Hot Times 27 Take Heart

Hot Times

Hysterectomy and Hormone Replacement Therapy Solve Decades of Problems

By Ronda Faries

Lauren Nist of Bremen was only 34 when she had a hysterectomy in November 2018, followed by the removal of one remaining ovary in early 2021.

While that seems young, the relief those surgeries brought followed a lifetime of gynecologic issues and associated chronic pain, as well as the joyous birth of a son and daughter with husband, Chris.

“I think my hormones were off, maybe for decades of my life,” said Nist. “But I didn’t know to complain about it.”

This revelation really hit home with Nist after the removal of her one remaining ovary and the start of hormone replacement therapy (HRT).

Now 36, she credits the use of implantable pellets for hormone replacement therapy – prescribed by Shannon Couvreur, DO, an OB/GYN with Tanner Healthcare for Women – with enabling her to feel and be her best as an adult.

“I noticed a difference within a week after getting the first pellets,” said Nist, who didn’t like the idea of hormone creams because she feared they could inadvertently affect her children. “And I can easily tell when they wear out and it’s time get more implanted.”

That timeframe for her is every 8 to 10 weeks.

Nist happily ticked off a list of how the pellets have helped and affected her: • A higher energy level • Better controlled ADHD • More passion/libido in her marriage • Better mental health • Less anxiety and no more panic attacks • Better able to build muscle mass • Less hair loss and acne, and no extra facial hair

“I have no side effects to the pellets,” said Nist. “I did try a higher dose that increased my testosterone too much, so I had to change back.”

She laughed as she explained that the temporary testosterone imbalance from the higher dose made her a little too aggressive.

To further explain the remarkable changes Nist described, she said people really need to know and understand what she’s already been through to get to this point.

Throughout her 20s, David Helton, MD, was her OB/GYN. Already suffering from endometriosis, Dr. Helton performed a diagnostic laparoscopy with D&C when Nist was in her late 20s, which helped, but didn’t completely alleviate her pain. By the time her son, Spencer, was born in November of 2014, Dr. Helton had stopped delivering babies, so Amy

Dodson, DO, took over her pregnancy care and delivered him at Tanner Medical Center/Carrollton.

During her pregnancy with Spencer, now 7, Dodson had discovered a small ovarian cyst and determined that it should be watched. After vaginally delivering her son, Nist just never went back for a follow-up ultrasound of the cyst – something she later wished she had done. When Dr. Dodson left the practice sometime after her son was born, Nist began seeing Dr. Couvreur.

“I feel like we’ve been on a journey together. Dr. Couvreur has been with me almost every step of the way,” said Nist. “She has been such an advocate for me. She even contacted my general practitioner about my blood pressure. She pays attention to everything.”

Nist explained that she was very depressed after the birth of her son and having a lot of pain. Thinking her pain was stomach-related, she went to see gastroenterologist Thelma Lucas, MD, with West Georgia Gastroenterologists, who didn’t find anything gastro-related to cause the pain she was experiencing in her abdomen.

Around the same time, Dr. Couvreur began treating her depression with a low dose antidepressant, which kept it at bay prior to and throughout her pregnancy with her daughter, Adaline, now age 4.

Early during her second pregnancy, Dr. Couvreur discovered an ovarian cyst – likely the same one that was very small in 2014 – except that it had grown to the size of a grapefruit. However, surgery wasn’t an option until after her daughter’s birth in August of 2017.

“It was a difficult time for Lauren,” said Dr. Couvreur. “She was dealing with normal pregnancy emotions while having incredible cyst pain. We actually decided to send her to a high risk obstetrical specialist to help manage the pain and provide guidance on delivery timing and planning.”

Nist dealt with the pain from the cyst during pregnancy the way she always had.

“I didn’t know any better than pain. My anxiety

was so high at times. Dr. Couvreur listened to my every concern and did all she could for me during that time.” At the time of the cesarean section birth of Adeline at Tanner Medical Center/Carrollton, the plan was to remove the cyst after the baby’s delivery. However, due to the large size of the cyst and dense scar tissue, they couldn’t safely perform the ovarian portion of the surgery. “During Lauren’s post-partum journey, she was diagnosed with gallstones. It only made sense to do a dual surgery with general surgery,” said Dr. Couvreur. Dr. Couvreur and general surgeon Jon Stanford, MD, with Carrollton Surgical Group, tag-teamed her laparoscopic surgery in November of 2017, removing the ovarian cyst, the ovary and tube, as well as her gallbladder – all in one marathon surgical session. For a time, she felt Lauren, with her children, Adaline, 4, and Spencer, 7. better. But within a year, her painful endometriosis was back. “Lauren had some abnormal findings on ultrasound that prompted another gynecologic surgery,” said Dr. Couvreur. “I performed that D&C in August of 2018 and a few months later, her hysterectomy.” The hysterectomy was performed with traditional open surgery through Nist’s cesarean scar. Dr. Couvreur made the decision to leave her remaining ovary, hoping it would produce enough hormones so that Nist would not need hormone replacement therapy. Nist was finally pain free for the first time in a very long time. “Her hysterectomy was definitely challenging with her prior surgeries, endometriosis and adhesive (scar tissue) disease,” said Dr. Couvreur. “But Lauren’s hysterectomy was necessary surgery to improve her quality of life.” For a few months all seemed well, but in December of 2020, Dr. Couvreur found a mass on Nist’s remaining ovary. Following an MRI that couldn’t determine if the mass was cancerous, the decision was made to remove it. The laparoscopic

surgery was performed in January of 2021. The mass turned out to be a hemorrhagic cyst – basically a blood-filled cyst and thankfully not a cancerous cyst.

Nist had to begin hormone replacement therapy soon afterwards.

“Women have been conditioned. You almost turn a blind eye on your own body,” said Nist. “Dr. Couvreur is a real ally. I truly believe she changed my life.”

The HRT pellets that Dr. Couvreur prescribed are inserted into a small “pocket” created at the back of her hip by a tiny cut. The pellets are slowly absorbed by Nist’s body over the next eight to 10 weeks. Each time, the “pocket” is rotated to the other hip, and she leaves the appointment with a small bandage.

“Pellet therapy is just one of the hormone replacement therapy options we can provide for our patients,” said Dr. Couvreur. “Based on Lauren’s symptoms and other medical conditions, we both thought HRT pellets were the best treatment plan for her. It’s a low-maintenance, effective therapy for Lauren as she is a busy mom of two. We can also adjust the dosing based on how she’s feeling.”

The pellets contain the amount of estrogen and testosterone that Dr. Couvreur has prescribed for Nist. Since the pellets are available at Tanner Healthcare for Women in Carrollton, when it’s time for more, Nist simply makes an appointment with Dr. Couvreur via the Tanner MyChart app. Tanner Healthcare for Women makes sure the appropriate hormones and dosing are available for implantation on the day of her visit.

“The hysterectomy and pellets have been great for me,” said Nist. “I have no more pain. I have no side effects and more energy than ever. And I couldn’t have gotten here without Dr. Couvreur’s help and support. I’ve been a ‘hot mess.’ She’s had her hands full with me, but she stepped up to the plate.”

“Lauren is an exceptional woman, mother and wife. She deserves to live a pain-free, balanced life. I have been blessed to have the opportunity to participate in her care, and along the way in her journey, we have become friends,” said Dr. Couvreur. “Lauren’s story is the epitome of OB/GYN. We take care of women in all stages of their lives from babies to pap smears to surgeries. It is a privilege to do what we do for women’s health.” WGW

Learn more about Tanner Women’s Care at www.TannerWomensCare.org. For more information about Tanner Healthcare for Women, visit www.TannerHealthcareForWomen.org.

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If you’ve been putting off needed surgery, it’s time to transform your life so you can live pain and symptom free. Learn more about our surgical care options at SurgeryAtTanner.org.