I was recently diagnosed with Adenomyosis

I was recently diagnosed with Adenomyosis – my doctor did an ultra sound after a pelvic exam. Have you heard of accupuncture or other alternative medicine being used to treat this problem?

Dear Susie-
We have many patients write in and call regarding the effectiveness of alternative treatments ie acupuncture, herbal therapies, diets. etc. Many of these treatments may be helpful treating the symptoms of the disease process, however they are not effective in treating the disease itself. Adenomyosis is a form of endometriosis that only attacks the uterine muscle. If left untreated surgically, it will continue to spread. The bulk of the disease needs to be surgically excised and I recommend laser treatment to the remaining area that is effected. This should be done as soon as the disease is discovered-waiting will only allow the adenomyosis to advance and spread.
FAS is designed to treat this disease without the need for a hysterectomy. Good Luck.

I am 36yrs old and I have two children and I have just underwent a laporoscopy in Dec. My doctor said that I have adenomyosis and wants to perform a hysterectomy, but I would like to have another child. So she has since said that we could wait until the pain is so bad that their is no alternative or to try and conceive. I am not ready to concieve just yet and the pain is not real painful. My question is should I wait? Or if I did the laser surgery would I still have the option to have another child?

Dear Pam-
In my practice, I do NOT recommend patients with adenomyosis wait for anything. If you want another child, you should probably attempt to conceive now. The longer you wait the more the muscle will be damaged by the disease, and you may not be able to carry the fetus.
If you are past child bearing concerns, once diagnosed I recommend immediate laser treatment. Most women require extensive laser surgery to effectively treat adenomyosis, and this will render the uterus incapable of pregnancy.
You have an important decision to make, but I would not wait. Good Luck

I am 35 years old. I had my first miscarriage when I was 24 and after that a series of miscarriages occured (9 miscarriages). I went to several doctors but could NOT really determined the cause. Some say I have incompetent cervix since I usually lost my babies when it reached 4 to 6 months. When I reached the age of 30, one of the doctors told me that I have adenomyosis and her diagnosis why Im losing my babies is because of that. I only have one child and hoping to have another one but do you think it will be possible to conceive again. My past miscarriages made it so traumatic that everytime I conceive, I feel so tortured. Please help me decide whether to hope for another chance or just forget it. Im feeling hopeless right now.

Dear Melba-
Your situation is a very difficult one, and very sad. I am sorry. Adenomyosis is a cause of miscarriages. The longer the endometriosis is allowed to invade the uterus, the more damage is done to the muscle of the organ. The muscle fibers can no longer stretch to accommodate the growing fetus. This is a disease that needs to be treated asap. A definitive diagnosis of Adenomyosis is difficult to obtain; a uterine muscle biopsy can be taken, but results do not always show up. It needs to be removed surgically.
If you gyn suspects Adeno, and you have had it this long, your chances of fertility are probably not high.
Good Luck.

I am 36 years old. I have always had severe bleeding and cramps. I have one child who is 5 years old. Three weeks ago I had surgery to remove what was supposed to be a large fibroid tumor. What was found was a adenomyoma. The doctor removed all that she could without going in to the lining of the uterus. Now she says that I should try to conceive as soon as possible. I am wondering what my chances are of carrying a pregnancy to term now that I have had the surgery. I had a miscarriage last summer. I would appreciate your thoughts.

Dear Joy-
There is no way to answer your question with certainty.
When I remove adenomyomas, my patient must wait one year in order to attempt a pregnancy, in order to allow the uterus to completely heal from the procedure.
I also do not allow my patients to go into active labor;they must have scheduled C-Sections to prevent any problems for mother and child. Good Luck.

i am 41 years old and in an attempt to end very irregular bleeding and pain I recently underwent a laproscopy, D&C,and a thermal ablasion.
3 months later I am having some recurrence of the bleeding and some minor other symptoms. My Dr says I have adenomyosis.
Is there a way to be sure other than an examinatioon of the uterus after removal?
My uterus is twice its normal size.
Paula

Dear PaulaW
This is another unfortunate case of a patient having to probably go through 2 surgical procedures. Ablation and D&C are procedures that treat symptoms, not diseases. This is especially the case for fibroids and adenomyosis….you bought some time but the disease has continued to spread/grow. Adenomyosis can be diagnosed with a uterine biopsy, however the results are often falsely negative, if the diseased portion of the muscle is missed during the biopsy attempt.
Most gyns will treat suspected Adeno with hysterectomy, I do not believe in that philosophy. With laser treatment and debulking of the disease, women can keep their organs without the monthly discomfort. Good Luck

Dear Doc,
What happens if this disease is left untreated? Will the cramping and bleeding increase? I do not know what I have. Haven’t been to a Gyn in almost 4 years. This has been going on for about 5-6 months. What do you mean by spreading? It would only affect the reproductive system, right?

JoAnna

Dear JoAnna-
You most definitely need to get a gynecological exam-not only to confirm a diagnosis but for a pap smear!!!!
Adenomyosis will spread as long as it is untreated-it is a disease of the uterine muscle and will not travel outside the organ.If left untreated, the pain and bleeding will continue, and most likely progress.
Go see your doctor-
Dr. DJ

I had a laproscopy in 1/97. At the time, the doctor said I had probable adnomyosis and endometriosis; however, the endometriosis was not outside the uterus. I have a 3rd degree retroverted uterus which at the time was 1 and 1/2 times its normal size. The uterus was boggy and moddled in appearance. I have bad back pain 3 weeks per month, heavy periods with clotting, painful sex and other pains all throughout the month. I am 30 years old with absolutely no plans for a family. My doctor says I can have a hysterectomy if I want it but I don’t know. I live in Georgia. ARe there doctors in Georgia who practice with your same philosophy?

Dear Cappi-
Unfortunately, we are not aware of any other physicians in the country currently performing our surgical procedure or with our organ sparing philosophy.
There is no need for you to have a hysterectomy, especially at your young age. Please read the section on the website discussing hysterectomy complications. These symptoms are a reality for many women after their uterus is removed, and they now have no recourse.
Our FAS procedure would remove the adenomyosis from your uterus and laser treat the remaining organ-your symptoms would be relieved and yet you will be able to keep your uterus for hormone regulation, sexual functioning etc. We have had many women come to see us for this same condition.
Please research your options carefully.

Dear Docs,
I have had 3 children, wore an IUD for 3 years, and had a tubal (cut,tied,burned) 15 years ago. My periods have been increasingly painful since that time. I was eventually diagnosed with endometriosis in March of 1999. My GYN found moderate disease, mostly on my tubes/ovaries and used cauterization to remove. I chose to try the natural progesterone cream for post-treatment, without much success. The pain has been increasing ever since. My new GYN (a highly acclaimed fertility expert at a University hospital) saw me 2 weeks ago and recommended another laparascopy to remove suspected further endometriosis. He then did a vaginal ultrasound and diagnosed me with adenomyosis, telling me that my only option there would be hysterectomy – at least the uterus. Do I really need two surgeries, even if i chose an alternative like the one you offer for the andeno? Please help….I’m so confused, especially now that I found your site!

Dear Renee-
Your “highly acclaimed fertility expert” appears to be in the same category as most other traditional gynecologists: their treatment of female disorders usually involves removing organs!! I do not follow this same philosophy. My FAS procedure would only subject you to one surgery-we could laser treat your endometriosis and adenomyosis at the same time. The laser is state of the art in the treatment of any form of endometriosis and is extremely effective. There is no reason to lose your uterus for this benign disease.
Good Luck

Dear Dr.D.J.,
I have been bleeding for almost a year now. My Dr.’s have given me ultrasounds,pap’s and an endometrial biopsy,all of which detected nothing out of the ordinary.I am 39 yrs old w/ 3 children ages 12,19,& 21.I had my tubes tied after the birth of my 3rd child.I’ve never had any health problems(other than hypertension)until last May when my periods became heavier and more frequent.Today my Dr. mentioned “Adenomyosis” for the first time.In the same breath he said hysterectomy.In the meantime he would like for me to take 2 birth control pills a day to see if the bleeding will stop.Sometimes I feel so frustrated.I want to keep all of my body parts but am so tired(literally) of the bleeding, very heavy at times,the backaches and the cramping that make me a prisoner in my own home!It seems like it is only getting worse.Your thoughts, please…. Thanx and Many Blessings……

Dear M.Martin-
Adenomyosis can be a very debilitating disease-you appear to have all the classic symptoms. Many women feel very frustrated because they are given very few options for treatment. Taking the BCPs may treat your symptoms of bleeding but will not effectively deal with the actual disease and its spread. You need to have the adeno removed.
Hysterectomy is the traditional approach; I do not advocate that drastic a procedure.My FAS procedure will remove the adeno and laser treat the uterus, allowing a woman to keep the organ for its other imperative functions. Before agreeing to a hysterectomy, please do your research thoroughly.
Good Luck

Dear Dr.
I saw my doctor over a year ago and he told me I have fibroid tumors. Previous to that he had prescribed hormone therapy, although I am pre-menopausal, to help with my periods which have become very heavy, lasting twice as long. They are still regular. He did not tell me to stop taking the hormones, when I told him I wanted to stop he said it was okay.

He never talked to me about the fibroids and since that time, quit the practice. Knowing what I do now, I believe him to be a very bad doctor.

I don’t know what to do, but know that I don’t want to lose my uterus! I have an appointment with a new doctor’s PA. I am not sure what they will find. I do know that I want to have the tumors removed.

What should I do next?

Dear Angry-
You received one of the typical traditional medical treatments for fibroids-the hormone supplementation will slow down the bleeding symptoms, but it will not stop the fibroid growth. This method helps the patient with quality of life, but only postpones the needed surgery, while allowing the fibroids to get larger.
See the new doctor…..get another surgical opinion. I would recommend you have the fibroid removed…but not the uterus. Do not wait much longer…the older you get the more difficult the recovery.

my dr. just told me, that i have adenomyosis.I have had bad periods all my life except when I was on birth control pills but I had to stop them because of my blood preasure,I don;t know what to do . she sugested depo shots to see if that will work until I make up my mind. what should I do?

Dear Laurie-
Depo shots are only a temporary fix….you need to address the problem. Why take unnecessary hormone manipulation??? Adenomyosis can be a very debilitating disease and needs to be treated as soon as possible. You did not mentioned your age….but I would recommend our FAS procedure, which would allow you to keep your uterus but laser treat and remove the disease.Do your research, make your decision and go with it!!!

One month ago, I had a DNC, and 2 large cysts were romoved from my ovaries. My doctor thought this would stop the constant bleeding and cramps. I had a normal period 3 days after the surgery. Now I am back to the heavy bleeding, cramping and blood clots. I have been on pain medication for almost 3 months now (off and on) My doctor told me today that I have Adenomyosis. I actually begged her to remove the uterus, because I am so tired of the pain and other symptoms. I am bloated all the time, even after losing 25 lbs, my abdomen is still huge! I only weigh 110 and I am 5’1″, which is a good weight for me. I can’t have any more children anyway, I’m 36 (tubes tied and burned). Is there some benefit to FAS for me? I almost would rather not have my uterus any more than to have this pain. How could FAS benefit someone who does not intend to have more children? The doctor said that she will leave the ovaries and take the uterus vaginally. I am just curious. Thanks. (My surgery is scheduled for June 19th.)

Dear Dr.
I am a 38 yr. old with two young children. I’ve had two C-sections, and after my second, I experienced pelvic pressure and a heaviness in my bladder. After many months of tests for interstitial cystitis etc… they discovered Adenomyosis through an M.R.I and also that my bladder is adhered to my uterus too causing the heavy feeling and bladder discomfort. I also have the heavy, clotting periods and find intercourse painful. My Gyno has recommended removing my uterus via laporascopy, leaving my ovaries and cervix. What are the possible negative results that I need to know??? I also heard that Progesterone therapy could help. Is this true??? Please give me some direction. Thanks,
Paula

Dear Lynda-
You are the perfect candidate for an FAS.
Many of my patients have FAS to save their fertility, these surgeries can be very difficult. If you are not interested in child bearing, FAS is very simple.
By saving your uterus, you will not disrupt your hormone regulation, nor your sexual functioning. You will also reduce the risk of heart disease and osteoporosis, which is common post hysterectomy. Please read the section on the website regarding “hysterectomy complications”-it is very depictive of many patients that call our office.
At 36 years old, you are far too young to be concerned with hormone and sexual problems. Please so your research carefully.
I know our FAS procedure would help you.

Dear Paula-
I just answered Lynda above you on the site regarding the same topic.
Hysterectomy can produce hormone imbalance, sexual dysfunction, heart disease, osteoporsis and bladder prolapse in women. It is an irreversible surgery-I do not recommend it as a primary form of treatment, unless there is a malignancy.
We could perform and FAS and remove your disease but allow you to keep your female reproductive system whole. Please read the website section on hysterectomy complications-we have women phone my office monthly with these side effects;they wish they had never had the procedure performed. Do your research carefully.

To Lynda,

As you can see, I am in a similar situation. Are you going ahead with the hysterectomy on June 19? I would love to “chat” with you on line about this. Hope you are coping with this, I know how horrible it is and how difficult it is to make a decision.

Paula

DEAR DR.
I HAVE JUST RECENTLY HAD A COMPLETE HYSTERECTOMY BECAUSE OF ADENOMYOSIS ENDOMETRIOSIS AND CYSTS ON BOTH OVARIES. I FELT THIS WAS MY LAST RESORT BEING I HAVE SUFFERED TERRIBLY WITH PAIN AND CONSTANT BLEEDING FOR THE PAST SEVEN YEARS . I HAVE TRYED EVERYTHING ELSE TO STOP THE PAIN AND BLEEDING AND HAVE WENT TO SEVERAL DR.S FOR HELP . I HAVE DONE EVEYTHING THEY HAVE ASKED OF ME AND NOTHING SEEMED TO WORK. THAT IS THE ONLY REASON I HAD THE HYSTERECTOMY DONE . MY PROBLEM IS THIS . SINCE THE SURGERY I CAN NOT MOVE MY BOWELS. THEY SAID TO USE STOOL SOFTNERS BUT THEY DID NOT HELP ONLY ALLOWING ME TO GO A SMALL AMOUNT AT A TIME. I WAS TOLD TO GIVE MYSELF ENEMAS WITH A LARGE BAG BECAUSE THE SMALL ONES DID NOT HELP. THEY CHECKED FOR A BLOCKAGE BUT THE TEST SHOWED NONE. I ALSO HAVE DEVELOPED PAIN IN MY BLATTER WHEN I URINATE WHEN THE BLATTER IS ALMOST EMPTY. I AM IN TERRIBLE PAIN ALL THE TIME. I HAVE NEVER HAD ANY PROBLEMS BEFOR THIS AT ALL. I DONT KNOW WHAT COULD BE CAUSING THIS IF YOU MIGHT KNOW PLEASE!!!!!! HELP ME THEY TOLD ME TO BE PATIENT AND I HAVE BEEN . BUT I AM RUNNING OUT OF PATIENTS. IF YOU CAN HELP I WOULD REALLY BE THANKFUL.VENA MY STOMACH SWELLS SO BIG THAT I LOOK LIKE IM 4 MONTHS PREGNANT. I AM 5 3 AND WEIGH 107. BEFORE SURGERY I WAS 122. THER WERE SOME COMPLICATIONS WITH SURGERY I BECAME ANEMIC AND I WAS TOLD TO EAT PROTEIN I HAVE BEEN EATING FIBER AS WELL. I WAS HOSPITALIZED FOR THIS AND THEN AGAIN BECAUSE OF THE AMOUNT OF ANTIBIOTICS THAT THEY GAVE ME CAUSED ANOTHER TYPE OF INFECTION IN MY BODY. I DONT KNOW WHAT TO DO I DONT WANT TO TAKE UP ANY MORE OF YOUR TIME BUT IF YOU CAN PLEASE HELP ME. PLEASE EMAIL ME BACK IM NOT VERY GOOD ON THE COMPUTER AND IM NOT SURE IF I COULD FIND THIS SPOT AGAIN.

Dear Vena-
Many patients can develop problems post surgery. Hysterectomy complications are more common than people think. Your bladder problem may be as simple as an infection from the catheter you had during surgery; and based on your symptoms, your colon has not started to work properly again since the procedure. High fiber diets are good, but I would return to your doctor for more advice, as long term use of enemas is not good.

Dear Dr. del Junco Jr.,
I had a laporoscopy last Thurs., 8/9/01. I was told that I do not have endometriosis. There is a possibility that I have adenomyosis. I was very disappointed because of the severe pelvic pain, extended periods, backaches, and inability to concentrate clearly in order to perform my job I have been enduring increasingly as I get older. I am now 45 years old. This whole ordeal is extremely frustrating!!!! I want to know what is wrong with me. My condition is very debilitating. Prior to my surgery, I purchased and read 4 books about endometriosis. I had literally diagnosed myself as having the disease. HELP!!!! What should I do next????? Pat

Dear Ms. Robinson-
Dont be frustrated-you were right!!! Adenomyosis is a form of endometriosis that attacks the uterine muscle. It is not visible, per se, on the outside of the uterus. Please read our website section.
You have all the classic symptoms of the disease…and if you are going to get any relief you need to have it removed. You will probably have great difficulty getting any treatment other than a hysterectomy, from traditional medical providers. If you are interested in saving your uterus, we can help you. Our FAS procedure has been very effective at giving women back a normal lifestyle.

Dear Dr.

I am 35 years old and I am trying to become pregnant for 2 1/2 years. I was just told that I have Adenomyosis based on an ultrasound and hysterosalpinogram. My periods are light and I do not have menstrual cramps. However, I have 1-2 days of bright red bleeding 10 days past ovulation. I am ovulating regularly, thyroid tested ok, tubes ok, but I have a couple small fibroids.

I do have some sharp/acidic/burning pain about 1″ to the right of my belly button – my Dr. says I have Irritable Bowel Syndrome. I was tested for Chron’s disease and it was negative. This burning comes and goes and it is manageable.

My dream would be to have a child. What should I do next?

Dear butterfly-
Adenomyosis cannot be diagnosed, with certainty, on an ultrasound. Tissue biopsies much be taken of the uterine muscle to conclusively diagnose the disease.
This disease usually produces significant pain during the cycle and very heavy periods with clots.
You may wish to contact a fertility specialist.
Good Luck

Dear Doctor,

I am 43 yrs old and two weeks ago I was diagnosed as having a fibroid tumor, about the size of a lime, and the gyn suspects adenomyosis. He suggested a hysterectomy. But I told him that I would like to think about it. But I don’t want a hysterectomy. That to me would be my final option. So I have been reading about what is out there for me. Though my family physician does not accept a hysterectomy, he also said that would be my final option. So with two different opinions now I am so confused on what to do. Please any help would be appreciated on my problem. Thank you for your time.

Dear Rose-
Traditional medicine will usually recommend hysterectomy for adenomyosis. Many doctors also advocate that surgery for fibroid tumors. I do not follow that philosophy. Adenomyosis is very treatable and managable with laser surgery. Our FAS procedure removes the fibroids and the adenomyosis while laser treating the remaining uterine muscle. Many of our patients are very happy with the post operative outcome-they have kept their uterus and have prevented the dreaded course of hysterectomy complications. You are far too young to have your uterus removed. Get a few more opinions….you know where we are. Good Luck

I am a 30 year old woman who was recently diagonsed with adenomyosis. My gyncologist put me on prometrium. Will this help the condition? I didn’t go through any treatment yet. I have a 10 year old an want to have another baby soon. Will there be a problem with me getting pregnant?

Dear Help-
Prometrium will probably help your symptoms, however will not treat the disease. Adenomyosis is very destructive to the uterine muscle. If allowed to spread, the damage is irreversible. Many women are unable to get pregnant with this disease, of if they do get pregnant, miscarry in the first trimester.
I recommend any woman with a confirmed diagnosis of adenomyosis, not wait to try to conceive. The longer you wait, the less chance of getting pregnant.
Please read my website section on this condition.
Good Luck.

Dear Doctor,
I have had heavy periods with large clots for the last 8-9 years. I am 51 years old andalthough my periods have been heavy, they have not been more than 6 days and have always been regular. However after light bleeding for approximately 17 days in September, my period became extremely heavy and I wound up in the emergency room, because I had lost so much blood. I was treated with projesterone and although it did help, my doctor did a D&C and hoped that I would return to normal. My bleeding continued afterwards, even with the projesterone, and since my uterus is still enlarged and there was no presence of fibroid tumors, she has diagnosed me with adenomyosis. She has put me on the birth control pill, but has suggested a possible hesterectomy if alternative treatments don’t help. I feel that it can’t be that much longer until I experience menopause, and if the bleeding can be kept somewhat under control, wouldn’t it be better to let nature eventually take its course?
I have had 3 children at age 22, 26 and 28, and my family history of reaching menopause seems to be around age 53 years. I would be grateful for any advice you can give me.

Dear Maureen-
We do not advocate the “wait and see” philosophy for fibroids and adenomyosis. Both the conditions are extremely responsive to estrogen changes in the body. Even though you may reach menopause in the next few years, if you are like most women, you will require some type of hormone replacement therapy. This will then start your disease spreading again. You need to have the condition surgically removed, without removing your uterus. We do a laser excision of the adenomyosis but offer the woman the option of keeping her organs intact for natural hormone changes and sexual functioning. If you are considering a hysterectomy, please do your research very thoroughly before electing this procedure. Many women call our practice weekly with complications post hysterectomy.
Take some time to make your decision. Good Luck

I AM A 31YR.OLD MOTHER OF 4. I STARTED AT AN EARLY AGE. I WAS 15 WHEN I HAD MY FIRST 17, 19, AND 21 WHEN I HAD MY LAST. I HAD A HYSTERECTOMY LAST WEEK DUE TO FIBROIDS AND SEVERE PAIN. I RECEIVED MY PATHOLOGY REPORT TODAY AND IT STATED THAT I HAD CHRONIC ADENOMYOSIS. I WAS JUST CURIOUS IF IT HAD ANYTHING TO DO WITH ME HAVING KIDS AT SUCH A YOUNG AGE. I FEEL GREAT TODAY AND ITS ONLY 6 DAYS AFTER SURGERY.

Dear Amy-
I am glad you are finally out of pain and discomfort.
Your early conceptions had nothing to do with Adenomyosis….this is a form of endometriosis and cause is not related to fertility.
Many women opt for a hysterectomy to relieve symptoms….the post operative complications usually do not begin immediately after surgery. Things like bladder and bowel prolapse, hormone imbalance, osteoporosis, early heart disease and sexual changes occur years down the road. I hope you will not end up a recipient of any of these conditions, and will remain happy with your decision.

Dr.:
I emailed you privately but will also post my questions here, as others may have a similar situation.
1.)My uterine size (as of 10 months ago) was 16 weeks, with 3 fibroids size of large orange, lemon, golfball. I’m now having a pulling/pain sensation AFTER sex, with pain located in lower vaginal canal. Any clue as to what that could be? (And it goes without saying that my periods are very lengthy, heavy.)
2.)I’m 50, beginning to get “warm” flashes, and wondered what you thought about salivary hormone testing to see how close menopause would be?
3.)I don’t plan to take HRT, but will be using soy and herbal products. Are you familiar with any relation soy has to fibroid growth?
4.) I’ve been using 2% natural progesterone cream for 4 years – since fibroids have been diagnosed. Since then fibroids have doubled in size. In your opinion, is there any relation?

If I can “hang” in there until menopause, obviously I’d like to, and not aggravate the situation further by taking HRT, but instead use alternatives.

Thank you.

Dear Shelley-
No way to know conclusively what might be producing your pain/pulling sensation until surgery-could be adhesions.
Saliva tests are not accurate…I would recommend a blood test to get specifics.
Soy does mimic estrogen at receptor sites…it is often used in natural HRT-and it can produce fibroid tumor growth.
Finally, progesterone helps to balance estrogen and is often beneficial in slowing down fibroid growth and symptoms.It would not contribute to making your tumors larger.
Based on your heavy bleeding and the size of your tumors..you need to have them removed.
I have been very brief since I did email you directly.

Dear Dr.,
I am 44 years old and have 3 children. I have been suffering from intense pain and pelvic cramps for 3-4 years. My gynae did a transvaginal ultrasound and I was informed that I probably have adenomyosis (tho’ he can’t be sure). I have used painkillers like Vioxx before but ended up with severe gastric problems. I am residing outside the US so FAS is out of question for me unless this technique is available in Singapore. Could you advise on medication as hysterectomy would be my last option.

Thank you.

Dear JSHL-
Unfortunately, FAS is not available in Singapore.
Adenomyosis is a disease that will continue to spread over time….if left untreated, the disease will eventually destroy or damage the entire uterine muscle. The pain will become increasingly severe and will last throughout the month. This is why many women resort to a hysterectomy…which we do not advocate.
Pain medication, however, is not a long term answer.
Once you reach menopause the disease will stop spreading and the symptoms will subside, IF you remain off hormone replacement therapy….however, at 44 years old you may have a long wait.
Of course, my answer to you is you need FAS…but the decision is yours.
Good Luck