Difficulties After a Second Myomectomy

Dear Dr. DJ,

My wife endured her second myomectomy in April this year. Since then, her periods have still been heavy, unlike after her first myomectomy (August ’97). Her doctor was surprised she was bleeding so much so soon because he said her uterine lining was very thin after her surgery.
We asked him about my wife’s heavy bleeding and he could not tell us why. He only suggested conceiving as soon as possible to avoid complications due to fibroid recurrence. He offered birth control pills, but we want children.
Fertility concerns aside, do you have any idea why my poor wife is bleeding so much? I was thinking because her uterus is enlarged because of the first large fibroid (typical estimate from pelvic exams has been a 12 week uterus), there is that much more lining to shed each month.
Each month she passes larger clots. Her last blood count shows her still very anemic. Her uterus is the shape of an unshelled peanut (first HSG,1997). Her doctor (reproductive endocrinologist) wants us to schedule another HSG so he can see if he was able to open both of her fallopian tubes. That is good and well, but we need to get her bleeding under control.
I have read your web page and you speak of reconstructing the uterus after surgery. Do you mean restoring it to its original shape? Do you remove part of it to accomplish restoration or restore only the sections disturbed by the procedure? Is it possible my wife’s uterus could be restored to its original shape? I am 39, my wife 36. We have no children.
Thank you for your time.

Dear Richard-
It is highly likely that your wife could have adenomyosis-which is endometriosis of the uterine muscle. This would account for her symptoms, especially the heavy bleeding. This is a completely separate diagnosis from fibroid tumors, and requires a uterine biopsy to confirm its presence. This is a very debilitating disease and will render the uterus infertile, as it penetrates into the muscle. The sooner your wife can get pregnant the better.
FAS does treat adenomyosis, but once the diseased tissue is removed, it often renders the woman sterile. We do reconstruct the organ after the procedure, but this is a layer by layer closure that attempts to approximate the original shape of the organ.
Good Luck.