The whatever was still present on today's ultrasound, and it's now obvious that it is contiguous with my endometrium. Instead of being all tucked inside my uterus like it should be, my endometrium appears to literally keep going right through my scar and to expand on the outside of my uterus. Dr. Boss says it's probably either more endometriosis or adenomyosis, and that there's really no good way to distinguish short of laparoscopy or hysterectomy. I'm a long way from ready to discuss the latter, and he doesn't recommend the former at this time.
This is logical enough, I suppose. Adenomyosis requires hysterectomy (or at least removal of a substantial chunk of uterus), but it's less clear-cut for endo. It's in a tricky spot, on the front of my uterus directly behind my bladder, and he is reluctant to go poking in there if it can be managed medically by cutting off the estrogen supply. Reading between the lines, it will probably happen sooner or later, but he wants to try drug approaches first.
Medical options are somewhat limited at the moment because I'm breastfeeding, so BCPs and Lupron and Danazol are all off the menu. I don't have much enthusiasm for them anyway, given the side effects and the limited effectiveness. We know I was hypoestrogenic for at least some of the time the endo was growing anyway, so it's questionable whether artificially-induced hypoestrogenism would help. On the other hand, I had bad periods as a teenager but was fine for all those years of BCP, so the BCP may have held it in check. BCP is easily reversible and has relatively mild side effects, so I'm more okay with that than the other two, after weaning.
The current plan is to do a pain-management approach. The pain has backed off some since I quit bleeding last week, and is mostly manageable at the moment with daily NSAIDs and the odd Percocet right now. We're going to keep doing that until I'm ready to wean or until I am dysfunctional enough to decide to do something about it. After that, we'll see. The simple fact is that we don't know what my natural progression is, and what my "normal" cycle will look like. I had four periods between the girls and Andrew, none of which were really terrible. Since Andrew's birth, things have been so muddled, with the infection and the endo and the lap, that it's just really not clear how things will settle down.
Another lap and/or a hysterectomy is probably in the cards eventually, because this stuff seems to be pretty aggressive. Four months ago, I didn't have endometriosis at all. Six weeks ago, the endometriosis was removed. In the four weeks after that, it appears to have regrown enough to flip my uterus around and escape its boundaries. At this rate, Tokyo better watch out.