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What Do These Following Blood And Ultrasound Reports Indicate?
Question: My wife is 29 year old with currently no kids.Just for your information we hadn't been trying as of now. She had normal periods with average cycle of 28-30 days for all these years. There is no discrepancy or any major abnormal symptoms during her periods. Last Menstrual Period – 2nd Feb,2017 and Recent Menstrual Period- 24th Feb,2017. Just in February she had 2 periods in 1 month with slight pain in the abdomen, very slight clot like feeling. Hence she consulted a gynaec for a casual check up, who did an ultrasound sonography. The sonography report stated an approx 3.4 into 3.1 into 2.6 cm sized anterior intramural fibroid is seen causing a focal bulge along the anterior surface. It reaches close to the endometrial surface without causing any indention. Endometrial echo appears normal in thickness and appearance.
The other parameters such as uterus, ovaries, bladder etc are normal.
She was advised to do an another sonography which detected as an ill defined,hypoechoic lesion {38 into 28mm] is seen in the anterior uterine wall. It shows normal blood supply on colour Doppler. It is causing selective thickening of the anterior uterine wall. Uterus measures 6.7 into 4.8 into 4.2 cm
Now 1st sonography report mentions that it is fundual intramural fibroid whereas other sonography report states it is adenomyoma. What should be our course of action. Doctor has advised a laproscopic surgery to detect the same. Overall health of my wife is fine with no major medical history or complications. Pursuant to the same we have following questions and need your advice.
Do you think this is a big cause of concern or we should wait for few more days probably 6 more months.?
Do you think if laproscopy is at all performed it will cause any fertility issues in future because of scaring or any other complications related to her health ?
Do you think this can be endometriosis or any other condition than above? We are confused. Please advise
Other parameters-
AMH Value- 2.34
Haemoglobin – 13.0
Plasma Glucose Fasting- 98
Plasma Glucose after 75gms glucose – 136;
Liver – Normal
Creatine- 0.8
Prothrombin – 11.5
Insulin – 12.7
Prolactin – 59
T3,T4 and TSH - Normal
The other parameters such as uterus, ovaries, bladder etc are normal.
She was advised to do an another sonography which detected as an ill defined,hypoechoic lesion {38 into 28mm] is seen in the anterior uterine wall. It shows normal blood supply on colour Doppler. It is causing selective thickening of the anterior uterine wall. Uterus measures 6.7 into 4.8 into 4.2 cm
Now 1st sonography report mentions that it is fundual intramural fibroid whereas other sonography report states it is adenomyoma. What should be our course of action. Doctor has advised a laproscopic surgery to detect the same. Overall health of my wife is fine with no major medical history or complications. Pursuant to the same we have following questions and need your advice.
Do you think this is a big cause of concern or we should wait for few more days probably 6 more months.?
Do you think if laproscopy is at all performed it will cause any fertility issues in future because of scaring or any other complications related to her health ?
Do you think this can be endometriosis or any other condition than above? We are confused. Please advise
Other parameters-
AMH Value- 2.34
Haemoglobin – 13.0
Plasma Glucose Fasting- 98
Plasma Glucose after 75gms glucose – 136;
Liver – Normal
Creatine- 0.8
Prothrombin – 11.5
Insulin – 12.7
Prolactin – 59
T3,T4 and TSH - Normal
Brief Answer:
Pictures of ultrasound needed
Detailed Answer:
Hello dear, thanks for trusting us with your health concerns
In my opinion there is no need to get any surgical treatment and just plan for a baby ahead.
In case you have ultrasound picture then kindly attach them as well so that I can advise you better about the diagnosis
Either way even if it is a fibroid there is no need to remove it as it is not interfering in endometrium so most likely not a cause of the bleeding
If at all it is adenomyosis then also there is no need to remove since you of course wish to keep uterus for the purpose of conception in recent future.
All in all no need to get it operated and just try to conceive as early as possible
Also your prolactin levels are high so consult your gynaecologist for Medicine
But in case you get repeated menstrual problem then definitely we will consider surgery and before that an MRI will be the best investigation
All the best
Regards
Dr Manisha
Pictures of ultrasound needed
Detailed Answer:
Hello dear, thanks for trusting us with your health concerns
In my opinion there is no need to get any surgical treatment and just plan for a baby ahead.
In case you have ultrasound picture then kindly attach them as well so that I can advise you better about the diagnosis
Either way even if it is a fibroid there is no need to remove it as it is not interfering in endometrium so most likely not a cause of the bleeding
If at all it is adenomyosis then also there is no need to remove since you of course wish to keep uterus for the purpose of conception in recent future.
All in all no need to get it operated and just try to conceive as early as possible
Also your prolactin levels are high so consult your gynaecologist for Medicine
But in case you get repeated menstrual problem then definitely we will consider surgery and before that an MRI will be the best investigation
All the best
Regards
Dr Manisha
Above answer was peer-reviewed by :
Dr. Nagamani Ng
Dear Dr XXXXXXX
Thank you for your response. I have attached the sonography pictures as required. The 1st picture is of 1st sonography which detected Fibroid. The other 9 images are of second sonography which detected adenomyoma. Although the 1st sonography pictures are not so clear as second. We also came to know from the doctor that adenomyoma and fibroid are not distinguishable and hence needs to be detected by only laproscopy. I have already uploaded the reports in my previous mail.
Please let us know your diagnosis on the same. Again am reiterating do you think this condition is something serious. Will conceiving be difficult with this condition and if at all conceiving happens will this have any affect on the mother or the baby.
If any of the conditions are there will it further grow at a faster rate and make our condition difficult?
My wife has been mentally disturbed when she came to know about this.
Please let us know your advice after confirming with the pictures.
Thank you for your response. I have attached the sonography pictures as required. The 1st picture is of 1st sonography which detected Fibroid. The other 9 images are of second sonography which detected adenomyoma. Although the 1st sonography pictures are not so clear as second. We also came to know from the doctor that adenomyoma and fibroid are not distinguishable and hence needs to be detected by only laproscopy. I have already uploaded the reports in my previous mail.
Please let us know your diagnosis on the same. Again am reiterating do you think this condition is something serious. Will conceiving be difficult with this condition and if at all conceiving happens will this have any affect on the mother or the baby.
If any of the conditions are there will it further grow at a faster rate and make our condition difficult?
My wife has been mentally disturbed when she came to know about this.
Please let us know your advice after confirming with the pictures.
Brief Answer:
No surgery needed
Detailed Answer:
Hi dear, Sorry for the delay in response
I have seen the attached pictures and it took me a while to get the printout to have a better understanding
It is most likely an adenomyosis of uterus which needs not to be surgically removed at all at this stage.
She can very well go ahead with conception and it will rather improve after conceiving.
In general in case after conception and delivery she has no symptoms per se then it can be left inside the uterus with no much harm.
Slightly increased chance of abortions is there but that can be managed by adequate treatment support so not much of an issue at present
But she can have difficulty in conception so start trying at the earliest
All the best
No surgery needed
Detailed Answer:
Hi dear, Sorry for the delay in response
I have seen the attached pictures and it took me a while to get the printout to have a better understanding
It is most likely an adenomyosis of uterus which needs not to be surgically removed at all at this stage.
She can very well go ahead with conception and it will rather improve after conceiving.
In general in case after conception and delivery she has no symptoms per se then it can be left inside the uterus with no much harm.
Slightly increased chance of abortions is there but that can be managed by adequate treatment support so not much of an issue at present
But she can have difficulty in conception so start trying at the earliest
All the best
Above answer was peer-reviewed by :
Dr. Kampana
Dear Dr.Mansiha,
Thank you for your reply. As per your suggestion, we would definitely try to conceive asap. And my last question to you on that is. What are the best days to try conceiving. As mentioned she had 2 periods in February i.e one on 2nd feb, 2016 which lasted for 4 last days and second was on 24th February which lasted for approx 3-4 days. This time as well as in future, what is the best time in MP to get conceived. Do you recommend any good ovulation kit to asses the day on which ovulation would take place. The conceiving should be before, after or on the day of ovulation. I believe that women's body is fertile only during certain point of month. To conclude i know these are all uncertain questions and all depends on one's fortune but just wanted to check theoretically.
Just fyi. she has been advised Caberlin 0.5 mg once per week and Myotol F twice every day for increase in prolactin.
Let me know if you have any other tips or suggestions overall.
Thank you for your guidance.. It was pleasure discussing with you.
Thank you for your reply. As per your suggestion, we would definitely try to conceive asap. And my last question to you on that is. What are the best days to try conceiving. As mentioned she had 2 periods in February i.e one on 2nd feb, 2016 which lasted for 4 last days and second was on 24th February which lasted for approx 3-4 days. This time as well as in future, what is the best time in MP to get conceived. Do you recommend any good ovulation kit to asses the day on which ovulation would take place. The conceiving should be before, after or on the day of ovulation. I believe that women's body is fertile only during certain point of month. To conclude i know these are all uncertain questions and all depends on one's fortune but just wanted to check theoretically.
Just fyi. she has been advised Caberlin 0.5 mg once per week and Myotol F twice every day for increase in prolactin.
Let me know if you have any other tips or suggestions overall.
Thank you for your guidance.. It was pleasure discussing with you.
Brief Answer:
Continue same medicine
Detailed Answer:
You are most welcome and all these questions are genuinely intriguing for most couples.
The best time for conception in regularly menstruating women is the middle ten days of the cycle as egg is released in between 14-17 days of the menstrual cycle.
So intercourse on alternate days during this period offers maximum chance of conception.
She should continue the medicine as prescribed and get her prolactin levels after 2 months of course of these Medicines
Missionary position of sex and lying down for a period of 15-20 minutes after climax is recommended to enhance chances of conception
Wish you luck soon
Take care
Continue same medicine
Detailed Answer:
You are most welcome and all these questions are genuinely intriguing for most couples.
The best time for conception in regularly menstruating women is the middle ten days of the cycle as egg is released in between 14-17 days of the menstrual cycle.
So intercourse on alternate days during this period offers maximum chance of conception.
She should continue the medicine as prescribed and get her prolactin levels after 2 months of course of these Medicines
Missionary position of sex and lying down for a period of 15-20 minutes after climax is recommended to enhance chances of conception
Wish you luck soon
Take care
Above answer was peer-reviewed by :
Dr. Yogesh D
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