I am a 21 year old female in college and on a tight budget which is why I avoid going to the hospital as much as possible. In the past three years I have had multiples cardiac related surgeries due to Marfan's Syndrom. I now have a mechanical valve and aortic replacement. I am on coumadin/warfarin to prevent blood clots. For six months, I was fine. My menstrual cycle was manageable. In the past six months I've been to the ER and seen two OBGYNs due to blood loss from heavy persistent vaginal bleeding. I know the cause of the bleeding is coumadin/warfarin.
Sometimes I am able to manage the problem on my own by increasing my intake of iron and vitamin K. However, this past month, I have not been as successful as in the past.
My OBGYN told me the only real option was an ablation operation to destroy the lining of my uterus. A second opinion said the same. Hormone therapy and birth control are not an option because all effective medications on the market increase risk of clotting. I have tried researching alternatives myself, but nothing seems applicable to my particular situation.
Is an ablation really my only choice? And what is the actual risk of stroke with a mechanical valve? Is coumadin really necessary?
No one seems to have these answers. Please, I am praying you can help me with these questions. |
Dear P. NummI forwarded your question to Anthony Dardano, M.D. and following is his reply: From the history I'm given this is far more complex due to the Marfan syndrome and the artificial heart valve. First and foremost let me say that anticoagulation therapy with coumadin is absolutely essential when there is a mechanical heart valve in place. Tiny blood clots form on these valves and when large enough they are released from the valve and enter the arterial system. When they end up in the smaller vessels they occlude them causing stroke, gangrenous limbs, etc, etc. Therefore without question, continue the coumadin.
Endometrial ablation in a patient your age in my mind is not a sound recommendation, although on the surface it may appear to be the answer. Remember, the procedure will leave you forever sterile. That is a decision no 21 year old should have to make in the face of a benign condition. Not only is this a medically poor recommendation, it is morally flawed as well. Endometrial ablation destroys the uterine lining but does not alter ovulation. Therefore, if the egg were to become fertilized, there is no lining for the fetus to adhere to and it is lost. This abortifacient feature of the ablation thus makes it morally objectionable. Of course, in the menopause, or the permanently infertile woman, this might be an option. Notice I did not mention abstinence as a factor because it would be naive on my part to expect a 21 year old to remain celibate for life because of a procedure.
I personally see no reason not to use a natural progestin temporarily to correct the abnormal bleeding. After all, you are anticoagulated already so the risk is minimized. Another warning: avoid any implantable therapy such as a progesterone filled IUD or depo provera injectable because here the clotting risk is not so easily reversed and their abortifacient action is objectionable as well.
Finally, seek the opinion of a sound pro-life physician. If need be consult the Pope Paul Institute in Omaha Nebraska as they certainly handle all difficult gynecological problems within the guidelines of the Catholic Church.
I hope what I have written helps. If you have any more concerns please do not hesitate to ask. May God bless you. Anthony N. Dardano, MD, FACOG, FACS
COPYRIGHT 2009 Click
here to send this Question and Answer to a friend |
