Sunday 28 January 2018

My Experience of a TCRE (Trans-cervical Resection of the Endometrium)

Surgical team and instruments
Operating Team Image, thanks to Shutterstock

I was keen to write this post as there seems to be very little information on the web about women’s personal experience of having a TCRE. Many, many women suffer in silence with heavy periods and I want to share my positive experience of having a simple day operation that can make the world of difference to your every day life.

A Brief History

I shared in a post a few months ago about how I've suffered with terrible heavy, frequent and painful periods for around a decade now. I honestly cannot tell you why I put up with it for so long, I think it had simply become a part of my life and I'd learnt to live with it. It was only when I was on holiday in May last year and my awful bleeding stopped me enjoying the pool every day with my girls that I realised something had to be done.

I have the most wonderful GP and she sent me off to see the gynae specialist nurse at the Conquest hospital (Hastings, East Sussex) as thankfully she knew I had been suffering for quite some time, having been prescribed Tranexamic Acid and Mefenamic Acid for a few years, as well as having scans for an embedded coil, missing strings and cysts. I was given a hysteroscopy and straight away the specialist nurse could see there were problems and referred me for an ablation of the endometrium.

I was led to believe this would be done by a simple balloon being inflated in me and radio waves passing through to burn off the excess lining of my womb. This is apparently a really simple procedure that the nurse can do, however she told me as my womb was quite enlarged (she didn't think it had ever fully shrunk back after having my twins) that it would be better to be done by one of the consultants with a general anaesthetic.

Meeting my Consultant

When I met the consultant he reviewed my notes and said he didn't feel I was suitable for the ablation due to the size of my uterus, the thickness of my endometrium and also the presence of fibroids. He felt it would be better to do my surgery the old fashioned way, which would mean him using a hysteroscope to see what needed to be taken away and then burning it away accordingly.

He told me I was very overweight and this could make the surgery more complex and he went through the risk factors with the surgery and what could go wrong, telling me I had a 70-80% success rate for the surgery. With those odds, I was happy to progress as I just needed some respite from the constant heavy bleeding.

Pre-Operative Injections

Before I was given a date for my surgery the consultant’s secretary rang me and told me I would need two injections of Zoladex. One two months before surgery and one a month before, this would thin the lining of my womb and hopefully stem my bleeding so the surgery would be easier. Thankfully as I've mentioned my GP surgery is exceptional and they booked me in the same day for my two injections and I was able to call back and get a date for my operation - 17th January 2018.

The injections were done by the Practice Nurse and they went into my stomach, it was a small slow-release pellet put in me and thankfully (I think due to my excess fat) they didn't hurt me at all and I didn't have any side effects from them. I did notice that after the second one I had some particularly heavy bleeding with a lot of clots being lost for a good week or so. My bleeding then settled down but never actually stopped, much to the surprise of my consultant.

Pre-Operative Assessment

A couple of weeks before the operation I had the pre-op appointment at the hospital and I was there for about 90 minutes. There was a very long questionnaire to complete and I had to take a full list of my prescribed medications with me. My height, weight, temperature, pulse and blood pressure were taken. Unfortunately my blood pressure gave rise to some concern so I was sent off to see my GP for another reading and to get some medication if necessary.

I also had to have my nose and underarm swabbed to check for MRSI, which I thought was excellent. Much better to prevent its admittance to hospital if they can, than deal with the infection spreading.

Due to my high blood pressure they also chose to give me an ECG to check my heart function and I was very reassured by how much care they take before admitting someone for an operation. Overall I found the nurses to be really friendly and efficient at the Conquest Hospital, Hastings.
I was also given lots of good information to take away with me explaining the procedure, what I could do to avoid hospital-acquired blood clots

The night before the operation

Of course I packed my day bag, keeping it light on what I took in. Just my dressing gown, slippers, my kobo to read, spare knickers and pads for after surgery and my phone with charger, in case of delays and boredom!

I took off all my jewellery to leave at home and also removed my nail polish to ensure the pulse reader would work properly.

After my dinner at my normal time I had a snack of some weetabix and semi-skimmed milk about 11.30pm in case the operation was delayed the next day, as I knew I'd be starving if I had to wait too long. They suggest a light snack and nothing too fatty the night before the operation.

The day of the operation

I was super grateful to be on the morning surgery list as this meant I could last eat at midnight the night before and have water or other clear fluids up to 6.30am. I'd been advised to bath or shower before coming to the hospital and of course I wanted to anyway.

I arrived at the hospital at 7.30am and I was told what ward I would go to for recovery after the operation, so my husband could head off armed with the info he needed. I wasn't told an expected discharge time then as the nurses said that often the consultant may change his list but that was OK, it was just good to know there was not any emergencies and that I should be operated on that morning.

As 8am arrived I was called in to see the consultant and then the anaesthetist to discuss the procedure and make sure all my notes and information was up to date. Once they were happy I was sent back to sit in the waiting room. The consultant informed me I should be operated on about 10am and I was super impressed when it was exactly 10am that I went through to the anaesthetic room.

Before that I had to meet with the nurse for my blood pressure, temperature and pulse to be taken. She went through all the pre-op questions again with also did a pregnancy test, as well as giving me my hospital ID band. It was all very straight-forward and nothing I felt I had to worry about.

About twenty minutes before my operation I was sent through to a cubicle with a hospital gown and some glamorous compression socks to get changed. I was offered help if I needed it but I was fine. My only question was what to do about my tampon as I was still wearing one at that point. I was given some net knickers and a pad to wear instead and yes I really did feel the height of glamour but honestly I was just glad to be getting the surgery I needed. I was able to wear my dressing gown over the gown whilst I waited.

My bag, coat and personal belongings were then placed in a large plastic tub and taken down to the recovery ward to be ready for me when I came out of the theatre.

I was collected by two anaesthetic nurses who again confirmed a lot of the information in my notes. It all felt very thorough and I felt cared for and safe. I was invited to lie down and had a cannula fitted, as well as a blood pressure monitoring cuff. Then the anaesthetise I had met earlier administered the anaesthetic and within seconds I was gone.

Waking from the Operation

The next thing I recall was waking up about 11.30am. I felt quite tired and disorientated as you'd expect but on the whole I was really pleased with how I felt. It didn't take long to come around and I was pushed around to the recovery ward about 12.30pm where I joined a couple of ladies who were waiting for their afternoon operations.

Tea and toast
Tea and Toast Image, thanks to Shutterstock

I was then thoroughly monitored over the next hour or so and encouraged to sit up to help my oxygen levels rise. Once my final set of observations was taken I was offered a hot drink and some toast, which I thoroughly enjoyed and polished off with no problem. Within a short time of finishing the HCA appeared again and asked me to go to the bathroom to pass urine, she offered me help off the bed but I felt OK and was able to go alone and pass urine without any pain or discomfort.

As I returned to my bed and confirmed I had been able to pee, she informed me I could get dressed and I would be able to be discharged soon. My Consultants Registrar came to see me and told me they considered my operation a success, they had found a large fibroid in my uterus and the consultant spent his time removing that. Which meant that I didn’t really have much of my endometrium taken away but they still felt confident I’d have a great result as now when my period is over my uterus will be able to clamp down and I should at last have breaks between my bleeds.

About 20 minutes later a nurse came to see me and checked I was OK taking Codeine, she gave me some to take away and said I could call my husband to collect me.

Leaving the Hospital

I was only allowed to leave the hospital with someone to drive me and an adult to stay with me for 24 hours. To be frank whilst I felt OK, I wouldn’t have wanted to drive as I’m sure my reactions wouldn’t have been very good.

They recommend that you check with your car insurer about when you are OK to drive, as 24 hours is the hospital recommendation but some insurers recommend up to 72 hours after the operation. They also say you should not drink alcohol, operate machinery or sign any kind of legal contract for 24 hours after your operation.

My After Operation Experience

I was able to leave the hospital about 3pm when my husband arrived to collect me. I was a little spacey but without any major pain. To be honest I just felt tired and like I needed a good sleep, so I headed home to do just that. I spent about four hours in bed and then got up and rested on the sofa for the evening.

I spent the next two days just relaxing in bed or on the sofa and didn’t do anything much. This was enough to allow me to feel really recovered and rested. Over the following week I had the odd twinge of period type pains but nothing unmanageable at all and as someone who used to take Mefenamic Acid for her menstrual pain this felt really easy.

Within a week of the operation I received a copy of the letter that my consultant had sent to my GP and this confirmed he had spent his time removing the large fibroid. He confirmed that generally my organs were in good health and that my uterus was the size of an 8 week pregnancy. He booked me in for a review in four months’ time and I was a little disheartened to read that he suspects I may need another trans-cervical resection in the longer term. However I can live with that fact if this operation gives me the relief that I am hoping I does.

With regard to bleeding, my experience has been that I had three days of absolutely nothing and then since I have had very light bleeding or even just spotting as they suggest and I’m now eleven days after the operation. I’ll update this post when it has been longer and I know more about how this will work out for me.

Update - end August 2018 (7 months post-op)

My experience of a TCRE has been good. I now have about 2 or 3 days of heavy bleeding a month, but nothing like I used to. I get a couple of weeks of no bleeding at all now and that is completely different. I still shed some clots but only during my heavy days and I don't flood like I used to. For me, this procedure has definitely been worth it.
My consultant said at the time he expected me to need another TCRE within a couple of years as he spent a lot of time getting rid of the large fibroid I had and less time, re-sectioning the endometrium but my bleeding was so horrific that if the operation gave me two years of it being manageable I was happy. So far it is 7/8 months of it being totally manageable and I'm so pleased to be able to swim and feel comfortable. Based on my experience, I'd happily recommend this operation to anyone who asks. 

Update - end of 2019

I started to have heavier periods again as 2019 progressed and by the end I was almost back to the same level of flooding, losing clots and near constant bleeding. My GP referred me back to the specialist at the hospital and as it was my second op, they wanted to get me in quickly so I was scheduled for March 2020 and started on Zoladex injections.

Update - January 2021

Of course, Covid-19 hit in March 2020 and thus my operation was postponed until May 2020. I had my pre-op and Covid swab and I was excited for the op and then they decided I could not have it as my BMI was too high and that made it to risky whilst Covid-19 was so prevalent. 
I continued with the Zoladex injections and didn't hear again for a number of months. In December 2020 I insisted that the consultant spoke to me as I was worried I had been on Zoladex for over a year and that is far more than is recommended as a pre-op measure. I got scheduled in as an emergency and had my second TCRE in early January 2021.
This time I didn't have a large fibroid for the consultant to cut away, but apparently there were smaller ones and he was able to remove a good amount of the lining of my womb. Post-op for me was very much like the first time around and I recovered quickly.

Update - January 2022

I was so pleased to find I didn't have any bleeding at all during most of 2021. Nothing, Not until early October 2021 and then I had some nasty period pains and some very heavy bleeding that lasted about three days. Since then I've had another couple of periods of about 3 or 4 days where I have had pain and bleed fairly heavily. I'm now 48 years old and I don't know whether I am perimenopausal or not, so it is hard to say why I didn't bleed for so long after my TCRE. One theory would be that after having the Zoladex injections for over a year, that it took quite a while for that to leave my body. 
I would still recommend having a TCRE if you had terrible bleeding like I did. If mine comes back again the my consultant has said I can have a hysterectomy, but she was trying to avoid that.

After Operation Care Recommendations

I was given a sheet of after-care information, specific for this operation and these are their recommendations –
  • Pain - You may experience some lower abdominal pains like you might during a period.
  • Pain Relief - They recommend that you ensure you have simple pain relief at home like paracetamol or ibuprofen, whatever you prefer to take.
  • Bleeding – They say you may have light bleeding or vaginal discharge for up to two weeks after the operation. 
  • Sex – You can resume sexual activity as soon as you are comfortable to do so
  • Washing – it is fine to wash, bath or shower as you desire
  • Work – Unless your work is manual or involves heavy lifting you are able to recommence it as soon as you feel well enough. However, if it does involve lifting or is very manual then they suggest having a couple of weeks off work.
If you are reading this as you too will be having a TCRE, I wish you all the best and do feel free to ask me any questions that I might be able to help with. Either below in the comments or email me on michelledpannell (at) gmail (dot) com if you'd rather ask in private.

Be blessed, Mich x

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A personal account of undergoing a Trans-cervical Resection of the Endometrium (TCRE), the full low-down, preparation, the actual operation and my recovery after.