryl

I would be eternally grateful for any help.

 

My wifes In bangkok and I'm in London, shes recently been to 2 hospitals due to severe pain and both have said it's due to a cyst on 1 ovary which she needs to have out.

We both want to try for children.

 

I'm trying to find a hospital in bangkok with a good gyno dept, and one that's affordable. We do not have health insurance and are a bit short on cash.

 

We just got married last month. We're both having a hard time at the moment.

 

Any advise, any, would be appreciated immensely.

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2 hours ago, cube789 said:

Hello Sheryl

I would be eternally grateful for any help.

 

My wifes In bangkok and I'm in London, shes recently been to 2 hospitals due to severe pain and both have said it's due to a cyst on 1 ovary which she needs to have out.

We both want to try for children.

 

I'm trying to find a hospital in bangkok with a good gyno dept, and one that's affordable. We do not have health insurance and are a bit short on cash.

 

We just got married last month. We're both having a hard time at the moment.

 

Any advise, any, would be appreciated immensely.

Removal of one ovary does not prevent having children, only the removal of both.

 

It is sometimes possible to remove a cyst without removing the ovary itself but even if not she will still be able to have children. However it is good to preserve the ovary where possible in case something later happens to the other one.So if she does end up having surgery she should tell the doctors she wants children and ask if it is possible to remove the cyst without removing the ovary. 

 

Many ovarian cysts do not require removal. Some are "functional" and change in size during the menstrual cycle; these require no treatment at all. Others are constant but small in size, these can just be monitored. However if the cyst ruptures or  causes rhe ovary to rwist (torsion) then surgery is needed on an urgent basis.

 

It is not unknown for some doctors in for-profit  private hospitals here to recommend unnnecessary surgery. So if the recommendation came from a for-profit private hospital it warrants verification. Should also find out the size of the cyst.

 

As a Thai citizen she is eligible for free care at a givernment hospital (and these will not do surgery unless really needed). For that she needs to go to the hospital responsible for the location whete she is registered in a "tabian ban" (house book). If that is a community hospital they will have to refer her onward to a higher level hospital but she has to start there and get a written referral form.

 

 

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Thank you so much.

She did travel back to surin to her local hospital where she stayed for 5 days whilst the doctors monitored her.

It does only flare up after her menstrual cycle.

 

They advised just to monitor it.

The private hospital prior to that advised to have the operation, so I think we will wait now until the unbearable pain occurs again, in which case she will need urgent treatment in bangkok.

 

I will keep looking for a hospital in case.

Thankyou kindly 

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Is it actually a single ovarian cyst or is it "chocolate cysts" i.e. endometriosis?

If the pain is cyclical and during her period then endometriosis is more likely and this is an altogether different thing than an ovarian cyst, which is usually painless unless it ruptures.

If she has endometriosis this often makes it hard to conceive.

At any private hospital treatment is going to be very expensive (as in hundreds of thousands of baht).

If it is suspected endometriosis then the surgery recommended by prior private hospital may have just been a largely diagnostic laparoscopy. Govt hospital might also do this but only if the pain persists over some time and Surin would have to refer her elsewhere for it.

Continue to be followed at the govt hospital or, if possible, return to the UK for treatment under NHS is best advice I can give you.

And try to get better information on the fiagnosis i.e. an actual ovarian cyst or suspected chovolate cysts/endometriosis.

Sent from my SM-J701F using Thailand Forum - Thaivisa mobile app

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