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Diagonsed with anemia and hemoglobin 7.5. MRI report showed solid appearing adnexal mass and enlarged uterus. What to do?

Mar 2016
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Practicing since : 2011
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I was diagonsed with iron deficiency anemia and my haemoglobin on 6/1/2013 was low ie 7.5. On 10/6/2012 my haemoglobin was also low 9.2. So my doctor ordered pelvic ultrasound, endoscopy,colonoscopy.
I am 51 years, 170 pounds and 5 feet 2 inches. Last Nov 2012 I had my last periods which was heavy (for 3 weeks). After that I have not had periods maybe due to menopause or approaching menopause.
My doctor did a biopsy of uterus and it was negative for cancer.
I had a pelvic and abdominal MRI done.
1. There is a heterogeneously enhancing solid appearing right adnexal mass. This mass measures 7.79 x 5.45 x 7.22 cm. Separate right ovary is not identified. The characteristics of this mass differs from uterine fibroids seen within the uterus. This could represent right ovarian mass and tumor.
2. The uterus is enlarged. There are multiple uterine fibroids.
3. There is a cyst in the left adnexa likely ovarian in origin. There is a second smaller cyst adjacent to this cyst. The main left adnexal cyst measures 2.7 x 4.17 x 3.0 cm.

My gynacologist is recommending hysterectomy with removal of both ovaries.
I need your advice if this is the right option or there is some alternative options which may be better.
Posted Wed, 31 Jul 2013 in Pregnancy
Answered by Dr. S Patra 52 minutes later

Thanks for writing to us. Followings are my comments regarding your query:

1) Your right sided pelvic adnexal mass is quite large and it may be tubo-ovarian mass as ovary is not separated. Uterus is also enlarged with multiple fibroids. Left sided adnexa contains a cyst with ovarian origin.

With above pelvic pathology, best and definite treatment option is total abdominal hysterectomy with removal of both sided ovaries (TAH + BSO). It is the gold standard choice of treatment in your age (51 years). Your consulting gynecologist is also recommending that. Please, consult with your doctor to undergo necessary investigations to complete the operation procedure.

After that, you can opt for hormone replacement therapy (HRT) for few years to eliminate post menopausal symptoms.

2) You need to take iron XXXXXXX food stuffs like chicken liver, broccoli, spinach, egg noodles, dried apricots, wheat germ etc along with iron supplement tablets to combat iron deficiency anemia. In addition, you need to control blood sugar with supportive medications.

Hope, it helps for your information. If you have any other query, you can freely ask me.

Wish your good health and take care yourself.

Dr Soumen
Above answer was peer-reviewed by
Follow-up: Diagonsed with anemia and hemoglobin 7.5. MRI report showed solid appearing adnexal mass and enlarged uterus. What to do? 1 hour later
1. Since right now hemoglobin is low ie 7.5 in XXXXXXX can I have these procedures (abdominal hysterectomy, removal of ovaries) with the low hemoglobin level or have to wait until hemoglobin level is up? If so, what hemoglobin level is advisable?
2. Also endoscopy, colonoscopy is it a must? Can it be done safely with this low level of hemoglobin?
Answered by Dr. S Patra 1 hour later

Thanks for follow up queries.

1) With low hemoglobin (7.5 gm%), no major operation is ideally advised. Here, you have to wait for few months till blood hemoglobin level is increased. You can take previously mentioned iron XXXXXXX food stuffs and iron supplement tablets to increase hemoglobin level.

Ideally, blood hemoglobin level would be at least 10 gm% to proceed any kind of major abdominal operation including hysterectomy.

2) Endoscopy or colonoscopy is supportive investigation to rule out other associated pathology and helps to assure fit for undergoing surgery. These are basically diagnostic procedures and can be done with low level of hemoglobin. Please, consult with your doctor for proper guidance.

Hope, I have answered your queries. If you do not have other queries, you can close the discussion.

Good luck and best wishes.

Dr Soumen
Above answer was peer-reviewed by
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