Misoprostol Question

[frolicnaked.livejournal.com]

I'm scheduled to get Essure tomorrow. Originally, the procedure was scheduled for 9:30am. I got a call this morning pushing it back to 3:30pm.

Which brings me to my question: I have 2 doses of misoprostol I'm supposed to insert to soften my cervix -- one pill the night before and one "1 upon waking in the morning, or 2 to 4 hours prior" to the procedure. Made perfect sense when the procedure was in the morning, but now "upon waking" and "2 to 4 hours prior" are not exactly the same thing.

1. Does the specific time even matter that much?


2. If so, when should I take it?

I've already called my doctor and am waiting to hear back from the office. I've also spoken with my pharmacist, who was unfamiliar with this specific situation and, considering that the prescribing instructions were now ambiguous, referred me back to my doctor.

Comments

[pinkminx.livejournal.com]

I'd understand that to mean that you have to insert the second dose at least 2-4 hours before the operation to give it enough time to do its magic. Make sense?

[frolicnaked.livejournal.com]

Right, but if I wake up at 7, is 10.5 hours between insertion and the procedure too much time elapsed?

[pinkminx.livejournal.com]

With the disclaimer that I'm not a pharmacist or doctor, here goes...

I don't know how fast chemically 'softened' cervices return to normal in non-childbirth situations, but I do know that cervical ripening agents that are used for inducing labour can take quite a while to work, and that postpartum cervixes take weeks, not hours to return to a harder, totally closed state. Based on that, it'd make sense -- to me, anyway -- to take the misoprostol earlier rather than later to give it a proper chance of working.

[frolicnaked.livejournal.com]

Just for funsies... The doc's office called back and advised a 2-6 hour window before the procedure. (Normally they schedule all their anesthesia-requiring procedures in the morning, so this is generally not a big deal.) According to their explanation, while it's unlikely that the cervix will re-close all the way, it can start to close again around 6 hours after the last pill is inserted.

[pinkminx.livejournal.com]

Ooooh, interesting. Thanks for checking back with that. :-)

[jennifer0246.livejournal.com]

i'd aim for 1 12h before and 1 4h before the procedure, recognizing that 12h before is the middle of the night, so i'd do it last thing before bed and plan to go to bed late :). i'd not stretch further than that, as you don't want the 2nd dose to be too far in advance so as to be less effective.

[frolicnaked.livejournal.com]

Fun times. Doc just called back:

1) Procedure is now at noon tomorrow. (Blame the anesthesiologist, not the gyno.)

2) Second pill no more than 6 hours prior to the procedure.

[jennifer0246.livejournal.com]

Ha. well, it's a good thing you have the day free.

And yeah, seems right. Don't want it to wear off or anything crazy like that.

I'll be thinkin' of your fallopian tubes tomorrow!

[frolicnaked.livejournal.com]

Yep, this is one of the reasons I wanted to hurry up and get it done during the summer. My schedule is 100% flexible through, well, tomorrow. But once I have students... I'd rather have them all in the procedure room with me than to write 5 separate sub plans.

[frolicnaked.livejournal.com]

Absolutely. I'd already planned on it. (At this point, most longtime VP readers know more about my sexual/reproductive bits than any single doctor I've ever had.) Though I think 2 or 3 other people have written about their experiences in our tagged entries (http://community.livejournal.com/vaginapagina/tag/essure-sterilization-procedure), if you feel like reading.

[mari-mac1109.livejournal.com]

Sounds like you've got your answer, so I'll just say: good luck and Fallopian mojo sent your way!

[pocochina.livejournal.com]

I hope it goes well!

[barrelofrain.livejournal.com]

Hope the procedure goes smoothly for ya! I know you're been kind of... looking forward? jumping through hoops? haha. Either way, I'm glad it's finally happening for you.

[frolicnaked.livejournal.com]

That second one. ;) I'm not actually looking forward to the sterilization, but I am looking forward to the ablation that should follow in the coming months (details to be determined after the new GYN gets a visual of the inside of my uterus). And sterilization is more or less a necessary part of that. So.

Thanks!

[happychildless.livejournal.com]

I thought there was an issue with doing ablation after Essure? I've read different takes on it, but I guess there are different ways to do it besides balloon. You are a braver woman than me, my IUD was invasive enough.

Oh yeah, I love how they say you get so many sick days, then leave you with crappy subs, if you get one at all.

[frolicnaked.livejournal.com]

There's an issue with doing NovaSure (the radiofrequency procedure) after Essure. The metal Essure inserts may draw heat away from the endometrium into the fallopian tube, which could result in:

1. some areas of the endometrium not being zapped completely.


2. damage to the fallopian tubes.


3. localized burning (http://www.novasure.com/novasure-procedure/novasure-indications.cfm) to other areas (though again, fallopian tubes are the likely target).

Of those, I find only the last option really off-putting. Though apparently, the Essure info (http://www.essuremd.com/Portals/essuremd/PDFs/L3002%2009_09_09%20smaller.pdf) just says, "Consequently, if using RF energy to perform endometrial ablation, direct contact with the Essure micro-inserts should be avoided." (My doc is comfortable performing NovaSure after Essure, though she has reservations that NovaSure will be less effective because of her placement of the device.) That said, my uterine anatomy makes me contraindicated for NovaSure, so it's likely not our ablation option of choice. We're keeping it on the list, though, as my doc has the equipment in-office, which would make a significant time/financial difference for me.

ThermaChoice, which is one balloon ablation method (though I do not know if there are others), is explicitly okay to be performed after Essure. From the same Essure info:

Bench and clinical studies have been conducted which demonstrate that balloon thermal (THERMACHOICE* Uterine Balloon System) and hydro-thermal (HTA** System) endometrial ablation of the uterus can be safely and effectively performed with the Essure micro-inserts in place. However, balloon thermal and hydrothermal endometrial ablation should only be performed after the 3-month Essure confirmation test.

Of all the ablation methods, it looks like only microwave ablation is an absolute no go. And I'm not totally sure how common microwave ablation is; none of the local providers I've spoken to have performed such a procedure.

[paraxeni.livejournal.com]

Good luck for tomorrow!

[frolicnaked.livejournal.com]

Thanks. I'm now freaked that the anesthesiologist will cancel/reschedule at the last minute. In which case, I am prepared to go in with naproxen and Percocet and just Get It Done. :P

[1girl.livejournal.com]

Good luck! Wishing you a swift recovery!