### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
I am looking into a hysterectomy and the OB doctor I saw yesterday seems to be pushing ablation vs. hysterectomy even though I have tried multiple treatments for my issues (heavy uncomfortable periods as many as 3 per month, headaches, fibroids, cramping etc..) and appears to be trying to sway my decision.  He has also stated that due to 4 previous c-sections I am not a candidate for either vaginal or laproscopic surgery.  I saw him for my annual screening due to my other doctor being on vacation.  Do you have any thoughts on a mandatory abdominal surgery after c-sections?

### output:

Hallow Dear, At the outset, let me assure you that cesarean section has nothing to do with your heavy uncomfortable periods and fibroid. In fact, your heavy painful periods are due to fibroid uterus. Had it been only heavy menstruation, thermal ablation would have helped you. Thermal ablation is destroying the lining of the uterus (endometrium) by very hot fluid. It is the endometrium of the uterus which gets thrown out as menstrual discharge. Hence, once the endometrium is destroyed, there is no menstruation, and no heavy bleeding. However, you have fibroid uterus. This fibroid(s) will remain in the uterine cavity though your menstruation has been stopped by thermal ablation. This fibroid can undergo atrophy after menopause, however, remains as a vulnerable tissue for any type of degeneration including cancer. I would advise you to go for hysterectomy and not thermal ablation. Of course, it is advisable to undergo hysteromicroscopically directed biopsy of the endometrium to find out the status of the endometrium before hysterectomy. In about 30% of cases, cancer of endometrium is known to coexist with fibroid since both these conditions are result of high estrogen condition. I hope this helps you. 