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Ovary Removed Due To Borderline Tumor. Trying To Conceive. Ultrasound Showed Thick Endometrium. Any Thoughts?
Question: Hi, I am 29 yrs old and have had my left ovary removed due to a boderline tumor which was diagnosed in 2010. My yearly examination showed everything under control. I got my yearly checkup done 5 days back, and even though the ultra sound and vaginal swab culture showed everything was okay, my CA125 levels have been increasing.
I am married and trying to conceive and I almost thought I was pregnant but the HPT taken just a day before my periods were to begin showed negative test.
My ultrasound has reported an endometrial thickness of 6.1mm (it was done 1 day after my periods ended) and some kind of focal hypercholic area measuring 19X17mm suggestive of some kind of focal adenomysis or fibroid of some kind. there is no fluid seen in the pouch of douglus.
My CA 125 done on the day of ultra sound was 51.2 and done 4 days after this was 57.7.
What could be the possible reason for this? I have been trying to conceive and don't know if I have as I also got my periods but they were light and patchy- SHould the ultra sound have revealed my pregnancy status even if I would have just been 2-3 weeks post conception?
I am married and trying to conceive and I almost thought I was pregnant but the HPT taken just a day before my periods were to begin showed negative test.
My ultrasound has reported an endometrial thickness of 6.1mm (it was done 1 day after my periods ended) and some kind of focal hypercholic area measuring 19X17mm suggestive of some kind of focal adenomysis or fibroid of some kind. there is no fluid seen in the pouch of douglus.
My CA 125 done on the day of ultra sound was 51.2 and done 4 days after this was 57.7.
What could be the possible reason for this? I have been trying to conceive and don't know if I have as I also got my periods but they were light and patchy- SHould the ultra sound have revealed my pregnancy status even if I would have just been 2-3 weeks post conception?
Hello,
Thanks for the query.
Let me answer your query one by one.
Good that you are prompt in getting yearly checkup and everything is fine as far as now.
As far as CA 125 is concerned, i would say it is very non specific. It is raised in many conditions including pregnancy, menstruation, pelvic inflammatory disease and endometriosis. Moreover your levels of CA 125 is just above the normal levels. So you need not be concerned about it.
HPT done one day before missed periods is not very much sensitive to detect early pregnancy. When HPT is done on missed period, sensitivity is 90%. But when HPT is done 1 week after missed periods, Sensitivity is 99%. So i recommend you to get a HPT after 1 week. Since CA 125 is increasing, it could be pregnancy as well.
Focal hypoechoic lesion of 19,17mm on USG is too small to comment. It could be an artifact as well. In order to confirm i suggest you to get a hysteroscopic directed biopsy which is gold standard investigation for the same.
Hope this answers your query. Feel free to ask for further clarifications.
regards,
Dr Nilofer
Thanks for the query.
Let me answer your query one by one.
Good that you are prompt in getting yearly checkup and everything is fine as far as now.
As far as CA 125 is concerned, i would say it is very non specific. It is raised in many conditions including pregnancy, menstruation, pelvic inflammatory disease and endometriosis. Moreover your levels of CA 125 is just above the normal levels. So you need not be concerned about it.
HPT done one day before missed periods is not very much sensitive to detect early pregnancy. When HPT is done on missed period, sensitivity is 90%. But when HPT is done 1 week after missed periods, Sensitivity is 99%. So i recommend you to get a HPT after 1 week. Since CA 125 is increasing, it could be pregnancy as well.
Focal hypoechoic lesion of 19,17mm on USG is too small to comment. It could be an artifact as well. In order to confirm i suggest you to get a hysteroscopic directed biopsy which is gold standard investigation for the same.
Hope this answers your query. Feel free to ask for further clarifications.
regards,
Dr Nilofer
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks for your answer, would you suggest that I get a HPT done now? Some doctors are suggesting getting a PET done to test whether there is any kind of malignancy anywhere. Would an ultrasound be able to detect a pregnancy of about 2 weeks?
It's just getting so blurry and I'm not sure how should I proceed. What else can be a reason for rising CA125 levels- as i was not having periods when i took the test and repeated it after 5 days.
It's just getting so blurry and I'm not sure how should I proceed. What else can be a reason for rising CA125 levels- as i was not having periods when i took the test and repeated it after 5 days.
Thanks for follow up query XXXXXXX
1. would you suggest that I get a HPT done now? I suggest you to do a HPT 1 week following missed periods.
2. Some doctors are suggesting getting a PET done to test whether there is any kind of malignancy anywhere. PET scan to be done only after ruling out pregnancy (after 1 week) as you will be exposed to radiation and it is not good for growing fetus.
3. Would an ultrasound be able to detect a pregnancy of about 2 weeks? Transvaginal USG detects pregnancy by 4.5 week(from 1st day of last menstrual period). Gestationl sac is visibe by 4.5 weeks.
4. how should I proceed? I suggest you to wait for 1 more week. If pregnancy is ruled out, then get a Hysteroscopic guided biopsy for focal hypoechoic lesion.
If it is negative, then nothing to worry. Ca 125 will normalize in 3 months period.
As your yearly examination is normal, be tension free.
Hope this answers your query.
regards,
Dr Nilofer
1. would you suggest that I get a HPT done now? I suggest you to do a HPT 1 week following missed periods.
2. Some doctors are suggesting getting a PET done to test whether there is any kind of malignancy anywhere. PET scan to be done only after ruling out pregnancy (after 1 week) as you will be exposed to radiation and it is not good for growing fetus.
3. Would an ultrasound be able to detect a pregnancy of about 2 weeks? Transvaginal USG detects pregnancy by 4.5 week(from 1st day of last menstrual period). Gestationl sac is visibe by 4.5 weeks.
4. how should I proceed? I suggest you to wait for 1 more week. If pregnancy is ruled out, then get a Hysteroscopic guided biopsy for focal hypoechoic lesion.
If it is negative, then nothing to worry. Ca 125 will normalize in 3 months period.
As your yearly examination is normal, be tension free.
Hope this answers your query.
regards,
Dr Nilofer
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks for your response..
another question-
what does endometrial thickness of 6.1mm mean on the day after my periods? Does this mean it's still thick or can it mean a successful conception/pregnancy in any case?
I did not have the normal periods I generally do.. I had a slight spotting 4-5 days before my periods were to start and then had very very light bleeding and the actual light period like bleeding happened only for 2 days.. but this too was very light as per my normal period. I also had very major cramps on the 1st day.
another question-
what does endometrial thickness of 6.1mm mean on the day after my periods? Does this mean it's still thick or can it mean a successful conception/pregnancy in any case?
I did not have the normal periods I generally do.. I had a slight spotting 4-5 days before my periods were to start and then had very very light bleeding and the actual light period like bleeding happened only for 2 days.. but this too was very light as per my normal period. I also had very major cramps on the 1st day.
Hello XXXXXXX
1.what does endometrial thickness of 6.1mm mean on the day after my periods? Does this mean it's still thick or can it mean a successful conception/pregnancy in any case? Normal endometrial thickness is 4mm soon after periods. Anything between 4-10mm in reproductive age group is considered normal. It is not a definitive evidence of pregnancy. Visualization of gestational sac by USG is definitive of pregnancy though endometriun is usually thick during pregnancy due to decidual reaction.
2.Bleeding 4-5 days before periods could be implantation bleeding.
You need to wait for 1 more week for definitive diagnosis. Thinks will be more clearer then.
Hope this helps.
regards,
DR Nilofer
1.what does endometrial thickness of 6.1mm mean on the day after my periods? Does this mean it's still thick or can it mean a successful conception/pregnancy in any case? Normal endometrial thickness is 4mm soon after periods. Anything between 4-10mm in reproductive age group is considered normal. It is not a definitive evidence of pregnancy. Visualization of gestational sac by USG is definitive of pregnancy though endometriun is usually thick during pregnancy due to decidual reaction.
2.Bleeding 4-5 days before periods could be implantation bleeding.
You need to wait for 1 more week for definitive diagnosis. Thinks will be more clearer then.
Hope this helps.
regards,
DR Nilofer
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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