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How do I begin. Ive been quite frustrated at thr care i have

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Hi. How do I begin...
Hi. How do I begin. Ive been quite frustrated at thr care i have been receiving over decades from gp's. I have Severe PTSD from incest and later sytematic sexual assualt when a homeless youth and abuse from multiple perpetrators and abductions. My medical history seems too long to put here so ill paste it once you reply ☺
Submitted: 2 years ago.Category: OB GYN
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Customer reply replied 2 years ago
Also at the same time my implanon hormone levels were checked and found to be not working (approx Nov 2013), my boobs were painfully hard, size G cup and had a ultrasound instead of mammogram. This is starting to happen again. Thinking i should retest if its absorbing too fast again. I was also on Efexor 225mg at that time and stopped it due to severely colourful and hearing full conversations in very vivid dreams. Last week I stopped the Efexor again. Im guessing the Implanon and Efexor causing more depression is linked to excessive hormones. Could i be right? If so how do I monitor my PTSD without getting more insomnia and dreams and how to i stay on a period free contraceptive?
Customer reply replied 2 years ago
Showing 2 different pelvic ultrasound results within 4 months, prolactin test taken in 2014. If you dont receive 3 photos let me know please. My Efexor amount this time was only for 6 months at 75mg, couldn't go up in dose as i need to work and Efexor has never stopped my insomnia or nightmares, only made nightmares worse and too fatigued to work after bad dreams. Makes more depression.
Answered in 30 minutes by:
8/30/2015
OB GYN Doctor: DrRussMD, Board Certified Physician replied 2 years ago
DrRussMD
DrRussMD, Board Certified Physician
Category: OB GYN
Satisfied Customers: 65,665
Experience: Internal Medicine--practice all of internal medicine, all ages, family, health, prevention, complementary medicine, etc.
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Hello

What is your exact question?

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Customer reply replied 2 years ago
As you can see there are many components to and many questions. Please answer
Customer reply replied 2 years ago
Or answer one component at a time. Im sure youll find the questions more specificly tailored to each issue.
OB GYN Doctor: Dr. D. Love, Doctor replied 2 years ago
Dr. D. Love
Dr. D. Love, Doctor
Category: OB GYN
Satisfied Customers: 19,114
Experience: Family Physician for 10 years; Hospital Medical Director for 10 years.
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There are several issues here, some of which can be interrelated.

The most recent ultrasound raises the possibility that adenomyosis is present. Adenomyosis is a condition in which the lining of the uterus grows down into the muscle layer of the uterus, and this can most often cause pain or abnormal bleeding. You do not note that your doctor discussed this with you, although you did mention that no fibroids were identified. If ultrasound is not able to make a clear diagnosis whether adenomyosis is present, then an MRI would be an option to try to obtain clear images of the uterus.

If adenomyosis is present, then the ultimate treatment would be a hysterectomy, which would resolve the symptoms associated with the adenomyosis and eliminate the need for discussion of contraceptives. If trying to avoid a hysterectomy, it can be tried to use hormonal interventions to try to control the adenomyosis. One of the newer treatments for adenomyosis that also may help to control the menstrual bleeding would be the hormone impregnated IUD.

As for depression, there are many people that notice that their depression is associated with hormone levels or hormone fluctuations. Many different patterns can be seen, so we will address whichever pattern is manifested in an individual. There is no direct evidence that Effexor is more prone to the effect of hormones than other antidepressants, but if that is what you have experienced, then we would still change to a different treatment.

It would be reasonable to only change one component of treatment at a time. If changing contraceptive and antidepressants at the same time, and there is a worsening of symptoms, it would be difficult to know which change was the underlying cause.

At this point, the usual approach would be interventions to address the possible adenomyosis, and that may require consultation with a Gynecologist, rather than further care from your GP.

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Customer reply replied 2 years ago
Thank you so much for your answer. Another question to help narrow down my choices.
I will attempt behavioural sex therapy, kinesiologist for muscle memories and a temporary valium if needing to relax. If all this doesn't work over time. Botox injection in the vaginismus related muscle could help me be confident to attempt the IUD. QUESTION: Could botox make me incontinent?
OB GYN Doctor: Dr. D. Love, Doctor replied 2 years ago

Yes, it could, although the likelihood of Botox causing incontinence is very low.

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Customer reply replied 2 years ago
Thank you. Could uterine spasms from vaginismus increase the risk of the IUD moving and getting stuck in the uterus wall or any other form of damage preventing having another child or create more Rhesus negative anti-D antibodies?
OB GYN Doctor: Dr. D. Love, Doctor replied 2 years ago

Vaginismus is typically not due to uterine spasms. However, if uterine spasms are present, it can increase the chance that an IUD can be pushed out, but it would not cause it to get stuck in the wall or create Anti-D antibodies. It is important to note that women frequently have uterine spasm/cramps during periods, including when an IUD is in place, and the IUD is usually not pushed out. If the uterine spasms are stronger than usual, the IUD will still usually not be passed, but there would be an increased chance.

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Customer reply replied 2 years ago
Thankyou. Ques 1) Is the IUD is going to prevent ovulation and prevent early menopause and also Andenomyosis from worsening?
Ques 2) Besides healthy diet, weight loss and avoid stress triggers, is there anything else i can do to prevent menopause, prevent further anti-D antibodies, and have at least 2 more babies (which im hoping for)?
OB GYN Doctor: Dr. D. Love, Doctor replied 2 years ago

The hormone impregnated IUD will suppress ovulation, but also will help to suppress growth of the lining of the uterus and its growth into the muscle layer that occurs with adenomyosis. There is nothing in the information that you have provided that indicates early menopause.

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